Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Apr 30, 2020

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

Lautenbaugh, Scott

Office Address (Street, Box, or Route)

1905 Harney St. #224

Permanent Residence (Street, Box, or Route)

16407 Taylor St.

City

Omaha

State

Zip

68102

City

Omaha

State

Zip

68116

Office Phone

(402) 702-1022

Home Phone

(402) 689-8718

Email Address

scott@lautenbaugh.com

PRINCIPAL {49-1480(2)}

Name

Nebraska Premium Tobacco

Office Phone

(402) 740-0503

Office Address (Street, Box, or Route)

13110 Birch Drive 108

Official to Whom Lobbyist is Accountable

Jeff Doll

City

Omaha

State

Zip

68164

Nature of Business {49-1480(3)}

romney11

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
15,000.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Cigar related legislation

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

Names and addresses of principal's officers:

Jeff Doll 13110 Birch Dr #108, Omaha NE 68164

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.

Lautenbaugh, Scott

Lobbyist Name

Apr 30, 2020

Date