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<br />. ; -.lCISCLOSURE OF LO8BYING ACTIVmES .... {(51/. :O~O'fOMS <br />CompJ." m~ torm to di$dœ8lot)þying .aivities PUl'$Uänt 1031 U.S.C. 1352 <br />(See t'8V8rsa tor pW)/ic ~W'd8n dísdQsuna.) <br />1. Type at F8d8r3J Action: 2. Sta'tWI of F8d8raJ Adton: 3. Report Typ8: <br />0 a.. c:gntraa D a. bidlc1ter/3ppUcaDen D a.. initiaJ filing <br />b. grant b. inilliU award b. ma18riaJ change <br />Co C:CClpetativ8 agrwement Co poat..W4Ud <br />d. lean For Iåt8riaJ Chang. qnty; . <br />8. loan guarant.. y."ar quarter <br />f. loan insuranca date ot last ~pen <br />4. Nam8 and Add,.... of Reporting Enüty: !. If R8pOrting Entity in No.. 4 Ia ~ Ent8r Nam. <br />and addt8U of Prim8: <br />I:I Prime I:I SWaward8e <br />~r .,~ <br /> <br />CDngreuicnal District, if known: <br /> <br />7. Fedend Program Nam8lDeac:iptlon: <br />O:Ingr888ianaf Dlatrtct, if knQWn: <br />e.. Faderal Department! Agency: <br /> <br />CFDA Numt)er. If appiicabj8: <br /> <br />8. Fedenat Adon NulTÚ)8(, if known: i. Awarct Amount, it known: <br /> <br />S <br /> <br />, O. a. Nam. and Add,... of LoàCying Entity be Indtvlch.lais Performing s.rvtcas {Including add/"8$S if <br />(if lncUviduæ. J.iut name. t/r:;r næT1e. Mi): dif/M8nr frem No.1 O;z) <br />(last t:amlI. Om name. MI): <br /> <br /> <br />. <br /> <br /> <br />I <br />. (.-n ~ $1881(., ~OOA. iI'~'TJ <br />11. Amount at Paynwnt (ch«ic aJJth6t~): 13. Type of Payment (check.u that ~Iy): <br />S t:I Ac:waI I:J pianned ~ a.. t1Itainar <br />b. one-time t.. <br />12. Fonn of Paym.nt (check ~t/ul:t ~y): Co c:gmmissjon <br />, d. cootlng8nt t.. <br />1:1 a.. cash e. d8f.mtd <br />r'"] b. Itrkinci; spec:üy: nat1Jr8 1. other. spedty: <br />væu. , <br />- <br />,~ dti8t Cascnption of s.rvica Performed Otto be Penonned and D8t8(8) at Setvica, fndudfng afficar(s), empjoyø(s). <br />or M8mber(a) contacted for Payment jndicat8d In itam '1: <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />(-=n eann..aan SltNIt., SF-I17-A. íI ~rl <br /> <br />j ,5. Ccntinuatian Sh..t{a) SF.1".A attached: I:I Va a He <br /> <br />16. I~, - IIYCUgn ft8 Iarm .. ~ C'f =-:11 u..s.c. <br />MC:IOI11 ~ n. ~ ot Iaooywwo¡ 1IICIMM8.. ..-. ~ Sign at u 18: <br />ot -= IOX1 wnc:n r-.nr:. -- ~ Qy ft8 II« -. - .. <br />D'8nAcIIan - ~ or -.cline. T11I8 ~ . ~ ~ Print Nama: <br />I !I:I:J1 U.S.C.1:1S2.. Tht8"'omaøon-oe~Iaft8~- <br />av>uIUIy ana - Oe ...-- Q pucIIc 1R&CMCIIOn. An'f ~ - .. 81 TItta: <br /> <br /> .II'Ier8QUwecs~snoIIoeWQ 8Q80ac:Ml*8frolnar.... -.n T818pl1on. He.: Dace: <br />i S10.000 ana n«..-.. ..., S1CX1.000 Icr - auc:n ~. <br /> <br /> ~......---R- - <br />S-~.111 <br />