Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 9, 2025

Clerk of the Legislature
Room 2014, State Capitol
PO Box 94604
Lincoln, NE 68509-4604
Phone: (402) 471-2608

For Calendar Year of:

Amended Registration

Lobbyist Registration Fee:
{49-1480.01}

Compensated

$300.00

(If you are a salaried employee of your principal, you are a compensated lobbyist.)

Not Compensated

$15.00

(File a Form E for quarterly report exemption. You are not exempt from the Form D Activity Report.)

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

Name

Mueller Robak

Office Address (Street, Box, or Route)

530 S. 13th Street, Suite 110

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68508

City

State

Zip

Office Phone

(402) 434-3399

Home Phone

Email Address

caitlin@muellerrobak.com

PRINCIPAL {49-1480(2)}

Name

Collective for Youth

Office Phone

(402) 932-2025

Office Address (Street, Box, or Route)

105 North 31st Avenue, Suite 103

Official to Whom Lobbyist is Accountable

Nicole Everingham

City

Omaha

State

Zip

68131

Nature of Business {49-1480(3)}

Nonprofit Organization

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
15,000.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} All matters of interest to principal

Description of industry, trade, profession, or interests and groups represented by the principal:
Nonprofit focused on afterschool and summer programming

Names and addresses of principal's officers:

Tony Veland, Board Chairman, Lincoln, NE 68508
Janice Garnett, Vice Chair, Omaha, NE 68182
Braxton Crowder, Treasurer, Omaha, NE 68102
Jeff Cole, Secretary, Lincoln, NE 68508
Deepak Khazanchi, Omaha, NE 68182
Josh Nichol-Caddy, Omaha, NE 68182
Nayeli Lopez, Omaha, NE 68110
Kristina Kamler, Omaha, NE 68102
Dr. Kandiest Martin-Brock, Omaha, NE 68131
Christine Cutucache, Bellevue, NE 68102

GIVE NAME and ADDRESS of any OFFICIAL in the Legislative or Executive Branch and of any members of any such official's staff or immediate family who is employed by you or by anyone acting on your behalf: {49-1480(8)}

I certify that all information presented in this form is accurate to the best of my knowledge.

Mueller Robak LLC

Lobbyist Name

Jan 9, 2025

Date