Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Aug 23, 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

$300.00

(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

Day, Corrie

Office Address (Street, Box, or Route)

211 N. 14th Street

Permanent Residence (Street, Box, or Route)

3315 S. 17th Street

City

Lincoln

State

Zip

68508

City

Lincoln

State

Zip

68502

Office Phone

Home Phone

(952) 388-9121

Email Address

corrieann2010@gmail.com

PRINCIPAL {49-1480(2)}

Name

Nebraska Civic Engagement Table

Office Phone

(402) 202-7955

Office Address (Street, Box, or Route)

211 N 14th Street, Suite 324

Official to Whom Lobbyist is Accountable

Meg Mikolajczyk

City

Lincoln

State

Zip

68508

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.
30.29 Per Hour

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

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

Names and addresses of principal's officers:

Robia Quasimyar
Karen Bell-Dancy
Corrie Kielty
211 N 14th Street, Suite 324

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)}

N/A

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

Corrie Day

Lobbyist Name

Aug 23, 2024

Date