In the Matter of  the Negotiated Rulemaking                              )
Committee for
Nomination for
[Proposed Negotiated Rulemaking Committee]                )                                    membership
NAC                )          on the committee.
 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 proposed by the State Real Estate Commission.

Name of nominee

Full address of nominee

Nominee's telephone number (including area code)


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

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

         5.              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):

         6.              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 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 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.

Name of Nominating Party    

Full address of nominating party

Telephone Number of nominating party
  (including area code)