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Health PAC
Name (print) Office (if applicable) District (if applicable)
5250 Neil Road, Ste.302, Reno, NV, 89502 7758270184
Mailing Address (include city and zip code) Telephone No.
aimee@nvha.net
E-Mail Address

 Select Appropriate Box(es)
CANDIDATE PAC POL PRTY IND EXP NONPROFIT CORP
LEGAL DEFENSE FUND AMENDED LOCAL BAG
Annual Filing - Due January 15, 2010
Period: Jan 01, 2009 - Dec 31, 2009
Report #1 - Due June 01, 2010*
Period: Jan 01, 2010 - May 27, 2010
Report #2 - Due October 26, 2010*
Period: May 28, 2010 - Oct 21, 2010
Report #3 - Due January 15, 2011*/**
Period: Oct 22, 2010 - Dec 31, 2010
Annual Filing - Due January 15, 2011
Period: Jan 01, 2010 - Dec 31, 2010
FILE
Oct 26 2010
 
ROSS MILLER
SECRETARY OF STATE
FOR OFFICE USE ONLY
      * These Reports are filed by incumbents/candidates in the 2010 election cycle
      ** Third Report suffices for 2011 Annual Filing if candidate also filed Report Nos. 1 and 2
1. Total Monetary Contributions Received in Excess of $100
    (See page 1 of instruction sheet)
$ 35,538.00   $ 44,030.00
2. Total Monetary Contributions in the form of loans guaranteed by a third
    party.  (See page 1 of instruction sheet)
$ 0.00   $0.00
3. Total Monetary Contributions in the form of loans that were forgiven
    (See page 2 of instruction sheet)
$ 0.00   $0.00
4. Total Amount of Monetary Contributions Received
    (Add Lines 1 through 3)  (See page 2 of instruction sheet)
$ 35,538.00   $44,030.00
5. Total Amount of Written Commitments for Contributions
    (When commitment is funded, report as contribution (monetary or in kind))
    (See page 2 of instruction sheet)

$ 0.00   $0.00
6. Total Value of In Kind Contributions Received in
    Excess of $100   (See page 2 of instruction sheet)
$ 0.00   $0.00
 
7. Total Monetary Expenses Paid in Excess of $100
    (See page 2 of instruction sheet)
$ 51,363.06   $53,863.06
8. Total Value of In Kind Expenses in Excess
    of $100  (See page 2 of instruction sheet)
$ 0.00   $0.00
 
I Declare Under Penalty of Perjury That the Foregoing is True and Correct.

Aimee Edwards 10/26/2010
Signature Date
 

 CAMPAIGN CONTRIBUTIONS Report Period   # 2
Health PAC
Name (print) Office (if applicable) District (if applicable)

Contributions in Excess of $100 or, When Added Together from One Contributor Exceeds $100
Transfer Total Amount of All Campaign Contributions to Line 1 of Contributions Summary


