File form with: Secretary of the Senate Office of Public Records 232 Hart Building Washington, D. C. 20510
PAYMENTS TO CHARITABLE ORGANIZATIONS IN LIEU OF HONORARIA SENATE RULE 35.4(b) [This form must be provided to the Secretary of the Senate within thirty (30) days after such designation or recommendation pursuant to rule 35.4(b). verification of registration status for lobbyists may be obtained from the senate office of public records, 202/224-0758. verification of registration of an agent of a foreign principal may be obtained from the u.s. department of Justice, Foreign Agent Registration Unit, 202/514-1231.]
REPORTING INDIVIDUAL'S NAME AND EMPLOYING OFFICE
□ Original □ Amended Version DATE OF CONTRIBUTION
name/address OF REGISTERED LOBBYIST OR FOREIGN AGENT MAKING CONTRIBUTION
NAME/ADDRESS OF CHARITABLE ORGANIZATION DESIGNATED/RECOMMENDED
AMOUNT OF CONTRIBUTION
Signature of Member, Officer, or Employee
Date SR35.4(b)