Lobbyist Amendment

Office of the City Clerk
P.O. Box 1088
Austin, Texas 78767

This report is to amend a current Lobbyist Registration form.

As to each lobby employer (a person who compensates another person to lobby on any municipal question of interest to the person) on whose behalf the registrant will lobby, state the following:

Registrant Information: 	Last Name:
     	First Name:
     	Middle Initial:
 	
Street Address:	     	
	City:
     	State:
     	Zip:
     	
Contact Information:	Phone Number:
     	E-mail (optional): 
     	

Name of Business:	Business Address:	Nature of Business:	Municipal Question(s) in which the registrant will lobby: 	Adding  or Deleting
entity: 	
     	     	     	     	     	
     	     	     	     	     	

*Additional pages in the back

If the Registrant is an agent or employee of a lobbying entity (a corporation, association, firm, partnership, committee, club, organization, or group of persons who are voluntarily in a concert that is compensated by a lobby employer to lobby), state the following: 

Name of Entity:	Nature of Business:	
     	     	

STATE OF TEXAS
COUNTY OF TRAVIS

AFFIDAVIT

I swear or affirm under penalty of perjury that this Lobbyist Amendment Form is true and correct and includes all information required to be reported by me pursuant to Section 4-8-6 of the Austin City Code of 2003 for the reporting period indicated.

__________________________
Signature of Affiant

SWORN TO AND SUBSCRIBED BEFORE ME by the said _______________________________,
on this the _______ day of _________________________, 200____, witness my hand and seal of office.

__________________________
Signature of Notary

(SEAL)

Name of Business:	Business Address:	Nature of Business:	Municipal Question(s) in which the registrant will lobby: 	Adding  or Deleting
entity: 	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	
     	     	     	     	     	

*Additional pages may be used if necessary