SFLLL_2_0-V2.0 WITH SIGNATURE PAGE.PDF

10. a. Name and Address of Lobbying Registrant:
9. Award Amount, if known:
$ 
* Street 1
* City
State
Zip
Street 2
* Last Name
Prefix
* First Name
Middle Name
Suffix
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352
OMB Number: 4040-0013 
Expiration Date: 02/28/2025
1. * Type of Federal Action:
a. contract
b. grant
c. cooperative agreement
d. loan 
e. loan guarantee
f. loan insurance
2. * Status of Federal Action:
a. bid/offer/application
b. initial award
c. post-award
3. * Report Type:
a. initial filing
b. material change
4.
Name and Address of Reporting Entity:
Prime
SubAwardee
* Name
* Street 1
Street  2
* City
State
Zip
Congressional District, if known:
5. If Reporting Entity in No.4 is Subawardee, Enter  Name and Address of Prime:
6. * Federal Department/Agency:
7. * Federal Program Name/Description:
CFDA Number, if applicable: 
8. Federal Action Number, if known:
b. Individual Performing Services (including address if different from No. 10a) 
Prefix
* First Name
Middle Name
* Street 1
* City
State
Zip
Street 2
11.
* Last Name
Suffix
Information requested through this form is authorized by title 31 U.S.C. section  1352.  This disclosure of lobbying activities is a material representation of fact  upon which 
reliance was placed by the tier above when the transaction was made or entered into.  This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to 
the Congress semi-annually and will be available for public inspection.  Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than 
$10,000 and not more than $100,000 for each such failure.
* Signature:
*Name:
Prefix
* First Name
Middle Name
* Last Name
Suffix
Title:
Telephone No.:
Date:
  Federal Use Only: 
Authorized for Local Reproduction 
Standard Form - LLL (Rev. 7-97)
Maricopa County Sheriff's Office
550 West Jackson Street
Phoenix
AZ: Arizona
85003-2412
Office of National Drug Control Policy
Clint
Hickman
Chairman
602-506-7642

HIDTA CY24 Application SFLLL
Maricopa County 
ATTEST: 
_____________________________________________ 
 Juanita Garza     
 Date 
 Clerk of the Board of Supervisors 
APPROVED AS TO FORM 
This ____ day of ____________________, 20__ 
By: ___________________________________ 
 Deputy Maricopa County Attorney