Far Av Zla Regis Tro Fitzgibbon

8/21/2019 Far Av Zla Regis Tro Fitzgibbon

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Received by NSD/FARA RegiaMtim]^ AM

u.s. Department

of justice

Exhibit

A to Registration Statement

Washington pc

20530 Pursuant

to the Foreign

Agents

Registration Act o

1938, as amended

INSTRUCTIONS. Furnish this exhibit for

EACH

foreign principal listed in an initial statement and for

EACH

additional

foreign principal acquired

subsequently.

The fil ing of this document, requires die payment of a filing fee as set

forth

in Rule (dXl) , 28 CF.R. § 5.5(d)(1). Compliance is

accompfehed by

filing an

eleetrntuc'Exhibit A

form

at

)frflrx//www,fara.gov.

Privacy

Act

Statement The filing of this document is required

by

me Foreign Agents Registration

Act

of 1938,, as amended, 22

U.S.G.

§ 611 etseq.,

for

the

purposes

of registration

under

the

Ac t

and public disclosure. Provision of the information requested s mandatory, and failure to provide this

information is subject to the penalty arid enforcement provisions established in Section

8

o f the

Act.

Everyregistration

statement,

short

form

registration

statement,

supplemental

statement, exhibit, amendment,

copy

of inforrnational

materials or other document or

mformation filed with

the

Attorney General

irn rthis

Actis a

public

iroord open to inspection and

copying

during the posted busing*

hours

ofthe

Registration

Unit tn

Washington, Dt .

Statements

are also available online at the Registration

Unit's

webpage: http://www-fara.goy. One copy o f

every such document, other than

informational

materials, is automatically provided to the

Secretary o f State pursuant

to Section 6(b) of the

Act,

and

copies o f any and

all

documents areroutinely made available to outer agencies, departments and Congress

pursuant

to Section

6(c)

of the Act the

Attorney General also: transmits a senri'-amiual report to Congress on me adtairjjstratron ofthe

Act

which lists the names o f all agents registered

unde

the

Ac t

and theforeign principals they

represent.

This report is available to the public in print and online at:htip://vmw.fip-a,gov.

Public Reporting Burden. Public reporting burden

for

mis collection of information is estimated to

average

.49

hours

per

response,

including the

time

for reviewing

instructions, searching existing

data sources,

gathering and maintaining the

data needed,

and completing and

reviewing

the

collection of information. Send

comments

regarding

his burden

estimate

or

any

other aspect

of

this

collection of information, including suggestions

for reducing his burden to Chief, Registration

Unit,

Counterespionage Section,

National

Security

Division,

U.S. Department of Justice, Washington,

DC 20530; and to foe Office o f Information and Regulatory A

ffairs,

Office o f Management and Budget, Washington, DC 20503.

1. Name and Address o f Registrant

FitzGibbon M e d i a j n c ^

2. Registration No.

3 Name'of Foreign Principal

Embassy of the Bolivarian Republic of Venezuela

4.

Principal Address o f Foreign Principal

1099 30th Street IMW

Washington, DC 20007

5. Indicate whether your

foreign principal

is one

o f

the

fo l low ing :

S Government

o f

a

foreign

country

1

•

Foreign

political

parry

• Foreign or domestic organization:

f

either, check one o fthe fo l low ing :

•

Partnership • Committee

Q Corporation • Voluntary group

• Association • Other (specify)

•

Individual-State nationality

6. f the foreign principal is a foreign government,

state:

a) Branch or agency represents

Embassy

of

the Bolivarian

Republic of

Venezuela

in

the

U5.

b) Name and

title

o f o f f i c i a l w i th whom registrant

deals

Maximi l len

Arvaiaiz, Charge

t Affairs

7.

f

the foreign principal is a foreign political party,

state:

a) Principal address

b) Name and

title

o f o f f i c i a l w i th whom registrant

deals

c)

Principal aim

1

Governmentof.a

foreign country,-'

as defined

in

Section

1(e) of

the

Act

includes any person

or group of persons exercising

sovereign

de facto or

de jure

political jurisd

over

any country, other than die

United

States, or over

any

part

of

such country,

and includes any

subdivision

of any such

group

and any

group or

agency

to which

such

sov

facto

or de jure authority or functions are directly or indirectly delegated. Such erm shall include any

faction

or

body

of insurgents

within

a country assuming to

exercis

governmental, authority

whether such faction

or body

of

insurgents has

cir

has not

been

recognized bv the

United

S

ates.

