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

Peetz & Company

Office Address (Street, Box, or Route)

1233 Lincoln Mall, Suite 202

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68508

City

State

Zip

Office Phone

(402) 438-4960

Home Phone

Email Address

cheyen@peetzco.com

PRINCIPAL {49-1480(2)}

Name

Children's Nebraska

Office Phone

(402) 955-4139

Office Address (Street, Box, or Route)

8200 Dodge Street

Official to Whom Lobbyist is Accountable

Chanda Chacon

City

Omaha

State

Zip

68114

Nature of Business {49-1480(3)}

HEALTH

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
12,000.00 Per Quarter

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Any and all matters of importance to Childrens Hospital & Medical Center

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

Names and addresses of principal's officers:

Chanda Chacon - 8200 Dodge Street - Omaha, NE 68114

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.

Peetz & Company

Lobbyist Name

Dec 29, 2023

Date