LD-1 Disclosure Form

Clerk of the House of Representatives
Legislative Resource Center
135 Cannon Building
Washington, DC 20515
http://lobbyingdisclosure.house.gov

Secretary of the Senate
Office of Public Records
232 Hart Building
Washington, DC 20510
http://www.senate.gov/lobby

LOBBYING REGISTRATION

Lobbying Disclosure Act of 1995 (Section 4)

Check One: New Registrant New Client for Existing Registrant Amendment

			1. Effective Date of Registration		3/31/2017
2. House Identification	435620001			Senate Identification	401104373-12

REGISTRANT Organization/Lobbying Firm Self Employed Individual

3. Registrant

Organization

YOUR AMERICAN FAMILY

Address

9108 Wellington Pl

Address2

City

Lanham

State

Zip

20706-2073

Country

USA

4. Principal place of business (if different than line 3)

City

State

Zip

Country

5. Contact name and telephone number

International Number

Contact

Mr. Donald R Green Jr

Telephone

2405736998

E-mail

d.green42192@gmail.com

6. General description of registrant’s business or activities

Supplemental Insurance & Online Marketing

CLIENT A Lobbying Firm is required to file a separate registration for each client. Organizations employing in-house lobbyists should check the box labeled “Self” and proceed to line 10. Self

7. Client name	YOUR AMERICAN FAMILY
Address

City

State

Zip

Country

USA

8. Principal place of business (if different than line 7)

City

State

Zip

Country

9. General description of client’s business or activities

LOBBYISTS

10. Name of each individual who has acted or is expected to act as a lobbyist for the client identified on line 7. If any person listed in this section has served as a “covered executive branch official” or “covered legislative branch official” within twenty years of first acting as a lobbyist for the client, state the executive and/or legislative position(s) in which the person served.

Name			Covered Official Position (if applicable)
First	Last	Suffix
Donald	Green		Proprietor

LOBBYING ISSUES

11. General lobbying issue areas (Select all applicable codes).

ACC

ADV

AGR

ALC

APP

ART

BAN

BNK

BUD

12. Specific lobbying issues (current and anticipated)

Social Security, ambiguity in our Federal system.

AFFILIATED ORGANIZATIONS

13. Is there an entity other than the client that contributes more than $5,000 to the lobbying activities of the registrant in a quarterly period and either participates in and/or in whole or in major part supervises or controls the registrant’s lobbying activities?

No --> Go to line 14.

Yes --> Complete the rest of this section for each entity matching the criteria above, then proceed to line 14.

Internet Address:

Name

Address

Principal Place of Business

Street

City

State/Province

Zip Code

Country

City

State

Country

City

State

Country

City

State

Country

FOREIGN ENTITIES

14. Is there any foreign entity

a) holds at least 20% equitable ownership in the client or any organization identified on line 13; or

b) directly or indirectly, in whole or in major part, plans, supervises, controls, directs, finances or subsidizes activities of the client or any organization identified on line 13; or

c) is an affiliate of the client or any organization identified on line 13 and has a direct interest in the outcome of the lobbying activity?

No --> Sign and date the registration.

Yes --> Complete the rest of this section for each entity matching the criteria above, then sign the registration.

Address

Ownership

Name

Street

Principal place of business

Amount of contribution

City

State/Province

Country

(city and state or country)

for lobbying activities

City

State

Country

City

State

Country

Signature

Digitally Signed By: Donald Green

Date

4/5/2017 6:31:09 PM

ADDITIONAL LOBBYISTS

10. Supplemental. List any additional lobbyists for this client not listed on page 1, number 10.

Name			Covered Official Position (if applicable)	Have you been convicted of a crime?
First	Last	Suffix

ADDITIONAL LOBBYING ISSUES
11. Supplemental. General lobbying issue areas. Enter any additional codes for issues not listed on page 2, number 11.

CAW

CDT

CIV

COM

CON

CSP

DEF

DIS

DOC

ADDITIONAL AFFILIATED ORGANIZATIONS13. Supplemental. List any other affiliated organization that meets the criteria specified and is not listed on page 2, number 13.

Name

Address

Principal Place of Business

Street

City

State/Province

Zip Code

Country

City

State

Country

City

State

Country

City

State

Country

ADDITIONAL FOREIGN ENTITIES
14. Supplemental. List any other foreign entity that meets the criteria specified and is not listed on page 2, number 14.

Name

Address

Principal place of business
(city and state or country)

Amount of contribution for lobbying activities

Ownership

Street
City	State/Province	Country

City
State		Country

City
State		Country

City
State		Country

ADDITIONAL LOBBYISTS

10. Supplemental. List any additional lobbyists for this client not listed on page 1, number 10.

Name			Covered Official Position (if applicable)	Have you been convicted of a crime?
First	Last	Suffix

ADDITIONAL LOBBYING ISSUES
11. Supplemental. General lobbying issue areas. Enter any additional codes for issues not listed on page 2, number 11.

ECN

EDU

ENG

ENV

FAM

FIN

FIR

FOR

GOV

ADDITIONAL AFFILIATED ORGANIZATIONS13. Supplemental. List any other affiliated organization that meets the criteria specified and is not listed on page 2, number 13.

Name

Address

Principal Place of Business

Street

City

State/Province

Zip Code

Country

City

State

Country

City

State

Country

City

State

Country

ADDITIONAL FOREIGN ENTITIES
14. Supplemental. List any other foreign entity that meets the criteria specified and is not listed on page 2, number 14.

