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HomeMy WebLinkAboutCFR-04.30.2013-Baxter,Brendalbxas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 46x3-5800 (TDD 1-800-735-2989) wwww ethics.state.tx.fis Revised 04119i2013 CANDIDATE 1 OFFICEHOLDER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 'I ' i ACCOUNT #f 2 Total pages filed: The C/01.1 Instruction Guide explains how to complete this force. {Eth c Coram scion Fte s) i 3 CANDIDATE t MSIMRS/MR FIRST Ml 0 of '' OFFICEHOLDER NAME iti! ate I l� = . € NICKNAME . .LAST _ , . SUFFIX APR 3 2013 ADDRESS IPOBOX; ii��} P X7`'1 E APTISU3TE#; CITY, STATE; ZIP CODE � 4 CANDIDATE / � OFFICEHOLDER MAILING ADDRESS (0 )'� Dato Han el vera or ostm rk d S T �. s C I Er t �. ' Al El change of address li 1 W V� t e - Receipt # A xxmt 5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION OFFICEHOLDER PHONE Date Processed � 6 CAMPAIGN MS,MRSiMR FIRST full Datelma{Ied TREASURER NAME.. t NICKNAME LAST SUFFIX 7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE), APTISUITEn: CITY, STATE, ZIPCODE TREASURER ADDRESS (residence of business) " 6 O 1A 8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER } PHONE ( 9 REPORT TYPE January Ira [`) 301h day before election a Runoff 15th day after campaign treasurer appointment fohiceliuk kn oniy) ❑ July 15 h day before election 1� Exceeded $500 F --j Final report (Attach CtOH - FR) limit 70 PERIOD..» t.,t«r.?r: Day Year Mcnts; � Das: � Year COVERED THROUGH 11 ELECTION ELECTIONDATE ! ELECTION TYPE Month Days Year Fraaary L Ruf o9onefal L]Specie! 12 OFFICE OFFICEI4ELD (if any) 13 OFFICE SOUGHT (if known) GO TO PAIGE 2 wwww ethics.state.tx.fis Revised 04119i2013 Texas Ethics Commission P.Q. Box 12070 Austin, Texas 78711--2070 (512) 463-5800 (TDD 1-800-735-2989) www ethics.state.tx.us Revised 04/1912013 CANDIDATE/ OFFICEHOLDER REPORT. FORM C/OH4 SUPPORT & TOTALS COVER SHEET PG 2 14 C1OH NAME j 15 ACCOUNT # (Ethics Co rrnission Filers) 16 NOTICE FROM i THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE POLITICAL IIt CANDIDATE/OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE's OR OFFICEHOLDER'S KNOWLEDGE OR COMMITTEE(S) CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY if THEY RECEIVE NOTICE OF SUCH EXPENDITURES. 1 COMMITTEE NAAE COMMITTEE TYPE I GENERAL COMMITTEE ADDRESS E1 a SPECIFIC Ej 4 i COMMITTEE TTEE CAM&AIGN TREASURER NAME i S additional pages I 1 i COMMITTEE CAMPAIGN TREASURER ADDRESS f 17 CONTRIBUTION TATA � 1. TOTAL. POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN ! PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF 'LOANS)y 9i EXPENDITURE , TOTALS 3_ TOTAL POLITICAL EXPENDITURES OF 5100 OR LESS, UNLESS ITEMIZED $ 7 i v 4. TOTAL POLITICAL EXPENDITURES 1 CONTRIBUTION 5. BALANCE TOTAL POLITICAL CONTRIBUTIONS I.IAINTAINED AS OF THE LAST DAY Z.OLt t,it OF REPORTING PERIOD & �LC f OUT T G � TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LTOOTALTAL S LOAN LOAN I LAST DAY OF THE REPORTING PERIOD E 18 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the accompanying report is true and correct and includes all information required to be reported by me under Title 15, Election Code, Signature of Candidate or Officeholder AFFIX NOTARY STAMP f SEAL ABOVE Sworn to and subscribed before me, by the said this the day of 20 to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath www ethics.state.tx.us Revised 04/1912013 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 q Total pages Schedule A. The Instruction Guide explains how to complete this form. 2 FILER NAME 3 ACCOUNT # (Ethics Commission Filers) r, 4 Date 5 Fill name of contributor ❑ out-of-state PAC(ID#. } 7 Amount of 18 In-kind contribution contribution (S) description (if applicable) 'J 6 Contributor address; City; State: Zip Code CJ; (If travel outside of Texas, complete Schedule T) 9 Principal occupation / Job title (See Instructions) 10 Employer (See Instructions) Date Full name of contributor ❑ out-of-statePAC (IM ) Amount of In-kind contribution contribution ($) I description (if applicable) Contributor address; City; State; Zip Code Ul Aa �,�°�7 (fes' -x + _ T ,T if travel outside of Texas, complete Schedule Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor ❑ out-of-statePAC(ID#: } Amount of In-kind contribution � ( p contribution (S) description (if applicable) „ N fit- S ` .'