Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 19, 2022

(This report is required to be filed on or before December 31 of each calendar year.)
49-1480.01(3)

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

Fellers, Ansley

Office Address (Street, Box, or Route)

5935 S 56th St # B

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68516

City

State

Zip

Office Phone

(308) 631-2165

Home Phone

Email Address

afellers@nebgrocery.com

PRINCIPAL {49-1480(2)}

Name

SHAZAM

Office Phone

(515) 288-2828

Office Address (Street, Box, or Route)

6700 Pioneer Parkway

Official to Whom Lobbyist is Accountable

Dan Kramer

City

Johnston

State

Zip

50131

Nature of Business {49-1480(3)}

Banking

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

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Electronic Funds Processing

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

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.

Ansley Fellers

Lobbyist Name

Dec 19, 2022

Date