 CONTRIBUTOR'S NAME AND
ADDRESS
 DATE OF EACH
CONTRIBUTION
 AMOUNT OF EACH
CONTRIBUTION
 CHECK
HERE
IF LOAN
 NAME AND
ADDRESS OF
3rd PARTY IF
LOAN
GUARANTEED
BY 3rd PARTY
 NAME AND ADDRESS
OF PERSON WHO
FORGAVE THE LOAN,
IF DIFFERENT THAN
CONTRIBUTOR
Murad Jussa
10301 Jeffreys Street
Henderson, NV 89052
06/01/2010$125.00   
Philip Landis
75 Pringle Way
Suite 601
Reno, NV 89502
06/01/2010$125.00   
Charles Scully
1155 Mill Street
Reno, NV 89502
06/01/2010$350.00   
Cora Case
1155 Mill Street
Reno, NV 89502
06/01/2010$100.00   
Kim Tulman
1155 Mill Street
Reno, NV 89502
06/02/2010$125.00   
Max Jackson
1155 Mill Street
Reno, NV 89502
06/07/2010$350.00   
Reed Howe
8280 West Warm Springs Road
Las Vegas, NV 89113
06/07/2010$125.00   
Harvey Fennell
1155 Mill Street
Reno, NV 89502
06/08/2010$250.00   
David Milovixh
235 West Sixth Street
Reno, NV 895026
06/09/2010$125.00   
John Deakyne
235 West Sixth Street
Reno, NV 89503
06/09/2010$250.00   
Gary Aldax
235 West Sixth Street
Reno, NV 89502
06/09/2010$125.00   
Cretan Meadows
235 West Sixth Street
Reno, NV 89503
06/09/2010$250.00   
Teressa Conley
3001 St. Rose Pkwy.
Henderson, NV 89052
06/09/2010$125.00   
Joel Muller
1155 Mill Street
Reno, NV 89502
06/10/2010$250.00   
John Cassani
1155 Mill Street
Reno, NV 89502
06/10/2010$125.00   
David Line
1155 Mill Street
Reno, NV 89502
06/11/2010$125.00   
Daniel Ferguson
235 West Sixth Street
Reno, NV 89502
06/14/2010$125.00   
Susan Loving
10301 Jeffreys Street
Henderson, NV 89052
06/14/2010$100.00   
Bill Newberg
1155 Mill Street
Reno, NV 89502
06/15/2010$250.00   
Robert Farrar
1155 Mill Street
Reno, NV 89502
06/15/2010$150.00   
Allan Hanssen
1155 Mill Street
Reno, NV 89502
06/15/2010$500.00   
Michael Uboldi
235 West Sixth Street
Reno, NV 89502
06/15/2010$500.00   
Darryl Dubroca
7000 West Spring Mountain Road
Las Vegas, NV 89117
06/15/2010$544.00   
Rod Davis
3001 St. Rose Parkway
Henderson, NV 89052
06/21/2010$500.00   
Ourida Diktkis
3001 St. Rose Pkwy.
Henderson, NV 89052
06/21/2010$125.00   
Ryan Moon
5400 S. Rainbow Blvd.
Las Vegas, NV 89118
06/24/2010$150.00   
Michelle Sanchez-Bickley
1155 Mill Street
Reno, NV 89502
06/24/2010$250.00   
Bertha Mullins
1155 Mill Street
Reno, NV 89502
06/24/2010$125.00   
Greg Boyer
1155 Mill Street
Reno, NV 89502
06/24/2010$500.00   
Kris Gaw
1155 Mill Street
Reno, NV 89502
06/24/2010$500.00   
Don Kowitz
235 West Sixth Street
Reno, NV 89503
06/29/2010$125.00   
James Parrish
118 East Haskell Street
Winnemucca, NV 89445
07/01/2010$500.00   
Frey Belete
901 Adams Blvd.
Boulder City, NV 89005
07/02/2010$100.00   
Leslie Smith
1155 Mill Street
Reno, NV 89502
07/12/2010$350.00   
Kirk Gillis
1155 Mill Street
Reno, NV 89502
07/12/2010$350.00   
Bob Bollard
10301 Jeffreys Street
Henderson, NV 89052
07/12/2010$125.00   
Vern Burk
901 Adams Blvd.
Boulder City, NV 89005
07/14/2010$200.00   
Carole Fisher
4141 South Swenson Street
Las Vegas, NV 89119
07/16/2010$250.00   
Mark Stoddard
48 West 1500 North
Nephi, UT 84648
07/16/2010$500.00   
Sylvia Young
3186 S. Maryland Pkwy.
Las Vegas, NV 89109
07/16/2010$4,938.66   
Wiill Wagnon
3100 North Tenaya Way
Las Vegas, NV 89128
07/16/2010$1,848.67   
Kimball Anderson
9300 West Sunset Road
Las Vegas, NV 89148
07/16/2010$1,212.67   
Charles Bibby
360 South Lola Lane
Pahrump, NV 89048
07/19/2010$125.00   
Lawson Fox
4925 Energy Way
Reno, NV 89502
07/20/2010$125.00   
Stacy Kendall
1155 Mill Street
Reno, NV 89502
07/20/2010$125.00   
Andy Pearl
1155 Mill Street
Reno, NV 89502
07/20/2010$250.00   
Phyllis Freyer
1155 Mill Street
Reno, NV 89502
07/20/2010$250.00   
Mark Stoddard
360 S. Lola Lane
Pahrump, NV 89048
07/20/2010$125.00   
Deborah Stout
620 Shadow Lane
Las Vegas, NV 89106
07/22/2010$250.00   
Betsy Sponsler
620 Shadow Lane
Las Vegas, NV 89106
07/27/2010$100.00   
Norman Deputy
P.O. Box 11335
Reno, NV 89510
07/28/2010$125.00   
Kathy Ancho
535 South Humboldt Street
Battle Mountain, NV 89820
07/30/2010$125.00   
Michael Gaughan
4500 W. Tropicana Avenue
Las Vegas, NV 89103
07/30/2010$1,000.00   
Robert David
1215 K Street
Suite 1900
Sacramento, CA 95814
08/02/2010$125.00   
Kathy Calhoun
824 Robinson Lane
Boulder City, NV 89005
08/03/2010$150.00   
Chris Bosse
1155 Mill Street
Reno, NV 89502
08/03/2010$500.00   
Marjorie Knight
3001 St. Rose Pkwy.
Henderson, NV 89052
08/03/2010$100.00   
Angelique Davison
5400 S. Rainbow Blvd.
Las Vegas, NV 89118
08/03/2010$100.00   
Leonard Freehof
5400 S. Rainbow Blvd.
Las Vegas, NV 89118
08/03/2010$365.00   
Margaret Covelli
5400 S. Rainbow Blvd.
Las Vegas, NV 89118
08/03/2010$125.00   
William Van Houweling
5400 S. Rainbow Blvd.
Las Vegas, NV 89118
08/03/2010$100.00   
Leanne Shields
5400 S. Rainbow Blvd.
Las Vegas, NV 89118
08/03/2010$100.00   
Robin Keith
4600 Kietzke Lane
Suite I-209
Reno, NV 89502
08/04/2010$500.00   
Jim Serratt
690 Edison Way
Reno, NV 89502
08/06/2010$650.00   
Susan Adamek
P.O. Box 778206
Henderson, NV 89077
08/09/2010$500.00   
Wendell Whitman
901 Adams Blvd.
Boulder City, NV 89005
08/09/2010$150.00   
Rick Kilburn
1409 East Lake Mead Blvd.
North Las Vegas, NV 89301
08/09/2010$125.00   
Tom Maher
901 Adams Blvd.
Boulder City, NV 89005
08/10/2010$250.00   
Val Baciarelli
102 East Lake Mead Pkwy.
Henderson, NV 89015
08/12/2010$300.00   
Dorothy Shepherd
102 East Lake Mead Pkwy.
Henderson, NV 89015
08/13/2010$250.00   
Marjorie Knight
102 E. Lake Mead Pkwy.
Henderson, NV 89015
08/13/2010$100.00   
Susan Davila
360 South Lola Lane
Pahrump, NV 89048
08/13/2010$375.00   
Jim Breslin
1155 Mill Street
Reno, NV 89502
08/19/2010$250.00   
Susan Adamek
3001 St. Rose Pkwy
Henderson, NV 89052
08/19/2010$250.00   
James Oscarson
360 S. Lola Lane
Pahrump, NV 89048
08/20/2010$125.00   
Bill Welch
5250 Neil Road
Suite 302
Reno, NV 89502
08/23/2010
09/28/2010
$500.00
$221.00
   
