Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Feb 7, 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

Blythe, Dustin

Office Address (Street, Box, or Route)

510 East Locust, Suite 200

Permanent Residence (Street, Box, or Route)

City

Des Moines

State

Zip

50309

City

State

Zip

Office Phone

(515) 494-2455

Home Phone

Email Address

db648x@att.com

PRINCIPAL {49-1480(2)}

Name

AT&T, Inc.

Office Phone

Office Address (Street, Box, or Route)

510 E Locust Street, Suite 200

Official to Whom Lobbyist is Accountable

Cheryl Reilly

City

Des Moines

State

Zip

50309

Nature of Business {49-1480(3)}

TELECOMMUNICATIONS

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
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: {49-1480(8)}

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

Blythe, Dustin

Lobbyist Name

Feb 7, 2019

Date