FORM

NSD-3

Received by

NSD/FARA

Registration

Unit

06/15/2015

9:46:45 A M R sedos/w



Received

by NSD/FARA Registration

Unit

06/15/2015 9:46:45 A M

8.

f

the

foreign principal is not a foreign

government

or a foreign political party:

a) State the

nature

of the business or

activity

of this foreign principal.

b) Is this foreign principal:

Supervised by a foreign

government,

foreign political party, or other foreign

prm

YesD

No •

Owned by a

foreign

government,

foreign political party, or

other

foreign

principal Yes • No •

Directed1 by

a oreign government,

foreign political

pa Yes • No •

Controlledby a

foreign

government,

foreign ootitical party, or

ofoer

foreign principal YesD

No D

Financed by a foreign government, foreign political party, or other foreign principal Yes

• No •

Subsidized in part

by

a foreign government, foreign political party,

or

other

foreign

principal

Yes • No •

9

Explain.

illy

ali items aaswenscl Yes Item o^b).. (Ifadditionalspace is needed

a

ull insert page must be used)

10. f

the

foreign

principal

is

an organization and

is

not owned

or

controlled by a foreign government, foreign political party or othe

foreign principal, state

who

owns and

controls

it.

EXECUTION

In accordance with

28

U.S.C.

§

1746, the

undesigned sweats

oi-

affirms under

penalty o f perjury that he/she has

read

foe

mformation

set

forth n this

Exhibit

A

to

the registration stitfement and that he/she is

familiar

with the

contents foerebf

and that su

contents

are in

meir entirety

true

and accurate to

the

best of his/her

knowledge

and belief.

Da^dfEpiibitA'

June

12,2015

Name and Title

Alexander

B. Thomson,

Senior Vice

President

Signature

/s/ Alexander

B. Thomson

eSigned

Received


Unit 06/15/2015

9:46:45

A M



Received

by NSD/FARA R e g i m ^ % ^ m ^ ^ , M ^ AM

ir.s. Department

of Justice

Exhibit B to

Registration

Statement

Washington

D 20530 Pursuant to the Foreign Agents

Registration

Act o

1938, as amended

INSTRUCTIONS.

A

registrant must furnish,

as

an Exhibit

B

copies

of

each

written

agreement

and the

erms

and conditions of

each oral agreement

with his oreign prmcipal, including

all

modifications

of such agreements,

or,

where no

contract

exists,

a full statement

of all the

circumstances by

reason of

which the

registrantsacting

as an

agent of a

foreign principal.

Compliance

is

accomplished

by

filing

an

electronic Exhibit B form at

http;//vy>ywiara,gov.

Privacy

Act

Statement.

The

filing

of

this

document

is required

for

the Foreign

Agents

Registration

Act

of 1938, as

amended,22

U.S.G.

§ 611

ets'eq

for

the purposes

of registration

under

the

Act

and public

disclosure.

Provision

of

the

information requested

is

mandatory,

and

failure

to

provide

themformation is

subject

o.the penalty

and enforcement provisions

established

m

Section

8 o f the Act. Every

reg stratipnstatement,

short

form

registration statement, supplemental statement,

exhibit, amendment,

copy of

informatibnal

materials

or

other document

or information

filed wit

Attorney

General meter this Act is a public

record

open to

public

examination,

inspection

and copying during the posted business

hours of the

Registration

Unit

in Washington, DC.

Statements

are

also available

online

at

foe

Registration

Unit's

webpage: hj^^Ayyjr^j^a^Qy..

One copy of

every

such document, other

than informational materials, is

automatically

provided to the Secretary

of

State pursuant

to

Section 6(b)

of

die

Act, and

copies

of any

and

ali

documents

are

routinely

made available

to

other agencies, departments

and

Congress

pursuant to

Section6(c) offoe

Act The

Attorney

General: also tjsmsmits,.a semi-annual report to Congress on

the adMoistration

of

the

Act

which lists, the

names of

aJJ

agents registered und

the

Act

and tlw

oreign rmodpals t represent This report

is

available to

the

public

in

print

and

online

at

fet^;//<yw\y.fara.goy.

