Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 21, 2018

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

Blake, Jeremiah

Office Address (Street, Box, or Route)

5400 S 16th Street

Permanent Residence (Street, Box, or Route)

6033 S 78th Street

City

Lincoln

State

Zip

68512

City

Lincoln

State

Zip

68516

Office Phone

(402) 540-9265

Home Phone

(402) 261-8778

Email Address

jeremiah.blake@charter.com

PRINCIPAL {49-1480(2)}

Name

Charter Communications, Inc.

Office Phone

(816) 222-5391

Office Address (Street, Box, or Route)

5400 S. 16th Street

Official to Whom Lobbyist is Accountable

Jarad Falk

City

Lincoln

State

Zip

68512

Nature of Business {49-1480(3)}

Telecommunications

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
1,000.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Telecommunications, taxes, and general business regulations

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

Names and addresses of principal's officers:

Perry Watson, 6550 Winchester Avenue, Kansas City, MO 64133

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.

Blake, Jeremiah

Lobbyist Name

Dec 21, 2018

Date