Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 24, 2024

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

Hettle, Arlo

Office Address (Street, Box, or Route)

211 N 14th St PO Box 83358

Permanent Residence (Street, Box, or Route)

211 N 14th St PO Box 83358

City

Lincoln

State

Zip

68501

City

Lincoln

State

Zip

68501

Office Phone

(402) 202-7955

Home Phone

(319) 529-1787

Email Address

arlo@nebraskatable.org

PRINCIPAL {49-1480(2)}

Name

Nebraska Civic Engagement Table

Office Phone

(402) 202-7955

Office Address (Street, Box, or Route)

PO Box 83358

Official to Whom Lobbyist is Accountable

Robia Qasimyir

City

Lincoln

State

Zip

68501

Nature of Business {49-1480(3)}

Nonprofit

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

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Voting rights, elections

Description of industry, trade, profession, or interests and groups represented by the principal:
Nebraska Table Members

Names and addresses of principal's officers:

Robia Qasimyir - PO Box 83358 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: {49-1480(8)}

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

Arlo Hettle

Lobbyist Name

Jan 24, 2024

Date