FORM
A
NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST
Jun 28, 2024
Amended Registration
Lobbyist Registration Fee:
{49-1480.01}

(If you are a salaried employee of your principal, you are a compensated lobbyist.)
(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)}

6940 South 110th Street 

 

LaVista 

NE 

68128 

 

 

 

(402) 597-5843 

 

lpolk@esucc.org 

PRINCIPAL {49-1480(2)}

(402) 597-4915 

6949 So. 110th Street 

ESUCC 

LaVista 

NE 

68128 

Education 

AMOUNTS GIVEN
4,687.50  Per Quarter  
IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Educational Service Unity coordinating Council  
Description of industry, trade, profession, or interests and groups represented by the principal:
Education 
Names and addresses of principal's officers:

6949 South 110th Street, LaVista NE 68128

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:

I certify that all information presented in this form is accurate to the best of my knowledge.

Larianne Polk

Lobbyist Name

Jun 28, 2024

Date