Form SR-RS, Page 1 of 2 (Rev. 12/4/2017) Elaine F. Marshall, Secretary of State Solicitor Registration Statement 2018 NO REGISTRATION FEE REQUIRED Solicitor Information Complete Name of Solicitor: Complete Name of Firm or Organization of Solicitor (If Applicable): Complete Name and Title of Authorized Representative of Solicitor: Mailing Address of Authorized Representative of Solicitor: Physical Address of Authorized Representative of Solicitor: Weekday Telephone for Authorized Representative of Solicitor: Fax No.: E-Mail Address: Signature of Representative Authorized to Sign for Solicitor Date Name & Title of Representative Authorized to Sign for Solicitor Date The Division will send notices regarding filing due dates electronically at no charge. If you desire to receive notices from our office in another format , please indicate that by checking the box and you will be invoiced according to G.S. 247 132-1(b). CERTIFICATION Solicitor Registration Statement 2018true, complete and correct in accordance with G.S. 247120C-215. By signing this certification, I understand I have an affirmative duty to understand and to comply with the Lobbying Law and the rules, including filing reports, as the law requires. SIGNATURE OF PERSON AUTHORIZED TO SIGN FOR SOLICITOR DATE American LegalNet, Inc. www.FormsWorkFlow.com Form SR-RS, Page 2 of 2 (Rev. 12/4/2017) Instructions 1. Do Not Use This Form If You Are Registering For Economic Information Protection. 2. Registration triggers reporting obligations. Quarterly reports must be filed regardless of whether you have any reportable expenditures. 3. order to influence or attempt to influence legislative or executive action in order to further the purposes of those who are doing the soliciting. G.S. 120C-100(a) (13). 4. Types of communication that triggers solicitation is an ad in print media, a television ad (including cable and satellite), e-mail or a Website posting, a mailed letter or flyer, phone calls, and finally, communicating with the public at a conference, meeting, or similar event. 5. Registration and reporting by solicitors are triggered when the total expense for solicitation of others exceeds $3,000.00 during any 90-day period. These expenses include the cost of producing and transmitting the communication. If the communication is made at a conference, meeting, or similar event, then the solicitor must include the costs of planning, hosting, sponsoring, and attending the event. 6. A solicitor cannot be a registered lobbyist or principal. 7. If you do not provide an email address on this form and do not mark the box to receive notices in another format (page 1 of this document), we are under no obligation to inform you of report due dates, form changes, or any other information we provide via electronic methods. 8. FILING SUBMISSION: Each required filing shall be submitted to the Department by the following method: (a) Electronically via the Secretary of State site, https://www.sosnc.gov/; Lobbying Compliance Division through a profile and document upload. Provided the original signed document is postmarked or delivered to the Department within seven days following the Department's receipt of the transmission. A filing for which the original is not postmarked or delivered to the Department within seven days following the Department's receipt of the transmission is void. (b) By United States mail at the following address: (c) By hand-delivery or by a designated delivery service authorized pursuant to G.S. 2471A-1, Rule 4 at the following street address: (d) How to e-file your Registration: E-file by using the Lobbying Compliance Division Portal on our website, https://www.sosnc.gov/ . Please send the hard copy to the Department within seven days or your registration will be void. Lobbying Compliance Division Dept. of the Secretary of State P. O. Box 29622 Raleigh, N.C. 27626 - 0622 Lobbying Compliance Div ision Dept. of the Secretary of State 2 S. Salisbury Street Raleigh, N.C. 27601 - 2903 American LegalNet, Inc. www.FormsWorkFlow.com