County of Los Angeles INSTRUCTIONS FOR AMENDMENT TO REGISTRATION STATEMENT FORM LOB 5 Chapter 2.160 of the Los Angeles County Code An Amendment to Registration Statement (Form LOB 5) is used for reporting changes to information contained in: · Lobbying Firm/Individual Lobbyist Registration Statement (Form LOB 1) · Lobbyist Employer Registration Statement (Form LOB 3) · Lobbyist Certification Statement (Form LOB 4) DEADLINE FOR FILING AN AMENDMENT TO REGISTRATION STATEMENT: · A lobbying firm adding a new client must file the Amendment to Registration Statement (Form LOB 5) PRIOR to attempting to influence any official county action on behalf of that client; · Within ten (10) days of the effective date of any other change. FEE: · There is no fee required for filing an Amendment to Registration Statement (Form LOB 5). However, if filing a Lobbyist Certification Statement (Form LOB 4) for adding an additional lobbyist, additional fees are required, refer to LOB 4 instructions. EXPLANATIONS OF HOW TO REPORT COMMON REGISTRATION AMENDMENTS ARE PROVIDED BELOW: FIRM · Adding a Lobbyist - Attach a completed Lobbyist Certification Statement (Form LOB 4) and 3x4 photograph (head & shoulders only) of the lobbyist · Deleting an Individual Lobbyist (no attachment is necessary) · Adding a new Lobbyist Employer/Client-Attach a Lobbying Activity Authorization (Form LOB 2) signed by the appropriate representative of the client · Deleting a Lobbyist Employer/Client (no attachment is necessary) A change in the Lobbyist Firm's designated Responsible Officer - Attach Section C of the Lobbying · Firm/Individual Lobbyist Registration Statement (Form LOB 1) containing the required information for the new Responsible Officer and his/her signature · Change in Firm's registration name (no attachment is necessary) · Change of business/mailing address or business telephone number (no attachment is necessary) LOBBYIST EMPLOYER/CLIENT · · · · · · · Adding an In-house Employee Lobbyist-Attach a completed Lobbyist Certification Statement (Form LOB 4) and 3x4 photograph (head & shoulders only) of the lobbyist Deleting an In-house Employee Lobbyist (no attachment is necessary) Adding a new Lobbying Firm (no attachment is necessary) Deleting a Lobbying Firm (no attachment is necessary) A change in the Lobbyist Employers designated Responsible Officer ­ Describe change under other Change in Employers/Clients's registration name (no attachment is necessary) Change of business/mailing address or business telephone number (no attachment is necessary) 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 Rev. 12/07 INTERNET ACCESS The Los Angeles County Lobbyist Ordinance, rules, operational procedures, registration/ reporting forms, registrants and their quarterly activity reports are accessible at: http://bos.co.la.ca.us/ American LegalNet, Inc. www.FormsWorkflow.com OFFICIAL USE ONLY COUNTY OF LOS ANGELES Amendment to Registration Statement Form LOB 5 Lobbying Firm Name of Filer: Address: City: Lobbyist Employer/Client E-Mail Address: Zip Code: Area Code & Fax Number: (No Dashes) State: Extension: (No Dashes) Area Code & Telephone Number: Part (A) - Description of Changes: Please check the appropriate box(s). If you are adding or deleting more than one lobbyist, lobbying firm or lobbyist employer/client you may list them under "Other". LOBBYING FIRM Adding Lobbyist Name of Lobbyist: Effective Date: Attach Lobbyist Certification Statement (Form LOB 4) Deleting Lobbyist Name of Lobbyist: Effective Date: No Attachment Required Adding Lobbyist Employer/Client Name of Lobbyist Employer/Client: Effective Date: Complete Part B and Attach Lobbying Activity Authorization (Form LOB 2) LOBBYIST EMPLOYER/CLIENT: Adding In-house Lobbyist Name of In-house Lobbyist:_____________________ Effective Date:_____________ Attach Lobbyist Certification Statement (Form LOB 4) Deleting In-house Lobbyist Name of In-house Lobbyist: Effective Date: No Attachment Required Adding Lobbying Firm Name of Lobbying Firm: Effective Date: Deleting Lobbyist Employer/Client Name of Lobbyist Employer/Client: Effective Date: Deleting Lobbying Firm Name of Lobbying Firm: Effective Date: Other : Describe changes in detail, indicate effective dates and provide attachments required. American LegalNet, Inc. www.FormsWorkflow.com County of Los Angeles Amendment to Registration Statement Form LOB 5 Part (B) - Lobbying Firm Adding a Lobbyist Employer/Client Name of Filer: Name of Lobbyist Employer/Client: Address: State: City: Area Code & Phone Number: Zip Code: E-Mail Address: (No Dashes) Check one box to describe the client named above: INDIVIDUAL BUSINESS ENTITY (Complete description below) Description of Business Activity: INDUSTRY, TRADE OR PROFESSIONAL ASSOCIATION (Complete description below) Description of Industry, Trade or Professional Association: Specific description of any portion or faction of the industry, trade or profession which the association exclusively or primarily represents: Number of members in association (check appropriate box) OTHER (Complete description below) Statement of Nature and Purpose: Description of any trade or profession or other group with a common economic interest which is principally represented or from which membership or financial support is principally derived: Part (C) 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. Date Executed: Name of Responsible Officer: Signature of Responsible Officer: City: State: Less Than 50 (Attach List of Members) More Than 50 American LegalNet, Inc. www.FormsWorkflow.com