Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 16, 2020

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

Blake, Jeremiah

Office Address (Street, Box, or Route)

5400 S 16th Street

Permanent Residence (Street, Box, or Route)

6033 S 78th Street

City

Lincoln

State

Zip

68512

City

Lincoln

State

Zip

68516

Office Phone

(402) 421-0378

Home Phone

(402) 261-8778

Email Address

jeremiah.blake@charter.com

PRINCIPAL {49-1480(2)}

Name

Charter Communications, Inc.

Office Phone

(816) 222-5391

Office Address (Street, Box, or Route)

5400 S. 16th Street

Official to Whom Lobbyist is Accountable

Jarad Falk

City

Lincoln

State

Zip

68512

Nature of Business {49-1480(3)}

Communications

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
1,000.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} telecommunications and business-related issues

Description of industry, trade, profession, or interests and groups represented by the principal:
cable television, broadband and business issues

Names and addresses of principal's officers:

Jarad Falk
Senior Director, Government Affairs
6555 Winchester Ave
Kansas City, MO 64133

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.

Blake, Jeremiah

Lobbyist Name

Dec 16, 2020

Date