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DISCLOSURE OF LOBBYING ACTIVITIES Approved by oM8 . <br /> Complete this- form to disclose lobbying activities pursuant to 31 U.S.C. 1352 osas-ooas <br /> See reverse for ublic burden disclosure. <br /> 1. Type of Federal Action: 2. Status of Federal Action: 3. ReporE Type: <br /> a. contract ~ ~a.'bid/offer/application ~ a. initial filing <br /> b. grant b. initial award b. material ange <br /> c. cooperative. agreement c. post-award For Materi ~ Change Only: <br /> d. loan year quarter <br /> <br /> . e. loan guarantee d e. of last report: <br /> f. loan insurance <br /> 4.. Name and Address of Reporting Entity: 5. If Reporting Entity jn No. 4 is a Subawardee, Enter Name <br /> ? Prime Q Subawardee and Address of P me: <br /> Tier ifknown: <br /> Con ressional District, ifknown: 4c on ressional District, ifknown: <br /> 6. Federal Department/Agency: federal Program Name/Description: <br /> CFDA Number, if applicable: <br /> 8: Federal Action Number, ifknown: 9. Award Amount, ifknown: <br /> $ <br /> 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services .(including address if <br /> (if individual, last name, first'name, MI different from No. 10a ) <br /> .~`J (last name, first name, MI . <br /> _ <br /> - <br /> Informatlon requested,,through thPS form is authorized by tltle 31 U.S.C. sectlon <br /> 11.1352 ThIs dlsdosurb of robb n actlvitles Is a material re SI nature: <br /> Yl 9 presentatlon of fad g <br /> upon which reliance was placed by the tier above when this transadlon was made print Name: MICHAEL- C . W I LD I S H <br /> orentered into:' Thls dlsdosure Is required pursuant to 31 U.S.C. 1352. This <br /> infonnatlon ;will be available for public inspection. Any person who fails to file the <br /> required dlsdosure shaA be sub]ed to a dvil penally of not lesg than $10,000 and Title: VICE P RE S I D E N T <br /> nd more than $100,000 for each such failure' S 41- 4 8 5 -17 0 Q <br /> Telephone No.: Date: <br /> Authorized for Local Reproduction <br /> Federal Use ODIy: Standard FormiLL(Rev.7-97) <br /> <br />