FORM LOB 4 Lobbyist Certification Statement {LOB 4}

FORM LOB 4, LOBBYIST CERTIFICATION STATEMENT, this form is used for: • Certification of an individual contract lobbyist or owner (including sole-proprietor), partner, officer or employee of a lobbying firm who qualifies as a lobbyist. • Certification of an in-house employee of a lobbyist employer who qualifies as a lobbyist. CERTIFICATION REQUIREMENTS: • Each individual contract lobbyist and each employee of a lobbying firm who qualifies as a lobbyist is required to complete the Lobbyist Certification Statement (Form LOB 4) as an attachment to the Lobbying Firm/ Individual Lobbyist Registration Statement (Form LOB 1) and provide a recent 3x4 inch photograph (head and shoulders only). • Each in-house employee of a lobbyist employer who qualifies as a lobbyist is required to complete a Lobbyist Certification Statement (Form LOB 4) as an attachment to the Lobbyist Employer Registration Statement (Form LOB 3) and provide a recent 3x4 inch photograph (head and shoulders only). • A $450 registration fee, made payable to the County of Los Angeles, is required if registration is filed between January 1st and September 30th. If registration is filed between October 1st and December 31st, the cost of registration is $337. www.FormsWorkflow.com