FORM
A-R
NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST
Dec 30, 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)}

4733 Happy Hollow Ln 

4733 Happy Hollow Ln 

Lincoln 

NE 

68516 

Lincoln 

NE 

68516 

(402) 420-6136 

(402) 420-6136 

Slkingery@gmail.com 

PRINCIPAL {49-1480(2)}

(336) 741-4500 

401 N. Main St. 

Jason Wood 

Winston-Salem 

NC 

27102 

TOBACCO 

AMOUNTS GIVEN
4,266.67  Per Month  
IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Anything pertaining to the tobacco industry  
Description of industry, trade, profession, or interests and groups represented by the principal:
Tobacco 
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.

Shannon L. Kingery

Lobbyist Name

Dec 30, 2023

Date