� it"" Contributor address: City: State; Zip Code ' g G a%r p p i V Jg.t'.�t ,,ppG. r t travel outside Texas. complete Schedule T) (If u, Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor ❑ out-of-stalePAC(ID# _ ) Amount of In-kind contribution Alol I �q contribution (S) description (if applicable) Contributor address: City; State; Zip Code t V KV N Texas, tete Schedule T !t travel outside of com Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor ❑out-of-statePAC (ID#_„__ _. a Amountof i In-kind contribution contribution ($) description (if applicable) M Contributor address: City: State: Zip Code j 0 6 Tom j ' `' t 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 04/19!2013 Texas Ethics Commission RO. Box 12070 Austin, Texas 78711-2070 (512) 403-5800 (TDD 1-800-735-2980 POLITICAL CONTRIBUTIONS SCHEDULE A OTHER THAN PLEDGES OR LOANS I Total pages Schedule A.- The instruction Guide explains how tocompletethis form.`vµA 2 FILER NAME 3 ACCOUNT (Ethics Commission Filers) 4 Date 5 Full name of contributor El out -at -state PAC (0# 7 Amount of 8 In-kind contribution } } , contribution (S) i description (if applicable) V 12 j 6 Contributor address; City; State: Zip Code + travel of Texas, complete Schedule T) (if outside 9 Principal occupation i Job title (See Instructions) 10 Employer (See Instructions) n Date Full name of contributor El out-ofstate PAC(ILW „- ._ Amount of In-kind contribution / ( contribution ($) description (if applicable) (I I< Contributor address, City; State; Zip Co e (If travel outside of Texas, complete Schedule T� Principal occupation i Job title (See Instructions) Employer (See Instructions) F Date Full name of contributor ❑ out-of-state PAC(in#.,,___.__,,-___.,,,_. -,_) Amount of In-kind contribution contribution (S) description (if applicable) Contributor address; City: State: Zip Code r t (if travel outside of Texas, complete Schedule T) Principal occupation 1 Job title (See Instructions) i Employer (See Instructions) Date ^^� Full name of contributor bout-ar-statePAC ttC#,,,_ _? Amount of In-kind contribution contribution (S) description (if applicable) r I Contributor address: City: State: Zip Code I if travel outside of Texas, Com lete Schedule T Principal occupation 1 Job title (See Instructions) Employer (See Instructions) Date Full name of contributor El out-of-siatePAC (IDfP _ Amountof ? In-kind contribution contribution (S) , description (if applicable) AVLC 0 Contributor address: City; State: Zip Code Atrjfi '. t € (Ili travel outside of Texas com_piet_e Schedule T Principal occupation 1 Job title (See Instructions) - - JW Employer (See Instructions) F 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 04/19/2013 Texas Ethics Commission P.O. Dox 12010 Austin, Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989) PLEDGE® CONTRIBUTIONS SCHEDULE B t �Tc�tatpages5chedu4e�_,__.._.� ._.... The Instruction Guide explains how to complete this form. 2 FILER NAME 3 ACCOUNT it (Ethics Commission Filers) 4 TOTAL OF UNITEMIZED PLEDGES: $ _ Amount of S Date 6 Full name of pledgor out-cfstate PAC(Ok 8 g In-kind description LA '�} qq - pledge (S) g (if applicable) 7 Pledgor address; City; State; Zip Coda �60 � � �. �� c�(r� _ i `` '-`�'�'-�' t � t° �' &6 I Teras, Schedule T} (if travel outside of complete 10 Principal occupation / Job title (See Instructions) 11 Employer (See Instructions) Date Full name of pledgor out-of-state PAC€IDt Amount of in-kind description i 6kGI J tCT ► i sw-f— pledge (S) (if applicable) 1�6v✓ Pledgor address; City; State; Zip Code i r (if travel outside of Texas. complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of pledgor 17 out -or, state PAC 01)9+ ) Amount of In-kind description pledge (S) (if applicable) Pledgor address-, City, State; Zip Code { (€f travel outside OT Texas, complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions) _ Date Full name of pledgor 17 out-oi-mtatePAC: (IOu ) Amount of In-kind description pledge (S) (if applicable) Pledgor address; City; State; Zip Code i (if travel outside of Texas. complete Schedule T) Principal occupation I Job title (See Instructions) Employee (See Instructions) Date Full name of pledgor 17 our-of-stato PAC (ID#,.