Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 15, 2023

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

Mortensen, Wayne

Office Address (Street, Box, or Route)

2530 Q Street

Permanent Residence (Street, Box, or Route)

2418 Calumet Court

City

Lincoln

State

Zip

68503

City

Lincoln

State

Zip

68502

Office Phone

(402) 477-7181, Ext. 202

Home Phone

(402) 541-9040

Email Address

Wayne.Mortensen@NWLincoln.org

PRINCIPAL {49-1480(2)}

Name

Neighborhoods, Inc. (dba NeighborWorks Lincoln)

Office Phone

(402) 477-7181

Office Address (Street, Box, or Route)

2530 Q Street

Official to Whom Lobbyist is Accountable

Adelle Burk, President

City

Lincoln

State

Zip

68503

Nature of Business {49-1480(3)}

Housing Developer

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
13,800.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Housing Policy and Appropriations, Community Development, Regional Planning

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

Names and addresses of principal's officers:

Adelle Burk, President, 3600 Smith St, Lincoln
Kay Walter, Vice President, 605 N 26th St, Lincoln
Thomas Klein, Treasurer, 1314 O St #404, Lincoln
Lindsay Limbach, Secretary, 3234 C St, Lincoln

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.

Wayne Mortensen

Lobbyist Name

Dec 15, 2023

Date