Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 20, 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

Matulka, Mark

Office Address (Street, Box, or Route)

4980 S. 118th Street

Permanent Residence (Street, Box, or Route)

16117 Cottonwood Street

City

Omaha

State

Zip

68137

City

Omaha

State

Zip

68136

Office Phone

(402) 896-3884

Home Phone

Email Address

mark.matulka@mosaicinfo.org

PRINCIPAL {49-1480(2)}

Name

Mosaic

Office Phone

(402) 896-3884

Office Address (Street, Box, or Route)

4980 S. 118th Street

Official to Whom Lobbyist is Accountable

Linda Timmons

City

Omaha

State

Zip

68137

Nature of Business {49-1480(3)}

Disability and health services

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

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Any and all matters relating to disability services.

Description of industry, trade, profession, or interests and groups represented by the principal:
Support services for people with intellectual disabilities.

Names and addresses of principal's officers:

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.

Matulka, Mark

Lobbyist Name

Dec 20, 2019

Date