Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 6, 2019

(This report is required to be filed on or before December 31 of each calendar year.)
49-1480.01(3)

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

$200.00

(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

Karnes, David K.

Office Address (Street, Box, or Route)

1650 Farnam Street

Permanent Residence (Street, Box, or Route)

9639 Oak Circle

City

Omaha

State

Zip

68102

City

Omaha

State

Zip

68124

Office Phone

(402) 346-6000

Home Phone

(402) 502-5058

Email Address

david.karnes@kutakrock.com

PRINCIPAL {49-1480(2)}

Name

EHPV Lottery Services LLC aka Big Red Keno

Office Phone

(402) 339-1200

Office Address (Street, Box, or Route)

11248 John Galt Boulevard

Official to Whom Lobbyist is Accountable

Daniel G. Pankow

City

Omaha

State

Zip

68137

Nature of Business {49-1480(3)}

Gambling

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

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Relating to gaming isues

Description of industry, trade, profession, or interests and groups represented by the principal:
Gaming

Names and addresses of principal's officers:

Gregory D. Erwin, Chairman, 11248 John Galt Boulevard, Omaha, NE 68137
Daniel Pankow, President and Chief Executive Officer, 11248 John Galt Boulevard, Omaha, NE 68137
Gary Vander Woude, Chief Financial Officer, 11248 John Galt Boulevard, Omaha, NE 68137
William F. Harvey, General Counsel, 11248 John Galt Boulevard, Omaha, NE 68137

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.

Karnes, David K.

Lobbyist Name

Dec 6, 2019

Date