HomeMy WebLinkAboutCFR-03.31.2013-Baxter,BrendaTexas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
www.ethics.state.tx.us Revised 09/28/2011
CANDIDATE 1 OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT
COVER SHEET PG 1
1 ACCOUNT #
2 Total pages filed:.
The C/OH Instruction
Guide explains how to complete this form.
(Ethics Commission Filers)
6
3
CANDIDATE /
MS/MRSIMR FIRST
MI
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CAMPAIGN
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Date Imaged
TREASURER
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NAME
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CAMPAIGN
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CITY; STATE;
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TREASURER
ADDRESS
(residence or business)
.
#
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8
CAMPAIGN
AREA CODE PHONE NUMBER
EXTENSION
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9
REPORT TYPE
Q January 15 ( 30th day before election
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15th da after
ED Runoff Y campaign
treasurer appointment
(officeholderonly)
ED July 15 ED 8th day before election
ED Exceeded $500 0 Final report (Attach C/OH - FR)
limit
10
PERIOD
Month Day Year
Month Day
Year
COVERED
THROUGH
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11
ELECTION
ELECTION DATE
ELECTIONTYPE
Month Day Year
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OFFICE
OFFICE HELD (if any)
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GO TO PAGE 2
www.ethics.state.tx.us Revised 09/28/2011
texas Ethics Commission
P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CANDIDATE / OFFICEHOLDER REPORT:
FORM C/OH
SUPPORT & TOTALS COVER
SHEET PG 2
14 C/OH NAME
15 ACCOUNT # (Ethics Commission Filers)
16 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE
POLITICAL
CANDIDATE / OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDERS KNOWLEDGE OR
COMMITTEE (S)
CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENDITURES.
COMMITTEE NAME
COMMITTEE TYPE
GENERAL
COMMITTEE ADDRESS
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
TOTALS
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
y{
2. TOTAL POLITICAL CONTRIBUTIONS
$
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
�/i
EXPENDITURE
TOTALS
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED
$
��•,,
4. TOTAL POLITICAL EXPENDITURES
$
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
OF REPORTING PERIOD
OUTSTANDING
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS
LAST DAY OF THE REPORTING PERIOD
$
18 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the
accompanying report
is true and crect and includes all info ation required to be reported by
me under Title 15, Election Code.
JESSICA ERIN BRETTLE
t NOTARY PUBLIC
{ asx.sY� State of Texans Signature of Candidate orOfficeholder
C trm, Exp. 06-01-2015
AFFIX NOTARY STAMP I SEAL ABOVE
Sworn to and subscribed before me, by the said �C`— a,.3�/�
this the
day of V i 20 to certify which, witness my hand and
seal of office.
ure fofficeradminfik ring oath Printed name of officer administering oath Title Icer administe h
www.e hies. ate.tx.us
Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
POLITICAL CONTRIBUTIONS
SCHEDULE A
OTHER THAN PLEDGES OR LOANS
Total pages Schedule A:
The Instruction Guide explains how to complete this form.
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
/ ...�
4 Date
5 Full name of contributor ❑ out-of-state PAC (10#7 }
7 Amount of 8 In-kind contribution
contribution ($} ( description (if applicable)
6 Contributor address; City; State; Zip Code
'
62
F t
(if travel outside of Texas, complete Schedule T)
9 Principal occupation 1 Job title (See Instructions)
10 Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC(IN: }
Amount of In-kind contribution
ll,N
contribution ($) description (if applicable)
Contributor address; City; State; Zip Code
'
jell
If travel outside of Texas, complete Schedule T
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor ❑ out-of-statePAC(iD#: )
Amount of In-kind contribution
el
contribution ($) ' description (if applicable)
{
. . . . . . . . . . . . . . . . . . . . . . .
,('(
b 1
Contributor address; City; State; Zip Code
3 �
C'�'
(if travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC(ID#: }
Amount of In-kind contribution
g I
� n f '. �
contribution ($) ' description (if applicable)
r# L. I)
t
Con-t.rib utor address; City; State; Zip Code
"
Schedule T
If travel outside of Texas, winplete
Principal occupation 1 Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC (ID#*
Amountof In-kind contribution
contribution {$) description (if applicable)
Contributor address; City; 6 State; Zip Code
If travel outside of Texas, complete Schedule T
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide foradditional reporting requirements.
www.ethics.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
PLEDGED CONTRIBUTIONS SCHEDULE B
The Instruction Guide explains how to complete this form.