Marjorie Knight
8280 W. Warm Springs Road
Las Vegas, NV 89113
08/23/2010$100.00   
Connie Clemmons-Brown
8280 W. Warm Springs Road
Las Vegas, NV 89113
08/23/2010$250.00   
Laurie Krueger
5250 Neil Road
Suite 302
Reno, NV 89502
08/24/2010$125.00   
Marissa Brown
5250 Neil Road
Suite 302
Reno, NV 89502
08/25/2010$125.00   
Mary Walker
1600 Medical Parkway
Carson City, NV 89703
08/25/2010$350.00   
Kenneth Bowman
10301 Jeffreys Street
Henderson, NV 89052
08/25/2010$100.00   
Jason Bleak
Highway 93 North
Caliente, NV 89008
08/25/2010$500.00   
Kevin Walters
3001 St. Rose Pkwy
Henderson, NV 89052
08/25/2010$125.00   
Ron Lurie
620 Shadow Lane
Las Vegas, NV 89106
08/25/2010$125.00   
Robert Orgill
620 Shadow Lane
Las Vegas, NV 89106
08/25/2010$125.00   
Andy North
3001 St. Rose Pkwy.
Henderson, NV 89014
08/26/2010$125.00   
Linda Faiss
901 Adams Blvd.
Boulder City, NV 89005
08/27/2010$150.00   
Kirk Lambert
901 Adams Blvd.
Boulder City, NV 89005
08/27/2010$160.00   
Jim Devolld
1155 Mill Street
RENO, NV 89502
08/27/2010$200.00   
Roy Robbins
1155 Mill Street
Reno, NV 89502
08/27/2010$125.00   
Gail Green
1155 Mill Street
Reno, NV 89502
08/27/2010$250.00   
Sharon Fiola
1155 Mill Street
Reno, NV 89502
08/27/2010$250.00   
Leo Seevers
1155 Mill Street
Reno, NV 89502
08/27/2010$125.00   
Gayle Hurd
1155 Mill Street
Reno, NV 89502
08/27/2010$100.00   
Sam King
1155 Mill Street
Reno, NV 89502
08/27/2010$250.00   
Joan Lapham
1155 Mill Street
Reno, NV 89502
08/27/2010$250.00   
Ellen Kelly
1155 Mill Street
Reno, NV 89502
08/27/2010$100.00   
Janette Townsend
1155 Mill Street
Reno, NV 89502
08/27/2010$250.00   
Stephen Bajo
1155 Mill Street
Reno, NV 89502
08/27/2010$500.00   
Lawrence Trilops
1155 Mill Street
Reno, NV 89502
08/27/2010$500.00   
David Schweer
1155 Mill Street
Reno, NV 89502
08/27/2010$125.00   
Helen Lidholm
235 West Sixth Street
Reno, NV 89502
08/30/2010$130.00   
Judith Brady
235 West Sixth Street
Reno, NV 89503
08/30/2010$100.00   
Kevin Stockton
620 Shadow Lane
Las Vegas, NV 89106
09/01/2010$842.00   
Dwight Hansen
5250 Neil Road
Suite 302
Reno, NV 89502
09/01/2010$125.00   
Smith Realty Finance
7655 Town Square Way
Suite 220
Reno, NV 89523
09/01/2010$125.00   
Doug Geinzer
P.O. Box 80808
Las Vegas, NV 89180
09/01/2010$125.00   
Debra Balido
901 Adams Blvd
Boulder City, NV 89005
09/03/2010$100.00   
Craig Bailey
901 Adams Blvd.
Boulder City, NV 89005
09/03/2010$200.00   
Dianna Todd
901 Adams Blvd
Boulder City, NV 89005
09/03/2010$100.00   
Timothy Deaton
2500 North Tenaya Way
Las Vegas, NV 89128
09/09/2010$125.00   
Misty Grimmer
1409 East Lake Mead
North Las Vegas, NV 89030
09/10/2010$250.00   
Joan Hall
P.O. Box 940
213 South Whitacre
Yerington, NV 89447
09/14/2010$300.00   
Jim Miller
1155 Mill Street
Reno, NV 89502
09/18/2010$225.00   
Eva LaBarge
5250 Neil Road
Suite 302
Reno, NV 89502
09/24/2010
09/24/2010
$721.00
$130.00
   

