LOBBYIST DISCLOSURE

							                                 LOBBYIST EMPLOYER DISCLOSURE
                                            PERIOD of April 1 – June 30, 2012
  DUE DATE: Wednesday, July 25, 2012, 4:30 p.m. This is not a postmark deadline. Your form must be received before the time
listed. Filing late results in a mandatory late fee of $35 plus $10 for each additional business day, not to exceed a maximum of $175. This
                                                        form can not be faxed or emailed.
         Vermont Secretary of State, Elections Division, 128 State Street, Montpelier, VT 05633-1101
                                           (802) 828-2363, liz.harrington@sec.state.vt.us
Name and Address, City/Town, State, Zip:                                            Name/Address Changes:




               1.) Compensation paid to lobbyist
                                    employers:
                     2.) Expenditures - Advertising:
                 3.) Expenditures - Telemarketing:
  4.) Expenditures - Contracts w/ legislators or
                        administrative officials:
                      5.) Expenditures - Other:
           6.) Subtotal expenditures
                     (add lines 2-5):
      7.) Total compensation + expenditures
                           (add lines 1 and 6):

 If you reported Expenditures for Telemarketing or Contracts with Legislators or Administrative officials
  above or if you need to report gifts to a legislator or administrative official, then you MUST attach the
                            Details of Expenditures or Gifts, providing details.
                                                   DETAILS ATTACHED
                                 We have attached Details of Expenditures or Gifts to this report.

      List Lobbyists Who Were Engaged by the Lobbyist Employer During the Reporting Period
Employer Name                                Employer Address




                    I declare under penalties of perjury that this information and all attachments are true and correct.


Signature:                                                                          Date:
                 DETAILS OF EXPENDITURES and/or GIFTS
              To be filed with the registered entity's disclosure report due July 25, 2012
                                  (PERIOD of April 1-June 30, 2012)
 This document is not a substitute for the Lobbying Disclosure Form due on the date listed above, but
  must be filed as needed in conjunction with that form. This form may not be faxed and MUST be
                    accompanied by the registered entity's regular disclosure report.
 Entity Filing (Circle ONE):         Lobbyist Employer             Lobbyist           Lobbying Firm
Name:
Address:
City, State, Zip:

                               DETAILS OF TELEMARKETING EXPENDITURES
Amount     To Whom Paid                   Date of Expenditure                     Description




                                             DETAILS OF CONTRACTS
Amount     Name of Legislator/Admin. Official                                     Start Date                  End Date




                                                  DETAILS OF GIFTS
Value      Recipient of Gift              Date                                    Nature of Gift              Requested By




               I declare under penalties of perjury that this information and all attachments are true and correct.



Signature:______________________________________________________________________                              Date: _____________