Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Mar 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

Bromm Nielsen & Mines

Office Address (Street, Box, or Route)

635 S 14th Suite 315

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68508

City

State

Zip

Office Phone

(402) 327-1603

Home Phone

Email Address

jb@bnmlobby.com

PRINCIPAL {49-1480(2)}

Name

Vapor Technology Association

Office Phone

(402) 327-1603

Office Address (Street, Box, or Route)

1201 Pennsylvania Avenue

Official to Whom Lobbyist is Accountable

Brittani Cushman

City

Washington

State

Zip

20004

Nature of Business {49-1480(3)}

Retail

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
5,000.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Taxes relating to tobacco and retail

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

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.

Bromm Nielsen & Mines

Lobbyist Name

Mar 22, 2019

Date