This page may be copied or duplicated if additional space is needed.

 

 WRITTEN COMMITMENTS Report Period   # 2
Health PAC
Name (print) Office (if applicable) District (if applicable)

Written Commitments in Excess of $100 or, When Added Together from One Entity Exceeds $100
Transfer Total Amount of All Written Commitments to Line 5 of Contributions Summary


 NAME AND ADDRESS OF PERSON WHO
MADE THE COMMITMENT
 DATE OF EACH
COMMITMENT
 AMOUNT OF EACH
COMMITMENT
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   

This page may be copied or duplicated if additional space is needed.

 

 CAMPAIGN EXPENSES Report Period   # 2
Health PAC
Name (print) Office (if applicable) District (if applicable)

Expense Categories

 CATEGORIES  CODE
 Office expenses A
 Expenses related to volunteers B
 Expenses related to travel C
 Expenses related to advertising D
 Expenses related to paid staff E
 Expenses related to consultants F
 Expenses related to polling G
 Expenses related to special events H
 ** Goods and services provided in kind for which money would otherwise
   have been paid
I
 Other miscellaneous expenses J










** NRS 294A.362 requires “In Kind” contributions and expenses to be reported on a separate form, which is attached.
 

 CAMPAIGN EXPENSES Report Period   # 2
Health PAC
Name (print) Office (if applicable) District (if applicable)

Expenses in Excess of $100
Transfer Total Amount of All Campaign Expenses to Line 7 of Expenses Summary


 NAME AND ADDRESS OF
 PERSON, GROUP OR
 ORGANIZATION WHO RECEIVED
 THE PAYMENT FOR THE
 EXPENSE(S)
CATEGORY
(See Previous Page)

