Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 14, 2023

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

Severino, Dylan

Office Address (Street, Box, or Route)

134 South 13th Street, #1010

Permanent Residence (Street, Box, or Route)

5019 North 25th Street

City

Lincoln

State

Zip

68508

City

Lincoln

State

Zip

68521

Office Phone

(402) 476-8091

Home Phone

(760) 889-7043

Email Address

dseverino@aclunebraska.org

PRINCIPAL {49-1480(2)}

Name

ACLU Nebraska

Office Phone

(402) 476-8091

Office Address (Street, Box, or Route)

134 S. 13th Street, #1010

Official to Whom Lobbyist is Accountable

Executive Director

City

Lincoln

State

Zip

68508

Nature of Business {49-1480(3)}

Civil rights & constitutional rights

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

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Civil rights & constitutional rights

Description of industry, trade, profession, or interests and groups represented by the principal:
Civil rights & constitutional rights

Names and addresses of principal's officers:

President: Ashlei Spivey, 12037 North 40th Street, Omaha, NE 68112
Treasurer: Michael Beverly Jr., 6611 North 155th Terrace Plaza Apt. 5301, Omaha, NE, 68116
Secretary: Shivani Sharma, 13622 Burt Street, Omaha, NE 68154

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.

Dylan Severino

Lobbyist Name

Dec 14, 2023

Date