Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Aug 9, 2022

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

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

Name

Ames, Ann

Office Address (Street, Box, or Route)

8231-B Northwoods Drive

Permanent Residence (Street, Box, or Route)

2128 Lake Street

City

Lincoln

State

Zip

68505

City

Lincoln

State

Zip

68502

Office Phone

(402) 476-2951

Home Phone

(402) 770-0249

Email Address

ann.ames@biginebraska.org

PRINCIPAL {49-1480(2)}

Name

Independent Insurance Agents of Nebraska

Office Phone

(402) 476-2951

Office Address (Street, Box, or Route)

8231 Northwoods Dr Suite B

Official to Whom Lobbyist is Accountable

City

Lincoln

State

Zip

68505

Nature of Business {49-1480(3)}

Insurance Trade Association

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

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Insurance, Insurance Regulations, Insurance Finance

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

Names and addresses of principal's officers:

Vincent Christensen, President - 1303 Jay Street, St. Paul, NE 68873
Zak Morken, Vice-President - 4915 Old Cheney Road, Lincoln, NE 68516
Doug Brummels, Treasurer - 710 W. 66th Street Place, Kearney, NE 68845

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)}

None

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

Ann E Ames

Lobbyist Name

Aug 9, 2022

Date