NRS 294A.365
DATE OF EACH
EXPENSE
AMOUNT OF
EACH EXPENSE
Sierra Discount Printing
848 Tanager St. #C
Incline Village, NV 89451
J06/25/2010$378.11
Brian Sandoval
PO Box 370297
Las Vegas, NV 89137
J08/16/2010$2,500.00
Rory Reid
P.O. Box 31210
Las Vegas, NV 89173
J08/16/2010$2,500.00
Steven Horsford
1306 West Craig Road,
North Las Vegas, NV 89032
J08/16/2010$2,500.00
Joyce Woodhouse
1000 N. Green Valley Ranch Parkway
Suite 440 Box #334
Henderson, NV 89074
J
J
08/16/2010
09/16/2010
$1,000.00
$500.00
Barbara Cegavske
6465 Laredo Street
Las Vegas, NV 89146
J08/16/2010$1,000.00
Joe Hardy
883 Nevada Way, Ste 3-B
Boulder City, NV 89006
J
J
08/16/2010
09/16/2010
$1,000.00
$1,500.00
Shelia Leslie
825 Humboldt Street
Reno, NV 89509
J08/16/2010$1,000.00
James Settelmeyer
770 Hwy 395
Gardnerville, NV 89410
J08/16/2010$1,000.00
Don Gustavson
P. O. Box 51601
Sparks, NV 89435
J08/16/2010$1,000.00
Ben Kieckhefer
10045 Goler Wash Court
Reno, NV 89521
J08/16/2010$1,000.00
Marilyn Kirkpatrick
4747 Showdown Drive
North Las Vegas, NV 89031
J08/16/2010$1,000.00
John Hambrick
11216 Dell Cliffs Ct.
Las Vegas, NV 89144
J08/16/2010$1,000.00
Ellen Spiegel
1953 Kachina Mountain Dr.
Henderson, NV 89011
J08/16/2010$1,000.00
Marilyn Dondero-Loop
3724 Emerald Bay cir
Las Vegas, NV 89147
J08/16/2010$1,000.00
Harvey Munford
809 Sunny Place
Las Vegas, NV 89106
J08/16/2010$1,000.00
John Oceguera
7655 Chaumont St
Las Vegas, NV 89123
J
J
08/16/2010
10/06/2010
$2,500.00
$1,000.00
KELVIN ATKINSON
5631 INDIAN SPRINGS STREET
NORTH LAS VEGAS, NV 89031
J08/16/2010$1,000.00
Lynn Stewart
2720 Cool Lilac Avenue
Henderson, NV 89052
J08/16/2010$1,000.00
Melissa Woodbury
2654 West Horizon Ridge Parkway
Ste B5-280
Henderson, NV 89052
J08/16/2010$1,000.00
Marcus Conklin
1600 Palmae
Las Vegas, NV 89128
J08/16/2010$1,500.00
Debbie Smith
3270 Wilma Drive
Sparks, NV 89431
J08/16/2010$1,500.00
Jodi Stephens
PO Box 51315
Sparks, NV 89435
J08/16/2010$1,000.00
John Ellison
P.O. Box 683
Elko, NV 89803
J08/16/2010$1,000.00
Pete Goicoechea
P.O. Box 97
Eureka, NV 89316
J08/16/2010$1,500.00
Tom Grady
6707 Paljay Ct.
Las Vegas, NV 89103
J08/16/2010$1,000.00
Pete Livermore
4 Raglan Circle
Carson City, NV 89701
J08/16/2010$1,000.00
Michael Roberson
P.O. Box 97251
Las Vegas, NV 89193
J08/16/2010$500.00
April Mastroluca
265 Copper Glow Court
Henderson, NV 89074
J08/16/2010$500.00
Phil Salerno
639 Pyramid Way
Sparks, NV 89431
J08/16/2010$500.00
David Bobzien
1605 Wesley Dr
Reno, NV 89503
J08/16/2010$500.00
Pat Hickey
625 Rosewood Drive
Reno, NV 89509
J08/16/2010$500.00
A Bud and Beyond
P.O. Box 6546
Incline Village, NV 89450
H09/03/2010$484.95
Randy Kirner
PO Box 17388
Reno, NV 89511
J09/16/2010$500.00
Gary Fisher
8321 Spinnaker Cove Drive
Las Vegas, NV 89128
J09/16/2010$500.00
Mo Denis
3204 Osage Ave
Las Vegas, NV 89101
J09/16/2010$1,000.00
Richard McArthur
4640 Panoramic Court
Las Vegas, NV 89129
J09/16/2010$500.00
Benny Yerushalmi
10620 So Highlands Pky #110-485
Las Vegas, NV 89141
J09/16/2010$1,000.00
Nevada Senate Republican Caucus
6655 S. Tenaya Way
Suite 120
Las Vegas, NV 89113
J10/06/2010$2,000.00
Nevada Senate Democratic Caucus
1210 S. Valley View Road
Suite 114
Las Vegas, NV 89102
J10/06/2010$2,000.00
Nevada Assembly Democratic Caucus
2251 North Rampart Blvd., #341
Las Vegas, NV 89128
J10/06/2010$2,000.00
Nevada Assembly Republican Caucus
6655 S. Tenaya Way
Suite 120
Las Vegas, NV 89113
J10/06/2010$2,000.00
 
