Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 23, 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

Kelley Plucker, LLC

Office Address (Street, Box, or Route)

2804 S 87th Avenue

Permanent Residence (Street, Box, or Route)

2804 S 87th Avenue

City

Omaha

State

Zip

68124

City

Omaha

State

Zip

68124

Office Phone

(402) 397-1898

Home Phone

Email Address

nikki@kelleyplucker.com

PRINCIPAL {49-1480(2)}

Name

Eastern Nebraska Human Services Agency

Office Phone

(402) 444-6500

Office Address (Street, Box, or Route)

4715 S 132nd Street

Official to Whom Lobbyist is Accountable

ENSHA Governing Board

City

Omaha

State

Zip

68137

Nature of Business {49-1480(3)}

HEALTH

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
2,000.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Description of industry, trade, profession or interests and groups represented by the principal

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

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.

Kelley Plucker, LLC

Lobbyist Name

Dec 23, 2019

Date