Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 28, 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

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

Name

Clark, Mitchell

Office Address (Street, Box, or Route)

301 S 13th St #600

Permanent Residence (Street, Box, or Route)

8252 Ryley Ln

City

Lincoln

State

Zip

68508

City

Lincoln

State

Zip

68512

Office Phone

(402) 261-9671

Home Phone

(402) 416-4031

Email Address

mclark@firstfivenebraska.org

PRINCIPAL {49-1480(2)}

Name

First Five Nebraska

Office Phone

(402) 261-9671

Office Address (Street, Box, or Route)

301 S. 13th Street, Suite 600

Official to Whom Lobbyist is Accountable

Jason Prokop

City

Lincoln

State

Zip

68508

Nature of Business {49-1480(3)}

Public Charity

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
80,000.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Early childhood education

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

Names and addresses of principal's officers:

Mary Jo Pankoke, CEO
Nebraska Children and Families Foundation
215 Centennial Mall South #200
Lincoln, NE 68508

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.

Mitchell Clark

Lobbyist Name

Dec 28, 2022

Date