Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 20, 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

Melotz, Shawn

Office Address (Street, Box, or Route)

10404 N 132nd Street

Permanent Residence (Street, Box, or Route)

10404 N 132nd Street

City

Omaha

State

Zip

68142

City

Omaha

State

Zip

68142

Office Phone

(402) 689-2365

Home Phone

(402) 689-2365

Email Address

shawn@melotzgroup.com

PRINCIPAL {49-1480(2)}

Name

Papio Valley Preservation Association, Inc.

Office Phone

(402) 427-5452

Office Address (Street, Box, or Route)

P.O. Box 200

Official to Whom Lobbyist is Accountable

City

Kennard

State

Zip

68034

Nature of Business {49-1480(3)}

Association

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 Other

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

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

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.

Shawn Melotz

Lobbyist Name

Dec 20, 2023

Date