BEFORE THE STATE REAL ESTATE COMMISSION
STATE OF NEBRASKA

In the Matter of  the Negotiated Rulemaking                              )                                 Nomination for
Committee for
          )                  membership
[Proposed Negotiated Rulemaking Committee]               )                               on the Committee
 
NAC                )     (interest inadequately represented)
 Title Number                         Chapter-Section

        1.        The undersigned person (the nominating party) hereby nominates the following person (the nominee) for 
membership on the above-referenced negotiated rulemaking committee.

                                 
                          
Name of nominee
                                 

                          
Full address of nominee
                                 

                                  
Nominee's telephone number (including area code)

         2

       3.            The nominee is authorized to represent parties related to the interest listed above because:

         4.              The nominee can adequately represent the interest listed above because:
                 

         5.              Reasons that persons already serving on the above-referenced negotiated rulemaking committee do not
adequately represent the interest listed in paragraph 2 above include:
          

         6.              In support of the nomination of the nominee, the nominating party will submit,  within five days from 
submitting this form, the following documents to this  petition (list all documents to be submitted):

       7.               The nominating party believes that the nominee will represent the interest identified above to the best of 
his or her ability and that the nominee is willing to actively negotiate in good faith to reach a consensus on the proposed 
rule to be considered by the above-referenced negotiated rulemaking committee because:

Submission of this Nomination for Membership on the Committee (interest inadequately represented) verifies that all statements and information provided herein are true and correct and may be used as necessary by the Nebraska Real Estate Commission if furtherance of assuring compliance with the laws it regulates.

Dated               
Name of Nominating Party    

Full address of nominating party

Telephone Number of nominating party
  (including area code)