Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 16, 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

Benson, Brandon

Office Address (Street, Box, or Route)

1464 Morena Blvd

Permanent Residence (Street, Box, or Route)

301 Maple St.

City

San Diego

State

Zip

92110

City

Louisville

State

Zip

68037

Office Phone

(540) 441-7227

Home Phone

Email Address

bbenson@cosaction.com

PRINCIPAL {49-1480(2)}

Name

Convention of States Action

Office Phone

(540) 441-7227

Office Address (Street, Box, or Route)

5850 San Felipe, Suite 580A

Official to Whom Lobbyist is Accountable

Mark Meckler

City

Houston

State

Zip

77057

Nature of Business {49-1480(3)}

Political

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
5.00 Percentage of salary

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} All matters related to a Convention of States under Article V of the U.S. Constitution

Description of industry, trade, profession, or interests and groups represented by the principal:
Nonprofit promoting principles of self-governance

Names and addresses of principal's officers:

Mark Meckler, President, 5850 San Felipe, Suite 580A, Houston, TX 77057
Michael Ruthenberg, Executive Vice President, 5850 San Felipe, Suite 580A, Houston, TX 77057
Tim Murphy, CFO, 5850 San Felipe, Suite 580A, Houston, TX 77057

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.

Benson, Brandon

Lobbyist Name

Jan 16, 2019

Date