Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 LOBBY TERMINATION NOTICE (TDD 1-800-735-2989) FORM ACCOUNT # Do Not Complete This Form Unless You Marked "Final" As The Report Type On The Lobby Activities Report. A Final Lobby Activities Report Must Be Filed With This Lobby Termination Notice. REGISTRANT NAME TN PAGE # OFFICE USE ONLY I, ________________________________________________________, a registrant under Chapter 305 of the Texas Government Code, hereby state as of the filing of this notice I have ceased to engage in all activities requiring registration under Chapter 305. I acknowledge that I am filing a Lobby Activities Report - Form HD / PM LA for any period during which I was registered and for which I have not already Receipt # filed such report. Amount Legal _____________________________________________________ Date Processed Signature of Registrant Date Imaged AFFIX NOTARY STAMP / SEAL BELOW Sworn to and subscribed before me, by the said __________________________________________, this the ____________ day of _____________________, 20_________, to certify which, witness my hand and seal of office. Signature of officer administering oath Print name of officer administering oath Title of officer administering oath BEFORE YOU TERMINATE YOUR LOBBY REGISTRATION you should be aware of the following: FINAL REPORT -- A final Lobby Activities Report must be filed with the termination form. The final report should report all lobby activities from the day after the period covered by your last Lobby Activities Report through the termination date. The termination date is the date the Lobby Termination Notice is filed with the commission. Page 2 of the form LA Instruction Guide explains when a report is filed with the commission. NOTE: The ending date for the "Period Covered" on your Lobby Activities Report (question 6) should be the same as your termination date, the date the termination notice is filed. TERMINATION NOTICE -- A termination form should not be filed unless you have entirely ceased your lobby activity for the rest of the calendar year. You should not file this form if you have ceased lobbying for one employer or client but you continue to, or may, lobby on behalf of others during the calendar year. EXPIRED REGISTRATION -- All lobby registrations expire at midnight on December 31 each year, unless renewed or terminated at an earlier date. You are not required to file this form unless you want to terminate your registration before December 31. SIGNATURE -- The termination notice must be signed by the individual registrant or, if the registrant is a business, by a person whose actions legally bind the organization, such as the owner, an officer, or a director. LATE FINES -- Filing a termination form does not relieve you from your obligation to file any unfiled reports due or to pay any late fines assessed before you filed the termination form. www.ethics.state.tx.us Revised 11/30/2004 American LegalNet, Inc. www.FormsWorkFlow.com