Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 18, 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

Gould, John 'Jack'

Office Address (Street, Box, or Route)

2621 Wimbledon Ct.

Permanent Residence (Street, Box, or Route)

2550 County Road A

City

Lincoln

State

Zip

68506

City

Valparaiso

State

Zip

68065

Office Phone

(402) 784-6461

Home Phone

Email Address

jackgould

PRINCIPAL {49-1480(2)}

Name

Common Cause National

Office Phone

Office Address (Street, Box, or Route)

2621 Wimbledon Ct.

Official to Whom Lobbyist is Accountable

City

Lincoln

State

Zip

68506

Nature of Business {49-1480(3)}

Non-profit Public Interest

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 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Voting rights, campaign finance, government access, redistricting, government accountability

Description of industry, trade, profession, or interests and groups represented by the principal:
Public interest, representing all Nebraskans.

Names and addresses of principal's officers:

Karen Hobart Flynn, President, Martha Tierney, Board Chair, 805 15th Street, NW, Suite 800, Washington, DC 20005

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.

John "Jack" Gould

Lobbyist Name

Dec 18, 2023

Date