Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 12, 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

Waggoner, Karin

Office Address (Street, Box, or Route)

1012 Douglas Street #406

Permanent Residence (Street, Box, or Route)

1012 Douglas Street #406

City

Omaha

State

Zip

68102

City

Omaha

State

Zip

68102

Office Phone

Home Phone

Email Address

NebraskansAGO@gmail.com

PRINCIPAL {49-1480(2)}

Name

Nebraskans Against Government Overreach

Office Phone

Office Address (Street, Box, or Route)

1012 Douglas Street #406

Official to Whom Lobbyist is Accountable

City

Omaha

State

Zip

68102

Nature of Business {49-1480(3)}

Education

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

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Property Tax, Education, Religious Freedom, Health Care, Government Accountability

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.

Karin Waggoner

Lobbyist Name

Jan 12, 2024

Date