Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jul 8, 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

$300.00

(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

Pertzborn, Haley

Office Address (Street, Box, or Route)

6221 S 58th St Suite A

Permanent Residence (Street, Box, or Route)

171 S 90th St Apt 346

City

Lincoln

State

Zip

68516

City

Lincoln

State

Zip

68520

Office Phone

(402) 420-1500

Home Phone

(515) 783-3585

Email Address

haley.pertzborn@npharm.org

PRINCIPAL {49-1480(2)}

Name

Nebraska Pharmacists Association

Office Phone

(402) 420-1500

Office Address (Street, Box, or Route)

6221 South 58th Street, Ste A

Official to Whom Lobbyist is Accountable

City

Lincoln

State

Zip

68516

Nature of Business {49-1480(3)}

Professional Association

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

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Items relevant to pharmacy

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

Names and addresses of principal's officers:

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.

Haley Pertzborn

Lobbyist Name

Jul 8, 2024

Date