Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Mar 3, 2025

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

Kurtenbach, James M

Office Address (Street, Box, or Route)

1011 N Ankeny Blvd, Suite 1123.

Permanent Residence (Street, Box, or Route)

PO Box 528

City

Ankeny

State

Zip

50021

City

Ames

State

Zip

50201

Office Phone

(515) 291-9814

Home Phone

(515) 291-9814

Email Address

jim.kurtenbach@amfreechamber.com

PRINCIPAL {49-1480(2)}

Name

American Free Enterprise Chamber of Commerce

Office Phone

(515) 291-9814

Office Address (Street, Box, or Route)

1011 N Ankeny Blvd, Suite 1123.

Official to Whom Lobbyist is Accountable

Self

City

Ankeny

State

Zip

50021

Nature of Business {49-1480(3)}

Public Advocacy

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

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

Description of industry, trade, profession, or interests and groups represented by the principal:
Members of AmFree Chamber of Commerce

Names and addresses of principal's officers:

Gentry Collins, CEO & Chairman of the Board
Jim Kurtenbach, Treasurer & Member of the Board
1011 N Ankeny Blvd, Suite 1123, Ankeny, IA 50021

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.

James M Kurtenbach

Lobbyist Name

Mar 3, 2025

Date