STATE
OF NEVADA
Disclosure
of Representation and Counseling
of
Private Person Before Public Agency
NRS
281A.410(3) requires any legislator or other public officer who has, within the
preceding year, represented or
counseled a private person for compensation before a state agency of the
executive branch, to file with the Commission on Ethics, not
later than January 15 of each year,
a written disclosure providing (a) the name of the client;
I HEREBY DISCLOSE that during calendar year , in the capacity of
I represented or counseled a private person for compensation before a state agency of the executive branch and hereby make a disclosure of such representation pursuant to NRS 281A.410(3).
| Client: | |
| State Agency: | |
| Nature of the Representation: |
| Client: | |
| State Agency: | |
| Nature of the Representation: |
Check here if additional pages attached.
| Date | ___________________________________________ | |
| Print Name | Signature |
Please return completed form by January 15 to:
Nevada
Commission on Ethics
3476 Executive Pointe Way, Suite 10
Carson City, Nevada 89706
Rev. 11/2007