Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Mar 27, 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

Radcliffe, Walter H. of Radcliffe Gilbertson & Brady

Office Address (Street, Box, or Route)

625 S. 14th Street, Suite 100

Permanent Residence (Street, Box, or Route)

1701 South 33rd

City

Lincoln

State

Zip

68508

City

Lincoln

State

Zip

68506

Office Phone

(402) 476-7272

Home Phone

(402) 488-0609

Email Address

WRadcliffe@RGBLOBBY.com

PRINCIPAL {49-1480(2)}

Name

Coin Laundry Association c/o MultiState Associates LLC

Office Phone

(630) 963-5547

Office Address (Street, Box, or Route)

17w635 Butterfield Road, Suite 145,

Official to Whom Lobbyist is Accountable

Brian Wallace

City

Oakbrook Terrace

State

Zip

60181

Nature of Business {49-1480(3)}

self-service laundry

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
7,500.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} self-service laundry

Description of industry, trade, profession, or interests and groups represented by the principal:
self-service laundry

Names and addresses of principal's officers:

Brian Wallace 17w635 Butterfield Road, Suite 145, Oakbrook Terrace, IL
60181.

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.

Walter H. Radcliffe

Lobbyist Name

Mar 27, 2024

Date