Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Feb 21, 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

Chamblee, Shanna

Office Address (Street, Box, or Route)

5075 Titus Rd.

Permanent Residence (Street, Box, or Route)

5075 Titus Rd.

City

Titus

State

Zip

36080

City

Titus

State

Zip

36080

Office Phone

(334) 235-0650

Home Phone

(334) 235-0650

Email Address

schamblee@termlimits.com

PRINCIPAL {49-1480(2)}

Name

U.S. Term Limits

Office Phone

(231) 282-1167

Office Address (Street, Box, or Route)

13001 Founders Square Drive, 2nd floor, Suite 200

Official to Whom Lobbyist is Accountable

Scott Tillman

City

Orlando

State

Zip

32828

Nature of Business {49-1480(3)}

Issue Advocacy

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

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} LR282

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

Names and addresses of principal's officers:

Scott Tillman, National Field Director

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.

Shanna Chamblee

Lobbyist Name

Feb 21, 2024

Date