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)

Amended Registration
Lobbyist Registration Fee:
{49-1480.01}

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

1650 Farnam Street 

9639 Oak Circle 

Omaha 

NE 

68102 

Omaha 

NE 

68124 

(402) 346-6000 

(402) 502-5058 

david.karnes@kutakrock.com 

PRINCIPAL {49-1480(2)}

(402) 339-7776 

11248 John Galt Boulevard 

Jake Dawes 

Omaha 

NE 

68137 

Offender Monitoring 

AMOUNTS GIVEN
500.00  Per Year  
IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Matter related to justice system handling of alcohol related offenders  
Description of industry, trade, profession, or interests and groups represented by the principal:
 
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
Jake Dawes, Chief Operating 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
David K. Karnes, Legislative 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:

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