Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 30, 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

Kingery, Shannon L.

Office Address (Street, Box, or Route)

4733 Happy Hollow Ln

Permanent Residence (Street, Box, or Route)

4733 Happy Hollow Ln

City

Lincoln

State

Zip

68516

City

Lincoln

State

Zip

68516

Office Phone

(402) 420-6136

Home Phone

(402) 420-6136

Email Address

Slkingery@gmail.com

PRINCIPAL {49-1480(2)}

Name

RAI Services Co. (Reynolds American Inc.)

Office Phone

(336) 741-4500

Office Address (Street, Box, or Route)

401 N. Main St.

Official to Whom Lobbyist is Accountable

Jason Wood

City

Winston-Salem

State

Zip

27102

Nature of Business {49-1480(3)}

TOBACCO

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
4,266.67 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Anything pertaining to the tobacco industry

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

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.

Shannon L. Kingery

Lobbyist Name

Dec 30, 2023

Date