Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 29, 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

Keigher, Timothy P.

Office Address (Street, Box, or Route)

1320 Lincoln Mall, Suite 10

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68508

City

State

Zip

Office Phone

(402) 474-3810

Home Phone

Email Address

tkeigher@keigherassociates.com

PRINCIPAL {49-1480(2)}

Name

Nebraska Petroleum Marketers & Convenience Store Association

Office Phone

(402) 474-6691

Office Address (Street, Box, or Route)

1320 Lincoln Mall, Suite 10

Official to Whom Lobbyist is Accountable

John Dilsaver

City

Lincoln

State

Zip

68508

Nature of Business {49-1480(3)}

PETROLEUM

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)} Issues related to marketing petroleum and convenience store products in Nebraska

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

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.

TIMKKA

Lobbyist Name

Dec 29, 2023

Date