Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 5, 2024

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

Keener, Chris

Office Address (Street, Box, or Route)

13001 Founders Square Drive, 2nd floor, Suite 200

Permanent Residence (Street, Box, or Route)

11543 E. Agate Lane Apt 21

City

Orlando

State

Zip

32828

City

Wichita

State

Zip

67226

Office Phone

(231) 282-1167

Home Phone

(918) 202-8565

Email Address

ckeener@termlimits.com

PRINCIPAL {49-1480(2)}

Name

U.S. Term Limits

Office Phone

(231) 282-1167

Office Address (Street, Box, or Route)

13001 Founders Square Drive, 2nd floor, Suite 200

Official to Whom Lobbyist is Accountable

Scott Tillman

City

Orlando

State

Zip

32828

Nature of Business {49-1480(3)}

Issue Advocacy

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
2,250.00 Per Month

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

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

Names and addresses of principal's officers:

Scott Tillman 1408 Andrew ST SE, Kentwood, MI 49508

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.

Chris Keener

Lobbyist Name

Jan 5, 2024

Date