Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Nov 28, 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

Wagner, Chris

Office Address (Street, Box, or Route)

6001 Dodge Street, CEC 228

Permanent Residence (Street, Box, or Route)

11620 M Circle

City

Omaha

State

Zip

68182-0600

City

OMAHA

State

Zip

68137

Office Phone

(402) 963-9047

Home Phone

(402) 516-5765

Email Address

chris@projectextramile.org

PRINCIPAL {49-1480(2)}

Name

Project Extra Mile

Office Phone

(402) 963-9047

Office Address (Street, Box, or Route)

6001 Dodge Street, CEC 228

Official to Whom Lobbyist is Accountable

City

Omaha

State

Zip

68182-0600

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.
0.00 Percentage of salary

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Public policy issues related to alcohol

Description of industry, trade, profession, or interests and groups represented by the principal:
Public Health Non-Profit

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.

cwagner

Lobbyist Name

Nov 28, 2023

Date