FORM
A
NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST
Jan 3, 2024
Amended Registration
Lobbyist Registration Fee:
{49-1480.01}

(If you are a salaried employee of your principal, you are a compensated lobbyist.)
(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)}

PO Box 83358 

2240 Calvert Street 

Lincoln 

NE 

68501 

Lincoln 

NE 

68502 

(402) 202-7955 

(402) 202-7955 

Mmikolajczyk 

PRINCIPAL {49-1480(2)}

(402) 202-7955 

PO Box 83358 

Board 

Lincoln 

NE 

68501 

nonprofit 

AMOUNTS GIVEN
60.57  Per Hour  
IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} voting rights, democracy  
Description of industry, trade, profession, or interests and groups represented by the principal:
nonprofit 
Names and addresses of principal's officers:

Nebraska Table Board of Directions: 211 N 14th Street, Set 324, Lincoln, NE 68501

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:

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

Megan N Mikolajczyk

Lobbyist Name

Jan 3, 2024

Date