Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Nov 13, 2023

(This report is required to be filed on or before December 31 of each calendar year.)
49-1480.01(3)

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

Burk, Adelle

Office Address (Street, Box, or Route)

3105 N 93rd Street

Permanent Residence (Street, Box, or Route)

3600 Smith Street

City

Omaha

State

Zip

68134

City

Lincoln

State

Zip

68506

Office Phone

(402) 441-3321

Home Phone

Email Address

aburk@ppncs.org

PRINCIPAL {49-1480(2)}

Name

Planned Parenthood North Central States

Office Phone

(515) 280-7004

Office Address (Street, Box, or Route)

671 Vandalia Street

Official to Whom Lobbyist is Accountable

Andi Curry Grubb

City

St Paul

State

Zip

55114

Nature of Business {49-1480(3)}

501(c)3 nonprofit

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

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Healthcare

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

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: {49-1480(8)}

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

Adelle Burk

Lobbyist Name

Nov 13, 2023

Date