Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Oct 24, 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

Perkins-Wade, Jaden

Office Address (Street, Box, or Route)

4923 S. 24th St., Suite 3A

Permanent Residence (Street, Box, or Route)

3325 Riverview Blvd

City

Omaha

State

Zip

68107

City

Omaha

State

Zip

68108

Office Phone

(402) 933-6095

Home Phone

(402) 510-3490

Email Address

Jaden@heartlandworkerscenter.org

PRINCIPAL {49-1480(2)}

Name

Heartland Workers Center

Office Phone

(402) 933-6095

Office Address (Street, Box, or Route)

4923 S. 24th St., Suite 3A

Official to Whom Lobbyist is Accountable

Lina Traslavina Stover

City

Omaha

State

Zip

68107

Nature of Business {49-1480(3)}

Non-profit

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
3,138.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Workers rights, Immigrant advocacy

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

Names and addresses of principal's officers:

Rev. Ernesto Medina

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.

Jaden Perkins-Wade

Lobbyist Name

Oct 24, 2023

Date