Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 18, 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

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

Name

Zych, Michelle

Office Address (Street, Box, or Route)

1111 N 13th Street #106

Permanent Residence (Street, Box, or Route)

5702 T Street

City

Omaha

State

Zip

68102

City

Omaha

State

Zip

68117

Office Phone

(402) 827-9280

Home Phone

(402) 905-7819

Email Address

mzych@omahawomensfund.org

PRINCIPAL {49-1480(2)}

Name

Women's Fund of Greater Omaha, Inc.

Office Phone

(402) 827-9280

Office Address (Street, Box, or Route)

1111 N 13th Street #106

Official to Whom Lobbyist is Accountable

Board of Directors

City

Omaha

State

Zip

68102

Nature of Business {49-1480(3)}

MISCELLANEOUS

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 Percentage of salary

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Any issues relating to women and girls

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

Names and addresses of principal's officers:

Cheryl Duryea, President
7602 Pacific Street, Suite 300
Omaha, NE 68117

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)}

Not applicable

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

Zych, Michelle

Lobbyist Name

Dec 18, 2018

Date