Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jun 28, 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

Polk, Larianne

Office Address (Street, Box, or Route)

6940 South 110th Street

Permanent Residence (Street, Box, or Route)

City

LaVista

State

Zip

68128

City

State

Zip

Office Phone

(402) 597-5843

Home Phone

Email Address

lpolk@esucc.org

PRINCIPAL {49-1480(2)}

Name

Educational Service Unit Coordinating Council

Office Phone

(402) 597-4915

Office Address (Street, Box, or Route)

6949 So. 110th Street

Official to Whom Lobbyist is Accountable

ESUCC

City

LaVista

State

Zip

68128

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.
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: {49-1480(8)}

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