1 Total pages Schedule B:
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED PLEDGES: b b b b b
$
S Date
6 Full name of pledgor ❑ out-of-state PAC(ID#: t
8 Amount of 19 In-kind description
pledge ($} I (if applicable)
7 Pledgor address; City; State; Zip Code
(If travel outside of Texas, complete Schedule T)
10 Principal occupation / Job title (See Instructions)
11 Employer (See Instructions)
Date
Full name of pledgor Elout-of-state PAC(ID#: 1
Amount of In-kind description
pledge ($) ' (if applicable)
Pledgor address; City; State; Zip Code
(If travel out.... of Texas, complete Schedule T)
Principal occupation / Job title (See instructions)
Employer (See Instructions)
Date
Full name of pledgor ❑ out-of-statePAC(IN: )
Amount of I in-kind description
pledge ($) I (if applicable)
Pledgor address; City; State; Zip Code
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of pledgor 0 out-of-state PAC (ID#, )
Amount of In-kind description
pledge ($) ( (if applicable)
Pledgor address; City; State; , Zip Code
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of pledgor ❑out-of-statePAC (0#: )
Amountof ( In-kind description
pledge ($) I (if applicable)
Pledgor address; City; State; Zip Code
'
(if travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
www.ethics.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
LOANS SCHEDULE E
1 Total pages Schedule E:
The Instruction Guide explains how to complete this form.
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4
TOTAL OF UNITEMIZED LOANS: b b
$
5 Date of loan
7 Name of lender ❑ out-of-state PAC (ID#: )
9 Loan Amount ($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Lender address; City; State; Zip Code
10 Interest rate
6 is lender
a financial
Institution?
11 Maturity date
Y N
12 Principal occupation i Job title (See Instructions)
13 Employer (See Instructions)
14 Description of Collateral
15 Check if personal funds were deposited into political account
❑ none
❑
16 GUARANTOR
17 Name ofguarantor
19 Amount Guaranteed ($)
INFORMATION
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18 Guarantor address; City; State; Zip Code
(� not applicable
20 Principal Occupation (See instructions)
21 Employer (See Instructions)
Date of loan
Name of tender out-of-state PAC (ID#:
Loan Amount ($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lender address; City; State; Zip Code
interestrate
Is lender
a financial
Institution?
Maturity date
Y N
Principal occupation 1 Job title (See Instructions)
Employer (See Instructions)
Description of Collateral
Check if personal funds were deposited into political account
❑ none
❑
GUARANTOR
Name of guarantor
Amount Guaranteed ($)
INFORMATION
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Guarantor address; City; State; Zip Code
not applicable
Principal Occupation (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If lender is out-of-state PAC, please see instruction guide for additional reporting requirements.
