LOBBYIST ACTIVITY REPORT
W.S. 28-7-201
A fillable PDF version of this form is available on the Secretary of State’s website at:
http://soswy.state.wy.us/Forms/Lobbyists/LobbyistActivityReport.pdf
The Secretary of State’s Rules on Lobbyist Disclosure state: “A lobbyist who has incurred total
lobbyist expenses equal to or greater than five hundred dollars ($500.00) shall file an expense
report. If the total amount of lobbyist expenditures for reportable expenditures under
Wyoming Statute '28-7-201(d) and (e) is equal to or greater than five hundred dollars
($500.00), itemization of such expenses is required.”
Pursuant to W.S. 28-7-201, “joint reports by the lobbyist and organization may be made and the lobbyist
may report on behalf of the organization.”
Lobbyist Activity Reports shall be filed annually no later than June 30 for activities during the preceding
year – May 1 through April 30.
Penalty for not filing: Any person or organization failing to file a lobbyist activity report required under
this section or who files a lobbyist activity report containing information which the lobbyist knows to be
false is guilty of a misdemeanor punishable by a fine of not more than seven hundred fifty dollars
($750.00). Upon a second or subsequent conviction under this section, any person or organization shall
have his right to be a registered lobbyist revoked by the Secretary of State for a period of up to two (2)
years in addition to any fine. (W.S. 28-7-102)
FILING DEADLINE:
June 30
FILING OFFICE:
Wyoming Secretary of State, Election Division
2020 Carey Ave, Ste 600
Cheyenne, WY 82002
Email: [email protected]
Fax: (307) 777-7640
Report covers period from May 1st toApril 30th
Lobbyist Name:________________________________________
Check one :
Lobbyist Signature: ____________________________________
Total Lobbyist expenses were equal to or greater than $500.00.
Initial Report
Amended Report
Yes (If no, a report is not required.)
If reportable expenses are equal to or greater than $500.00, itemize below
. . Reportable expenses are defined inW.S.28-7-201(d) and (e).
Date of
Expenditure
Lobbyist’s Source
of Funding
Item or Activity
Name of Recipient
Expense
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TOTAL - PAGE 1
Page 1
$
II. Information required under W.S. 28-7-201(e) - Special Events/Functions
Date
Lobbyist’ s Source of Funding
Event or Function
Name of Group Invited
Expense
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Page 2
TOTAL - PAGE 2
$
GRAND TOTAL
$