Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 26, 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

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

Name

Mueller Robak

Office Address (Street, Box, or Route)

530 S. 13th Street, Suite 110

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68508

City

State

Zip

Office Phone

(402) 434-3399

Home Phone

Email Address

amber@muellerrobak.com

PRINCIPAL {49-1480(2)}

Name

Nebraska Medical Association

Office Phone

(402) 474-4472

Office Address (Street, Box, or Route)

233 S. 13th Street, Suite 1200

Official to Whom Lobbyist is Accountable

Dale Mahlman

City

Lincoln

State

Zip

68508

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.
50,000.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} All matters of interest to the Nebraska Medical Association

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

Names and addresses of principal's officers:

PRESIDENT: RICHARD BLATNY, 827 6TH ST, FAIRBURY, NE 68352
SECRETARY AND TREASURER: TODD A PANKRATZ, MD, 2115 N. KANSAS AVENUE, SUITE 204, HASTINGS, NE 68901

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.

Mueller Robak

Lobbyist Name

Dec 26, 2019

Date