FORM
A
NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST
Feb 7, 2019
Amended Registration
Lobbyist Registration Fee:
{49-1480.01}

(If you are a salaried employee of your principal, you are a compensated lobbyist.)

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

510 East Locust, Suite 200 

 

Des Moines 

IA 

50309 

 

 

 

(515) 494-2455 

 

db648x@att.com 

PRINCIPAL {49-1480(2)}

 

510 E Locust Street, Suite 200 

Cheryl Reilly 

Des Moines 

IA 

50309 

TELECOMMUNICATIONS  

AMOUNTS GIVEN
20.00  Percentage of salary  
IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} all matters affecting telecommunications  
Description of industry, trade, profession, or interests and groups represented by the principal:
 
Names and addresses of principal's officers:

To be supplied

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:

I certify that I am the Lobbyist listed above and that all information presented in this form is accurate to the best of my knowledge.