Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 8, 2019

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

Baumfalk, Benjamin

Office Address (Street, Box, or Route)

301 S. 13th Suite #600

Permanent Residence (Street, Box, or Route)

5901 Bridle Ln

City

Lincoln

State

Zip

68508

City

Lincoln

State

Zip

68516

Office Phone

(402) 261-9671

Home Phone

(402) 730-3681

Email Address

bbaumfalk@firstfivenebraska.org

PRINCIPAL {49-1480(2)}

Name

First Five Nebraska

Office Phone

(402) 261-9671

Office Address (Street, Box, or Route)

301 S. 13th Street, Suite 600

Official to Whom Lobbyist is Accountable

Becky Veak

City

Lincoln

State

Zip

68508

Nature of Business {49-1480(3)}

Public Charity

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)} Early Childhood Education

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

Names and addresses of principal's officers:

Mary Jo Pankoke, CEO, Nebraska Children and Families Foundation.
215 Centennial Mall South, Suite #200. Lincoln, NE 68508

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.

Baumfalk, Benjamin

Lobbyist Name

Jan 8, 2019

Date