Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 27, 2020

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 Governmental Relations, LLC

Office Address (Street, Box, or Route)

2804 S 87th Avenue

Permanent Residence (Street, Box, or Route)

City

Omaha

State

Zip

68124

City

State

Zip

Office Phone

(402) 397-1898

Home Phone

Email Address

nikki@kgr-ne.com

PRINCIPAL {49-1480(2)}

Name

Jensen Rogert Associates, Inc.

Office Phone

(402) 436-2165

Office Address (Street, Box, or Route)

625 S. 14th Street, Suite A

Official to Whom Lobbyist is Accountable

Kent Rogert

City

Lincoln

State

Zip

68508

Nature of Business {49-1480(3)}

Lobbying

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
10,000.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} all matters as directed by principal

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

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 Governmental Relations, LLC

Lobbyist Name

Jan 27, 2020

Date