Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 22, 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

Goldwater, Barry M.

Office Address (Street, Box, or Route)

3219 East Camelback Road

Permanent Residence (Street, Box, or Route)

3219 East Camelback Road, Suite 552

City

PHOENIX

State

Zip

85018

City

Phoenix

State

Zip

85018

Office Phone

(602) 840-3510

Home Phone

Email Address

bmg@sippapu.com

PRINCIPAL {49-1480(2)}

Name

Nationwide Mutual Insurance Company

Office Phone

(515) 508-3400

Office Address (Street, Box, or Route)

1100 Locust Street, D1-7C-0301

Official to Whom Lobbyist is Accountable

Anne Saxon

City

Des Moines

State

Zip

50391

Nature of Business {49-1480(3)}

Asbestos Transparency, Insurance

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)} Asbestos Transparency

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

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)}

I certify that all information presented in this form is accurate to the best of my knowledge.

Goldwater, Barry M.

Lobbyist Name

Jan 22, 2019

Date