Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 30, 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

Jensen Rogert Associates, Inc.

Office Address (Street, Box, or Route)

625 S. 14th Street, Suite A

Permanent Residence (Street, Box, or Route)

625 S 14th Street, Suite A

City

Lincoln

State

Zip

68508

City

Lincoln

State

Zip

68508

Office Phone

(402) 436-2165

Home Phone

(402) 436-2165

Email Address

kent@jensenrogert.com

PRINCIPAL {49-1480(2)}

Name

Blue Gems ABA

Office Phone

(402) 807-7447

Office Address (Street, Box, or Route)

4747 Pioneers Blvd Suite 10B

Official to Whom Lobbyist is Accountable

David Wolf

City

Lincoln

State

Zip

68506

Nature of Business {49-1480(3)}

Applied Behavior Analysis

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
2,000.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Matters pertaining to the licensure of Applied Behavior Analysts in Nebraska

Description of industry, trade, profession, or interests and groups represented by the principal:
Applied Behavior Analysis

Names and addresses of principal's officers:

David Wolf, CEO
311 Blvd of Americas, Ste 304, Lakewood NJ 08701

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)}

None

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

Jensen Rogert Associates, Inc.

Lobbyist Name

Dec 30, 2024

Date