FORM
A-R
NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST
Dec 29, 2023

(This report is required to be filed on or before December 31 of each calendar year.)
49-1480.01(3)

Amended Registration
Lobbyist Registration Fee:
{49-1480.01}

(If you are a salaried employee of your principal, you are a compensated lobbyist.)
(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)}

301 S. 13th Street, Suite 400 

 

Lincoln 

NE 

68508 

 

NE 

 

(402) 476-1188 

 

jkohout@kisselkohoutes.com 

PRINCIPAL {49-1480(2)}

(402) 444-6534 

4715 S 132nd St 

Association members 

Omaha 

NE 

68137 

Association of Behavioral Health Regions 

AMOUNTS GIVEN
3,216.66  Per Month  
IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Issues as directed by the client relating to behavioral health  
Description of industry, trade, profession, or interests and groups represented by the principal:
Association 
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:

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

KisselES

Lobbyist Name

Dec 29, 2023

Date