Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 29, 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

Gullickson, Hans

Office Address (Street, Box, or Route)

510 East Locust Street, Ste 200

Permanent Residence (Street, Box, or Route)

7427 S. Clarkson Circle

City

Des Moines

State

Zip

50309

City

Centennial

State

Zip

80122

Office Phone

(303) 547-5653

Home Phone

(303) 547-5653

Email Address

cookk4@rjrt.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.
36.00 Per Hour

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Tax and regulatory issues

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

Names and addresses of principal's officers:

Jason Wood, 401 N. Main Street, Winston-Salem, NC 27101

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.

Hans Gullickson

Lobbyist Name

Jan 29, 2024

Date