Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 24, 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

Bromm Nielsen & Mines

Office Address (Street, Box, or Route)

635 S 14th Suite 315

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68508

City

State

Zip

Office Phone

(402) 327-1603

Home Phone

Email Address

coleen@bnmlobby.com

PRINCIPAL {49-1480(2)}

Name

LegalShield

Office Phone

(580) 310-6801

Office Address (Street, Box, or Route)

One Pre-paid Way

Official to Whom Lobbyist is Accountable

Mark Nelms Assistant General Counsel Reg

City

Ada

State

Zip

74820

Nature of Business {49-1480(3)}

Prepaid legal expense

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)} All matters relating to legal expense

Description of industry, trade, profession, or interests and groups represented by the principal:
Pre-paid legal expense

Names and addresses of principal's officers:

Mark Nelms Assistant General Counsel Regulatory Compliance One Pre-paid Way, Ada, Oklahoma

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.

Bromm Nielsen & Mines

Lobbyist Name

Dec 24, 2018

Date