Public Reporting Burden: Public

reporting

burden for

his

collection

of information is estimated

to

average

.33

hours

per

response, including

the

time for reviewing

nstructions, searching

existing data sources, gathering and

maintatmng

the data

needed,

and completing and

reviewing

he

collection

of

mformation. Send comments regarding

his burden

estimate or any

other

aspect

of this

collection

of

information,

includingsuggestion

for

reducing

this burden

to

Chief,' Registration Unit, Counterespionage Section,National

Security

Division, U.S. Department of Justice, Washingt

DC 20530;

and

to theOffice of

mformation and

Regulatory Affairs,

Office

of

Management

and

Budget,

Washington,

DC 20503.

1.. Name o f Registrant

FitzGibbon Media, Inc.

2.

Registration

No.

3 .

Name o f Foreign

Principal

Embassy of the

Bolivarian

Republic

of Venezuela

Check Appropriate

Box:

4. _\

The agreement

betweenfoe

registrant and the

above-named foreign principal

is

a formal written

contract. f this box

is

checked, attach a

copy

of

foe contract

to

this

exhibit.

5.

•

There is no

formal written contract

between the

registrant

and the

foreign principal.

The

agreement with

the

above-named

foreign

principal has

resulted from an exchange of correspondence. I f this box is checked, , attach a copy of alii pertinent

correspondence, including a copy of any

initial proposal

which

has

been adopted by reference

in

stwh-con«sp<mdeiiq

6.

•

The

agreement

or undeirsfonding between the

registrant

and the

foreign

principal is

the

result

of

neither

aformal written

contract nor an exchange o f correspondence between the parties. f this box is checked,

give

a complete description below

of

the terms

arid

conditions

o f the

oral

agreement or

ifoderstwding, its duration,

the foes and expenses,

i f

any,

to

be received

7. Describe fully the

nature

and

method

of performance of the

above

indicated agreement or understanding.

Registrant will provide

public

relations

strategy

and media relations services to the Embassy ofthe

Bolivarian

Republic of

Venezuela per the

terms

of the

attached contract

Received by NSD/FARA Registration Unit 06/15/2015 9:46:45 A M

FORM

NSD-4

Revised 03/14



Received


Unit

06/15/2015 9:46:45

A M

8. Describe

fully trie-activities

the

registrant

engages

in

or proposes to

engage in

on

behalf

of the above foreign principal.

Registrant

will provide publicrelatiom strategy and

media relations

services to the Embassy

of

the Bolivarian

Republic of

Venezuela per the terms ofthe attached

contract.

9. Wilfthe

activities on behalf

of

foe

above foreign prmcipal'include political

activities

as defined

in Section i(o)

ofthe

Act

and in

foe

footnote

below? Yes • No S

f

yes,

describe

all

such

political

activities indicating, among other things, the

relations,

interests

or policies

to

be influenced

together with the means to be employed to achieve

ins

purpose.

EXECUTION

In

accordance

with

28

U.S.C.

§

1746, the

undersigned

swears

or affirms

under penalty

of

perjury

that

he/she

has

read

the

mformation

set forth n

this Exhibit B to foe

registration

statement and

that he/she

is familiar

with foe

contents

thereof and that

such

contents

are

in

meir entireh/ true

and

accurate

to

the

best of his/her knowledge

and

belief.

Date

of

Exhibit

B

June 12,2015

Name and

Title

Alexander

B. Thomson,

Senior Vice

President

Signature

fs/

Alexander

B. Thomson

eSigned

Footnote:

Political activity, asdefined in Section l(o) of he Act, means any activity which the person engaging in believes will ,or

that

the person intends

o

n any way influenc

any agency or offioial

of he

Government

of the

United States or any section

of

the public

within the

United States with

reference

to

trmoiating, adopting,

or changing the

domestic or oreign policies of ite United States or with referenced country or a foreign political

party.

. . . -

Received by NSD/FARA Registration Unit 06/15/2015 9:46:45 A M



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Documents

Far Av Zla Regis Tro Fitzgibbon