www. aIhics.state. tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
POLITICAL EXPENDITURES SCHEDULE F
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made By
Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F:
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
8 PURPOSE
(a) Category (See categories listed at the top of this schedule)
(b) Description (if travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date §§
Payee, name
Amount ($)
Payee address; City; State; Zip Code g^
t gt 6 r} O
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Complete ONLY if direct Candidate ! Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount {$)
Payee address; City; State; Zip Code
4—,..s..s`+„ 4 i q .s. b^t^•
PURPOSE
Category (See categories listed at the torp of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
A v k P( S I '
iii A,$ t t g%
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
L
Amount {$)
Payee address; City; State; Zip Code
a
s LAN10 DCL
) `
✓yd ? t
•.3
PURPOSE
Category (Seb�e. categories listed at the top of this schedule)
Description 111,ravel outside of Texas, complete Schedule T)
OF
EXPENDITURE
A I i t i ? s
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
POLITICAL EXPENDITURES
SCHEDULE G
MADE FROM PERSONAL FUNDS
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made By
Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G:
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
r�
4 xY. M�.,✓
� � �
d
.+ Y �
E
4 Date
5 Payee name
4f Y 4Y f M F
y y�
i r4
j
6 Amount ($)
7 Payee address; City; State; Zip Code
i L4
,,Reb ement From
® political contributions
,f ,s r) ' ✓
intended
8 PURPOSE
(a) Category (See categories listed at the top of this schedule)
(b) Description (if travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
i i t Pt t r¢tWS
C
-t
Date
Payee name
Amount ($}
Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Reimbursement from
1 political contributions
intended
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
from
ElReimbursement
political contributions
intended
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
PAYMENT FROM POLITICAL CONTRIBUTIONS SCHEDULE H
TO A BUSINESS OF CIOH
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made By
Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H:
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4 Date
5 Business name
6 Amount ($}
7 Business address; City; State; Zip Code
8 PURPOSE
(a) Category (See categories listed at the top of this schedule)
(b) Description (if travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Business name
Amount ($)
Business address; City; State; Zip Code
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Business name
Amount ($}
Business address; City; State; Zip Code
PURPOSE
Category (See categories listed at the top of this schedule)
Description (it travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Complete ONLY if direct Candidate 1 Officeholder name Office sought Office held
expenditure to benefit CIOH
Date
Business name
Amount ($)
Business address; City; State; Zip Code
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
NON-POLITICAL EXPENDITURES
SCHEDULE I
MADE FROM POLITICAL CONTRIBUTIONS
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made By
Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
I Total pages Schedule 1:
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4 Date
6 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
8 PURPOSE
(a) Category (See categories listed at the top of this schedule)
(b) Description (See instructions regarding type of information required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
PURPOSE
Category (See categories listed at the lop of this schedule)
Description (See instructions regarding type of information required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
PURPOSE
Category (See categories listed at the top of this schedule)
Description (See instructions regarding type of information required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See categories listed at the top of this schedule)
Description (See instructions regarding type of information required.)
PURPOSE
OF
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
INTEREST EARNED, OTHER CREDITS/GAINS/
REFUNDS, AND PURCHASE OF INVESTMENTS SCHEDULE 1'C
The Instruction Guide explains how to complete this form.
1 Total pages Schedule K:
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4 Date
5 Name of person from whom amount is received
8 Amount
(S)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Address of person from whom amount is received; City; State; Zip Code
7 Purpose for which amount is received
Date
Name of person from whom amount is received
Amount
M
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
Date
Name of person from whom amount is received
Amount
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
Date
Name of person from whom amount is received
Amount
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www. ethics. state. tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
IN-KIND CONTRIBUTION OR POLITICAL EXPENDITURE SCHEDULE T
FOR TRAVEL OUTSIDE OF TEXAS
The Instruction Guide explains how to complete this form. 1 Total pages Schedule T:
2 FILER NAME 3 ACCOUNT # (Ethics Commission Filers)
4 Name of Contributor /Corporation or Labor Organization/ Pledgor / Payee
5 Contribution / Expenditure reported on:
❑ Schedule A ❑ Schedule B F'] Schedule C ❑ Schedule D ❑ Schedule F F'] Schedule G
❑ Schedule H ❑ Schedule N ❑ COH-UC ❑ COH-T ❑ PAC -C ❑ PAC -E
6 Dates of travel 7 Name of person(s) traveling
8 Departure city or name of departure location
9 Destination city or name of destination location
10 Means of transportation 11 Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor/ Corporation or Labor Organization / Pledgor / Payee
Contribution / Expenditure reported on:
❑ Schedule A ❑ Schedule B ❑ Schedule C ❑ Schedule D ❑ Schedule F ❑ Schedule G
❑ Schedule H ❑ Schedule N ❑ COH-UC ❑ COH-T ❑ PAC -C ❑ PAC -E
Dates of travel Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
Contribution / Expenditure reported on:
❑ Schedule A ❑ Schedule B ❑ Schedule C ❑ Schedule D ❑ Schedule F ❑ Schedule G
❑ Schedule H ❑ Schedule N ❑ COWLIC ❑ COH-T ❑ PAC -C ❑ PAC -E
Dates of travel Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation Purpose of travel (including name of conference, seminar, or other event)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 09/28/2011