Name

Address

Principal place of business
(city and state or country)

Amount of contribution for lobbying activities

Ownership

Street
City	State/Province	Country

City
State		Country

City
State		Country

City
State		Country

ADDITIONAL LOBBYISTS

10. Supplemental. List any additional lobbyists for this client not listed on page 1, number 10.

Name			Covered Official Position (if applicable)	Have you been convicted of a crime?
First	Last	Suffix

ADDITIONAL LOBBYING ISSUES
11. Supplemental. General lobbying issue areas. Enter any additional codes for issues not listed on page 2, number 11.

HCR

HOM

HOU

IMM

IND

INS

INT

LAW

LBR

ADDITIONAL AFFILIATED ORGANIZATIONS13. Supplemental. List any other affiliated organization that meets the criteria specified and is not listed on page 2, number 13.

Name

Address

Principal Place of Business

Street

City

State/Province

Zip Code

Country

City

State

Country

City

State

Country

City

State

Country

ADDITIONAL FOREIGN ENTITIES
14. Supplemental. List any other foreign entity that meets the criteria specified and is not listed on page 2, number 14.

Name

Address

Principal place of business
(city and state or country)

Amount of contribution for lobbying activities

Ownership

Street
City	State/Province	Country

City
State		Country

City
State		Country

City
State		Country

ADDITIONAL LOBBYISTS

10. Supplemental. List any additional lobbyists for this client not listed on page 1, number 10.

Name			Covered Official Position (if applicable)	Have you been convicted of a crime?
First	Last	Suffix

ADDITIONAL LOBBYING ISSUES
11. Supplemental. General lobbying issue areas. Enter any additional codes for issues not listed on page 2, number 11.

MED

MIA

MMM

MON

NAT

PHA

REL

RES

RET

ADDITIONAL AFFILIATED ORGANIZATIONS13. Supplemental. List any other affiliated organization that meets the criteria specified and is not listed on page 2, number 13.

Name

Address

Principal Place of Business

Street

City

State/Province

Zip Code

Country

City

State

Country

City

State

Country

City

State

Country

ADDITIONAL FOREIGN ENTITIES
14. Supplemental. List any other foreign entity that meets the criteria specified and is not listed on page 2, number 14.

Name

Address

Principal place of business
(city and state or country)

Amount of contribution for lobbying activities

Ownership

Street
City	State/Province	Country

City
State		Country

City
State		Country

City
State		Country

ADDITIONAL LOBBYISTS

10. Supplemental. List any additional lobbyists for this client not listed on page 1, number 10.

Name			Covered Official Position (if applicable)	Have you been convicted of a crime?
First	Last	Suffix

ADDITIONAL LOBBYING ISSUES
11. Supplemental. General lobbying issue areas. Enter any additional codes for issues not listed on page 2, number 11.

SCI

SMB

TAX

TRD

VET

WEL

URB

AER

AUT

ADDITIONAL AFFILIATED ORGANIZATIONS13. Supplemental. List any other affiliated organization that meets the criteria specified and is not listed on page 2, number 13.

Name

Address

Principal Place of Business

Street

City

State/Province

Zip Code

Country

City

State

Country

City

State

Country

City

State

Country

ADDITIONAL FOREIGN ENTITIES
14. Supplemental. List any other foreign entity that meets the criteria specified and is not listed on page 2, number 14.

Name

Address

Principal place of business
(city and state or country)

Amount of contribution for lobbying activities

Ownership

Street
City	State/Province	Country

City
State		Country

City
State		Country

City
State		Country

ADDITIONAL LOBBYISTS

10. Supplemental. List any additional lobbyists for this client not listed on page 1, number 10.

Name			Covered Official Position (if applicable)	Have you been convicted of a crime?
First	Last	Suffix

ADDITIONAL LOBBYING ISSUES
11. Supplemental. General lobbying issue areas. Enter any additional codes for issues not listed on page 2, number 11.

TOB

FUE

MAN

CHM

SPO

UNM

WAS

FOO

CPI

ADDITIONAL AFFILIATED ORGANIZATIONS13. Supplemental. List any other affiliated organization that meets the criteria specified and is not listed on page 2, number 13.

Name

Address

Principal Place of Business

Street

City

State/Province

Zip Code

Country

City

State

Country

City

State

Country

City

State

Country

ADDITIONAL FOREIGN ENTITIES
14. Supplemental. List any other foreign entity that meets the criteria specified and is not listed on page 2, number 14.

Name

Address

Principal place of business
(city and state or country)

Amount of contribution for lobbying activities

Ownership

Street
City	State/Province	Country

City
State		Country

City
State		Country

City
State		Country

ADDITIONAL LOBBYISTS

10. Supplemental. List any additional lobbyists for this client not listed on page 1, number 10.

Name			Covered Official Position (if applicable)	Have you been convicted of a crime?
First	Last	Suffix

ADDITIONAL LOBBYING ISSUES
11. Supplemental. General lobbying issue areas. Enter any additional codes for issues not listed on page 2, number 11.

RRR

TRA

ROD

TOR

CPT

AVI

ADDITIONAL AFFILIATED ORGANIZATIONS13. Supplemental. List any other affiliated organization that meets the criteria specified and is not listed on page 2, number 13.

Name

Address

Principal Place of Business

Street

City

State/Province

Zip Code

Country

City

State

Country

City

State

Country

City

State

Country

ADDITIONAL FOREIGN ENTITIES
14. Supplemental. List any other foreign entity that meets the criteria specified and is not listed on page 2, number 14.

Name

Address

Principal place of business
(city and state or country)

Amount of contribution for lobbying activities

Ownership

Street
City	State/Province	Country

City
State		Country

City
State		Country

City
State		Country