Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 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

Jensen Rogert Associates, Inc.

Office Address (Street, Box, or Route)

625 S. 14th Street, Suite A

Permanent Residence (Street, Box, or Route)

625 S 14th Street, Suite A

City

Lincoln

State

Zip

68508

City

Lincoln

State

Zip

68508

Office Phone

(402) 436-2165

Home Phone

(402) 436-2165

Email Address

kent@jensenrogert.com

PRINCIPAL {49-1480(2)}

Name

Nebraska Intellectual Disabilities Services Providers

Office Phone

(402) 375-2880

Office Address (Street, Box, or Route)

PO Box 330

Official to Whom Lobbyist is Accountable

Alan Zavodny

City

Wayne

State

Zip

68787

Nature of Business {49-1480(3)}

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
12,027.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Matters impacting community services to persons with intellectual disabilities

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

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.

JensenRogertAssocInc

Lobbyist Name

Dec 28, 2023

Date