This page may be copied or duplicated if additional space is needed.

 


 IN KIND CONTRIBUTIONS AND EXPENSES REPORT




IN KIND CONTRIBUTION IS DEFINED AS THE VALUE OF SERVICES PROVIDED IN KIND FOR WHICH MONEY WOULD HAVE OTHERWISE BEEN PAID.
In kind contributions and expenses include: paid polling and resulting data, paid direct mail, paid solicitation by telephone, any paid paraphernalia that was printed or otherwise produced to promote a campaign and the use of paid personnel to assist in a campaign. An in kind contribution may also include, but is not limited to: goods and services such as billboards, office space, printing, food and beverage and yard signs.

The donor of in kind contributions shall furnish to the recipient (candidate or other person), a written statement setting forth the actual cost of those services or the fair market value within 30 days after the time he furnishes those services. (NAC 294A.043)

Examples of in kind contributions: (1) A person contributes billboard space and does not charge the candidate. The candidate would report the fair market value or actual cost of the billboard space as an in kind contribution; (2) A person pays for the printing cost of political signs for a candidate. The candidate would report the actual cost or fair market value of printing the signs as an in kind contribution.

Example of in kind expenses: (1) A person contributes the use of a large room to a candidate as an in kind contribution. Once the candidate utilizes the room it becomes an in kind expense to be reported.
 

 IN KIND CAMPAIGN
CONTRIBUTIONS
Report Period   # 2
Health PAC
Name (print) Office (if applicable) District (if applicable)

IN KIND

Contributions in Excess of $100 or, When Added Together from One Contributor Exceeds $100
Transfer Total Value of All In-Kind Campaign Contributions to Line 6 of Contributions Summary


 CONTRIBUTOR'S
NAME AND
ADDRESS
 DATE OF
EACH
IN KIND
CONTRI-
BUTION
 DESCRIPTION OF
EACH
IN KIND
CONTRIBUTION
 VALUE OR COST
OF EACH
IN KIND
CONTRIBUTION/
COMMITMENT
 CHECK
HERE
IF
LOAN
 NAME AND
ADDRESS OF 3rd
PARTY IF LOAN
GUARANTEED
BY 3rd PARTY
 NAME AND
ADDRESS OF
PERSON WHO
FORGAVE THE
LOAN
       
       
       
       
       
       
       
       
       
       
       
       
       





This page may be copied or duplicated if additional space is needed.

 

 IN KIND
WRITTEN COMMITMENTS
Report Period   # 2
Health PAC
Name (print) Office (if applicable) District (if applicable)

In Kind Written Commitments in Excess of $100 or, When Added Together from One Entity Exceeds $100
Transfer Total Amount of All Written Commitments to Line 5 of Contributions Summary


 NAME AND ADDRESS OF PERSON WHO
MADE THE IN KIND COMMITMENT
 DATE OF EACH
IN KIND
COMMITMENT
 AMOUNT OF EACH
IN KIND
COMMITMENT
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   

This page may be copied or duplicated if additional space is needed.

 

 IN KIND CAMPAIGN
EXPENSES
Report Period   # 2
Health PAC
Name (print) Office (if applicable) District (if applicable)

IN KIND

Expenses in Excess of $100
Transfer Total Value of All In-Kind Campaign Expenses to Line 8 of Expenses Summary



This page may be copied or duplicated if additional space is needed.

Prescribed by Secretary of State
NRS 294A.120, 294A.125,
294A.140, 294A.150, 294A.160
294A.200, 294A.210, 294A.220, 294A.362