Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 3, 2023

(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

Wickersham, William R.

Office Address (Street, Box, or Route)

611 Pier 2

Permanent Residence (Street, Box, or Route)

611 Pier 2

City

Lincoln

State

Zip

68528

City

Lincoln

State

Zip

68528

Office Phone

(402) 435-3543

Home Phone

(402) 435-3543

Email Address

bwickersham2@gmail.com

PRINCIPAL {49-1480(2)}

Name

Nebraska Association of Former State Legislators

Office Phone

(402) 429-9002

Office Address (Street, Box, or Route)

9021 Silver Oak Road

Official to Whom Lobbyist is Accountable

Vicki McDonald President

City

Lincoln

State

Zip

68526

Nature of Business {49-1480(3)}

MISCELLANEOUS

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 Per Year

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

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

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)}

None

I certify that all information presented in this form is accurate to the best of my knowledge.

William R. Wickersham

Lobbyist Name

Dec 3, 2023

Date