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VIRGINIA CONFLICT OF INTEREST AND ETHICS ADVISORY COUNCIL

Lobbyist Registration Form (Rev. 10/2016)

There is a $100 fee required for registration (local government employees are exempted from this fee). This form must be submitted electronically on the Council's website at ethics.dls.virginia.gov.

PART I: PRINCIPAL INFORMATION

Please provide the name of the Principal for which you intend to lobby

Permanent business address and telephone number of location where records are stored, if different from above:

101 N. Brand Blvd. 11th Floor Glendale, CA 91203 3233370183



Please provide the name of the Lobbyist registering to represent the Principal listed in Part I, item 1
  1. 1.Jerry Kilgore

  2. 1051 East Cary Street Suite 1420 Richmond, VA 23219

  3. 2024632529

  4. jkilgore@cozen.com


  5. Please provide the name of the individual who will retain ALL records, on behalf of the Lobbyist, with respect to your lobbying activities for the Principal identified in Part I, item 1, if different from the Lobbyist listed in Part II, item 1

  6. 2.Jerry Kilgore

  7. 1051 East Cary Street Suite 1420 Richmond, VA 23219

  8. 2024632529

  9. jkilgore@cozen.com


Permanent business address and telephone number of location where records are stored, if different from above:

1051 East Cary Street Suite 1420 Richmond, VA 23219 2024632529

Identify the subject matter (with as much specificity as possible) for which you expect to lobby
  1. 3.Matters pertaining to LegalZoom.

  2. Describe your relationship with the Principal listed in Part I, item 1 (check only one):

  3. 4.

  4. Employed (on the payroll of the principal)
  5. Retained (compensated but not on the payroll of the principal)
  6. Not Compensated (not compensated but expenses may be reimbursed)

  7. If you are employed by the Principal provide your job title

  8. 5.

I, the undersigned lobbyist, do state that the information furnished on this registration statement and on any and all accompanying statements attached thereto, is to the best of my knowledge and belief, complete and accurate.

Date: 1/11/2018 12:06:21 PM       Lobbyist Signature: Jerry Kilgore (Electronically Signed:1/11/2018 12:06:21 PM )

Note: Pursuant to § 2.2-423, a principal may elect to waive the principal signature requirement on disclosure filings by submitting a signature waiver form to the Virginia Conflict of Interest and Ethics Advisory Council after this registration form has been approved.
Virginia Conflict of Interest and Ethics Advisory Council