Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 14, 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

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

Name

Gould, John 'Jack'

Office Address (Street, Box, or Route)

1501 Washington Street

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68502

City

State

Zip

Office Phone

(402) 784-6461

Home Phone

Email Address

jhpinecrest@earthlink.net

PRINCIPAL {49-1480(2)}

Name

Common Cause Nebraska

Office Phone

(402) 710-0583

Office Address (Street, Box, or Route)

1501 Washington Street

Official to Whom Lobbyist is Accountable

City

Lincoln

State

Zip

68502

Nature of Business {49-1480(3)}

Public Interest

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 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Campaign Finance, Lobbying Reform, Redistricting, Government Transparency, Ethics, Accountability, Voting Rights

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

Names and addresses of principal's officers:

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.

Gould, John 'Jack'

Lobbyist Name

Jan 14, 2019

Date