Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 31, 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

Zulkoski Weber LLC

Office Address (Street, Box, or Route)

725 S 14th St

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68508

City

State

Zip

Office Phone

(402) 975-2195

Home Phone

Email Address

nancy@zulkoskiweber.com

PRINCIPAL {49-1480(2)}

Name

Nebraska Emergency Medical Services Association

Office Phone

(402) 719-0105

Office Address (Street, Box, or Route)

PO Box 1858

Official to Whom Lobbyist is Accountable

Debbie Von Seggern

City

Fremont

State

Zip

68026-1858

Nature of Business {49-1480(3)}

Health

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
2,100.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Any and all matters of interest to Principal

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

Names and addresses of principal's officers:

Debbie Von Seggern, President, PO Box 1858, Fremont, NE 68026
Dave Huey, 1st Vice President, PO Box 1858, Fremont, NE 68026
Karolyn McElroy, 2nd Vice President,PO Box 1858, Fremont, NE 68026
Brian Monaghan, Treasurer, PO Box 1858, Fremont, NE 68026
Pam Sybrant, Secretary, PO Box 1858, Fremont, NE 68026

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.

Zulkoski Weber LLC

Lobbyist Name

Dec 31, 2018

Date