Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Nov 29, 2018

(This report is required to be filed on or before December 31 of each calendar year.)
49-1480.01(3)

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

Becker, Jill

Office Address (Street, Box, or Route)

PO Box 83008

Permanent Residence (Street, Box, or Route)

2307 S. 75th Street

City

Lincoln

State

Zip

68501-3008

City

Lincoln

State

Zip

68506

Office Phone

(402) 858-3551

Home Phone

(402) 325-6274

Email Address

jill.becker@blackhillscorp.com

PRINCIPAL {49-1480(2)}

Name

Black Hills Energy

Office Phone

(605) 721-1700

Office Address (Street, Box, or Route)

7001 Mt. Rushmore Road

Official to Whom Lobbyist is Accountable

Jafar Karim

City

Rapid City

State

Zip

57702

Nature of Business {49-1480(3)}

ENERGY

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
5,000.00 Per Quarter

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

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

Names and addresses of principal's officers:

David Emery - 721 9th Street Rapid City, SD 57709
Linn Evans - 721 9th Street Rapid City, SD 57709

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.

Becker, Jill

Lobbyist Name

Nov 29, 2018

Date