Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 27, 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

Dubas, Annette

Office Address (Street, Box, or Route)

54906 N. 180th Ave.

Permanent Residence (Street, Box, or Route)

same

City

Fullerton

State

Zip

68638

City

same

State

Zip

same

Office Phone

(308) 550-0614

Home Phone

(308) 536-2082

Email Address

annette.dubas@nabho.org

PRINCIPAL {49-1480(2)}

Name

Nebraska Association of Behavioral Health Organizations

Office Phone

(308) 550-0614

Office Address (Street, Box, or Route)

P.O. Box 36

Official to Whom Lobbyist is Accountable

NABHO President

City

Fullerton

State

Zip

68638

Nature of Business {49-1480(3)}

HEALTH

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
2,000.00 Other

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Behavioral Health and Substance Use

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.

Annette Dubas

Lobbyist Name

Dec 27, 2022

Date