County of Los Angeles INSTRUCTIONS FOR AMENDMENT TO LOBBYING QUARTERLY REPORTS FORM LOB 10 Chapter 2.160 of the Los Angeles County Code An Amendment to Lobbying Quarterly Reports (Form LOB 10) is used to amend information on the following lobbying quarterly reports that have been previously filed: · · · · Form LOB 6 Form LOB 7 Form LOB 8 Form LOB 9 ­ ­ ­ ­ Lobbyist Quarterly Report Lobbying Firm Quarterly Report Lobbyist Employer Quarterly Report Report of Person or Entity Spending $5,000 or More to Influence Official County Actions If the information being amended affects the lobbying quarterly reports filed by a lobbyist and by his or her employer or firm, a separate Form LOB 10 must be filed by each. If the Form LOB 10 is being filed to amend information contained on the Form LOB 6, the Amendment must be verified and signed by the Lobbyist. VERIFICATION: If the Form LOB 10 is being filed to amend information contained on the Form LOB 7 the Amendment must be verified and signed by the person designated on the lobbying firm's registration statement as the responsible officer of the firm. In the case of a lobbyist employer (Form LOB 8) the Amendment must be verified and signed by the employer or, In the case of an organization, by a responsible officer of the organization or an attorney or a certified public accountant. No fee is required for filing a Form LOB 10. NOTE: The Form LOB 10 should not be used to amend information contained on a Registration Statement (Form LOB 1 or Form LOB 3) or the Lobbyist Certification Statement (Form LOB 4). Instead, a Form LOB 5 (Amendment to Registration Statement) must be filed. FILE THIS FORM WITH ORIGINAL SIGNATURE WITH THE: Executive Officer of the Board of Supervisors County of Los Angeles Kenneth Hahn Hall of Administration 500 W. Temple Street, Room 383 Los Angeles, California 90012 (213) 974 -1093 INTERNET ACCESS The Los Angeles County Lobbyist Ordinance, rules, operational procedures, registration/reporting forms, and information on registrants and their quarterly activity reports are accessible at: http://bos.co.la.ca.us/ Rev. 12/07 American LegalNet, Inc. www.FormsWorkflow.com OFFICIAL USE ONLY COUNTY OF LOS ANGELES Amendment to Lobbying Quarterly Reports Form LOB 10 Firm Employer/Client Page of Telephone Number & Extension Type or Print in Ink NAME OF EMPLOYER OR FIRM: (Please check box above to describe type of filer) ( NAME OF LOBBYIST: (If amendment to Form LOB 6) ) E- Mail Address (Optional) BUSINESS ADDRESS: (Number, Street & Suite) Fax Number ( City State Zip Code ) MAILING ADDRESS (Number, Street & Suite) (If different than above) City State Zip Code 1. The following information amends Lobbying Quarterly Report: Form LOB 6 Form LOB 7 Form LOB 8 for the period of: (Month/Day/Year) executed on: January ­ March 2. April ­ June July ­ September October ­ December (Enter Year) . Amended information affects items on Part(s)_________________ Section(s)_______________________. 3. Describe changes below or attach the page(s) you have amended: VERIFICATION I have used all reasonable diligence in preparing this Statement. I have reviewed this Statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on (Date) At (City and State) By (Signature of Responsible Officer) Name of Responsible Officer (Type or Print) Title American LegalNet, Inc. www.FormsWorkflow.com