Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 30, 2019

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

Catalyst Public Affairs

Office Address (Street, Box, or Route)

301 South 13th Street, Suite 402

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68508

City

State

Zip

Office Phone

(402) 261-5293

Home Phone

Email Address

tgay@catalystnebraska.com

PRINCIPAL {49-1480(2)}

Name

Sarpy County Board of Commissioners

Office Phone

(402) 593-4155

Office Address (Street, Box, or Route)

1210 Golden Gate Drive

Official to Whom Lobbyist is Accountable

Dan Hoins

City

Papillion

State

Zip

68046

Nature of Business {49-1480(3)}

Government

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
4,000.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Governmental Issues

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

Names and addresses of principal's officers:

Dan Hoins, 1210 Golden Gate Drive, Papillion NE 68046

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.

Catalyst Public Affairs

Lobbyist Name

Dec 30, 2019

Date