Nebraska Legislature - Lobbyist Reporting Application

Clerk of the Legislature

Room 2014 State Capitol

PO Box 94604

Lincoln, NE 68509

(402) 471-2608

NEBRASKA LOBBYIST
And PRINCIPAL
EXEMPTION STATEMENT

NADC FORM E

Submission Date: May 11, 2016

A lobbyist who does not receive lobbying receipts or make lobbying expenditures is exempt from filing quarterly reports upon filing this statement with the Clerk of the Legislature.
A principal who does not receive lobbying receipts or make lobbying expenditures and whose lobbyist does not receive lobbying receipts or make lobbying expenditures is exempt from filing quarterly reports upon filing this statement with the Clerk of the Legislature.
All lobbyists must file a Statement of Activity within 45 days after a Legislative Session even if this statement is on file.
The exemption lapses if lobbying receipts are received or lobbying expenditures made. If the exemption lapses, the obligation to file quarterly reports resumes.

ITEM 1

NATURE OF FILING

For Calendar Year of

2021

ITEM 2

NAME OF LOBBYIST AND PRINCIPAL

LOBBYIST

Lobbyist Name

Melotz, Shawn

Phone

(402) 689-2365

Address

10404 N 132nd Street

City

Omaha

State

Zip

68142

PRINCIPAL

Principal Name

Papio Valley Preservation Association, Inc.

Phone

(402) 427-5452

Address (Street, Box, or Route)

P.O. Box 200

City

Kennard

State

Zip

68034

ITEM 3

NATURE OF EXEMPTION (Check Appropriate Box)

Exemption for Lobbyist and Principal. This is to certify that neither the lobbyist nor the principal as shown herein will receive lobbying receipts or make lobbying expenditures. The undersigned lobbyist and principal therefore claim an exemption to quarterly reports (NADC Forms B and C) until such time as either the lobbyist or the principal receives lobbying receipts or makes lobbying expenditures. The undersigned lobbyist will file a Statement of Activity (NADC Form D) within 45 days after the end of each regular Session of the Legislature and as otherwise required by law.

Exemption for Lobbyist Only. This is to certify that the lobbyist shown herein will not receive lobbying receipts or make lobbying expenditures for the above named principal and therefore claims an exemption to quarterly reporting (NADC Form B) until such time as the lobbyist receives lobbying receipts or makes lobbying expenditures. The above named principal does expect to receive lobbying receipts or make lobbying expenditures and will file quarterly reports (NADC Form C) as required by law. The undersigned lobbyist will file a Statement of Activity (NADC Form D) within 45 days after the end of each regular Session of the Legislature and as otherwise required by law.

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

Melotz, Shawn

Lobbyist Name

May 11, 2016

Date