Received by NSD/FARA Registration Unit 02/10/2018 2:29:38 PM OMB No. 1124-0005; Expires May 31.2020 u.s. Department of justice Washington, dc Short Form Registration Statement Pursuant to the Foreign Agents Registration Act of 1938, as amended 20530 INSTRUCTIONS. Each partner, officer, director, associate, employee, and agent of a registrant is required to file a short form registration statement unless he engages in no activities in furtherance of the interests of the registrant's foreign principal or unless the services he renders to the registrant are in a secretarial, clerical, or in a related or simitar capacity. Compliance is accomplished by filing an electronic short form registration statement at https://www.fara.Bov. Privacy Act Statement. The filing of this document is required for the Foreign Agents Registration Act of 1938, as amended, 22 U.S.C. § 611 et seq., for the purposes of registration under the Act and public disclosure. Provision of the information requested is mandatory, and failure to provide the information is subject to the penalty and enforcement provision; established in Section 8 of the Act. Every registration statement, short form registration statement, supplemental statement, exhibit, amendment, copy of informational materials or other document or information filed with the Attorney General under 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 the Registration Unit's webpage: https://www.fnra.gov. One copy of every such document, other than informational materials, is automatically provided to the Secretary of State pursuant to Section 6(b) of the Act. and copies of any and all documents are routinely made available to other agencies, departments and Congress pursuant to Section 6(c) of the Act. The Attorney General also transmits a semi-annual report to Congress on the administration of the Act which lists the names of all agents registered under the Act and the foreign principals they represent, this report is available to.the public and online at: hnps'^w»y.far(Lgo\.. Public Reporting Burden. Public reporting burden for this collection of information is estimated to average .429 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 this burden estimate or.any other aspect of this collection of information, including suggestions for reducing this burden to Chief, Registration Unit. Counterintelligence and Export Control Section, National Security Division. U.S. Department of Justice. Washington. DC 20530: and to the Office of Information and Regulatory Affairs. Office of Management and Budget. Washington. DC 20503. I. Name Q)So^ 2. Registration No. George Cooper 3. Residence Address(es) 139 Grafton Street Chevy Chase, MD 20815 4. Business Address(es) 777 6th Street NW, 8th Floor Washington, DC 20001 5. Year of Birth 1969 6. If presait citizenship was not acquired by birth, indicate when, and how acquired. Nationality USA Present Citizenship USA 7. Occupation Government Affairs 8. What is th‘c name and address of the primary registrant? Name Forbes Tate Partners LLC 9. Indicate your connection with the primary registrant: E partner □ director Q officer □ associate 777 6th Street NW, 8th Floor Address Washington, DC 20001 □ employee □ consultant □ agent Q subcontractor □ other (specify}. 10. List every foreign principal to whom you will fender services in support of the primary registrant. Embassy of Japan 11. Describe separately and in detail all services which you will render to the foreign principal(s) listed in Item 10 either directly, or through the primary registrant listed in Item 8. and the date(s) of such services. (Ifspace is insufficient, afill insert page must be used.) Provide political analysis and information on policies of interest to the Embassy of Japan. FORM NSD-6 Revised 05'] 7 Received by NSD/FARA Registration Unit 02/10/2018 2:29:38 PM Received by NSD/FARA Registration Unit 02/10/2018 2:29:38 PM 12. Do any of the above described services include political activity as defined in Section 1 (o) of the Act and in the footnote below? Yes 0 No □ If yes, describe separately and in detail such political activity. Meetings with Members of Congress and Congressional staff. 13. The services described in Items 11 and 12 are to be rendered'on a D full time basis D part time basis 13 special basis 14. What compensation or thing of value have you received to date or will you receive for the above services? D Salary: Amount $per________________________ □ Commission at% of 13 Salary: Not based solely on services rendered to the foreign principal(s). D Fee: Amounts____________ □ Other thing of value_____________________ 15. During the period beginning 60 days prior to the date of your obligation to register to the time of filing this statement, did you make any contributions of money or otheT things of value from your own funds or possessions and on your own behalf in connection with any election to political office or in connection with any primary election, convention, or caucus held to select candidates for any political office? Yes 0 No □ If yes, furnish the following information: Date 12/01/2017 Amount or thing of Value $500 (contribution) Political Organization or Candidate Location of Event Kaine for Virginia EXECUTION In accordance with 28 U.S.C. § 1746, the undersigned swears or affirms under penalty of perjury that he/she has read the information set forth in this registration statement and that he/shc is familiar with the corn reot and that contents are in their entirety true and accurate to the best of his/her knowledge and belief (Date signature) (Sig ure) V Footnote; 'Political activity." u defined in Section «o)ofthe Act. means any activity which the person engaging in believes will, or that the person intends to, in any way influence any agency or official of the Government of the United States or any section of the public within the United States with reference to formulating, adopting, or changing the domestic or foreign policies of the United States or with reference to the political or public interests, policies, or relations of a government of a foreign country ora foreign political party. hy NSD/FARA Registration Unit 02/10/2018 2:29:38 PM