Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Mar 11, 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

Mueller Robak

Office Address (Street, Box, or Route)

530 S. 13th Street, Suite 110

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68508

City

State

Zip

Office Phone

(402) 434-3399

Home Phone

Email Address

amber@muellerrobak.com

PRINCIPAL {49-1480(2)}

Name

Circle City ABA

Office Phone

(317) 502-3512

Office Address (Street, Box, or Route)

550 Congressional Blvd, Ste 115 PMB 1051

Official to Whom Lobbyist is Accountable

William Cochrane

City

Carmel

State

Zip

46032

Nature of Business {49-1480(3)}

Healthcase

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
20,000.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} All matters of interest to principal

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

Names and addresses of principal's officers:

William Cochrane, Chief Strategy Officer

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.

Mueller Robak LLC

Lobbyist Name

Mar 11, 2024

Date