Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 19, 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

Ernst, Dan E.

Office Address (Street, Box, or Route)

455 S. 11th Street, Suite A

Permanent Residence (Street, Box, or Route)

6101 Woodstock Ave

City

Lincoln

State

Zip

68508

City

Lincoln

State

Zip

68512

Office Phone

(402) 476-8055

Home Phone

Email Address

dan@ncsa.org

PRINCIPAL {49-1480(2)}

Name

Nebraska Council of School Administrators

Office Phone

(402) 476-8055

Office Address (Street, Box, or Route)

455 S. 11th Street, Suite A

Official to Whom Lobbyist is Accountable

Dr. Michael Dualney, NCSA Executive Dire

City

Lincoln

State

Zip

68508

Nature of Business {49-1480(3)}

PROFESSIONAL

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
3,641.63 Per Quarter

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} General matters relating to public education and school administration.

Description of industry, trade, profession, or interests and groups represented by the principal:
Professional association for school administrators

Names and addresses of principal's officers:

Dr. Michael Teahon, NCSA Chair
Dr. Michael Dulaney, NCSA Executive Director

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)}

NONE

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

Ernst, Dan E.

Lobbyist Name

Dec 19, 2019

Date