Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 15, 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

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 Fuel Retailers

Office Phone

(308) 382-5501

Office Address (Street, Box, or Route)

PO Box 4905

Official to Whom Lobbyist is Accountable

Randy Gard

City

Grand Island

State

Zip

68802-4905

Nature of Business {49-1480(3)}

Fuel Retailers

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
15,000.00 Per Year

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:
Fuel Retailers

Names and addresses of principal's officers:

Randy Gard, PO Box 4905, Grand Island, NE 68802-4905
Dawn Caldwell, PO Box 209, Aurora, NE 68818
Jason Bassett, 1459 Grand Ave, Des Moines, IA 50309

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

Jan 15, 2019

Date