Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 7, 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

Gokie, Mark T.

Office Address (Street, Box, or Route)

501 S. 13th St.

Permanent Residence (Street, Box, or Route)

6510 Sonora Ct.

City

Lincoln

State

Zip

68508

City

Lincoln

State

Zip

68516

Office Phone

(402) 434-8367

Home Phone

(402) 423-0744

Email Address

mgokie@fmne.com

PRINCIPAL {49-1480(2)}

Name

Farmers Mutual of Nebraska

Office Phone

(402) 434-8300

Office Address (Street, Box, or Route)

501 S. 13th St.

Official to Whom Lobbyist is Accountable

Ann L. Parr

City

Lincoln

State

Zip

68501

Nature of Business {49-1480(3)}

INSURANCE

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

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

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

Names and addresses of principal's officers:

Mark T. Walz
Ann L. Parr
P.O. Box 81529
Lincoln, NE 68501

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.

Gokie, Mark T.

Lobbyist Name

Dec 7, 2018

Date