__ _7 Amount of In-kind description _. _ pledge (S) E (if applicable) Pledgor address; City-, State; Zip Code I i r (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 0411912013 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) www ethics.state.tx.us Revised 04119/2013 LOANS SCHEDULE E .1 %talpages Schedule € The Instruction Guide explains haw to complete this form. 2 FILER NAME 3 ACCOUNT # (Ethics Cornintssion Filers) 4 TOTAL OF UNITEMIZED LOANS: $ 5 Date of loan 7 Nance of tender / out-of-state PAC f,ID#: p 9 Loan Amount ($) 6 Is tender $ Lender address; City; State; Zip Code 10 Interest rate a financial r Institution? _ Maturity date Y N f` 12 Principal occupation 1 Job title (See Instructions) Employer (See Instructions) t 14 Description of Collateralmmm °jam€ 15 Check if personal funds were deposited into political account — none 16 GUARANTOR � 17 Name ofguarantor 19 Amount Guaranteed ($) INFORMATION l i6 j18 f Guarantor address; City; State; Zip Code not applicable / j 20 Principal Occupation (See Instructions) 21 Erriployer (See Instructions) Date of loan mmmN^u ~ Name of tent r�u N N41 emmu Loan Amount ($j PAC put -of -state llik€. Is lender Lendersddress: City; State; Zip Code Interest rate a financial Institution? Maturity date Y N Principal occupation ! Job title (See Instructions) Employer (See Instructions) Description of Collateral Check if personal funds were deposited into political account 0 none 10 GUARAN'T'OR Name of guarantor � Amount Guaranteed (S) INFORMATION S Guarantor address; City; State; Zip Code 01 not applicable P 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 ethics.state.tx.us Revised 04119/2013 Texas Ethics Commission RO. Box 12070 Austin, Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989) POLITICAL EXPENDITURES SCHEDULE F EXPENDITURE CATEGORIES FOR SOX 8(a) Advertising Expense Gift?Awardsrftemorials Expense Sala ries!WageslCon'tract tabor Loan Repayment/Reimbursement AccountingiBanking Legal Services SoitatationlFundraising 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 CandidaterOf#ieeholderl?olitieal Committee Fees Printing Expense Office OverheadlRentai 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 Payee na{me { 2C1 I �j --.� t 3 6 Amount (S) 7 Payee address; City: State; Zip Code i 8 PURPOSE (a) Category (See categories listed at the top of this schedule) ; (b) Description.1.1 travel outside of Texas, complete Schedule T) OF EXPENDITURE s� t tar p �i 4 Py= a x etz' tjs� �'`e-'t 1,t A-3 6, Li s i .. 9 Complete QNLY if direct Candidate i Officeholder name Office sought Office held expenditure to benefit. CIOH Dateu.mw:Payee* name�� Amount (S) ( Payee address; City, State: Zip Coda�/� t 1' PURPOSE a Category (See categories listed at the topyf his schedule) Description (if travel outside of Texas, complete Schedule T; OF 4 EXPENDITURE ... _._ Candidate t Offceholdrriame Office sought — Office held Complete gN-�tf direct expenditure to benefit CfOH 1. F �. ' fir:-....�..a._.e........_...-,._......�..-...m. .�_.."..�....e....._�._............_.--........_.....�..�..,....�.....��..®�....._.-.......-e.._��..m......., �..__.._. ._... -_Payee Da#e__.. � name ,' , I! Amount {$} f�.� Payee address; City; State; Zip Code PURPOSE C' t gory (See categories listed at the top of this schedule) i Description (If travel outside of Texas, complete Schedule T) OF EXPENDITURE Complete Q df A.Y if direct Candidate ; Officeholder name Office sought Office held expenditure to benefit Cl 14 Date { Payee name Amount ($) Payee address; City; State; Zip Code a PURPOSE Category (See categories listed at the top of this schedule) Description (!f travel outside of Texas, complete Schedule T) OF EXPENDITURE Complete QNLY if direct Candidate ! Officeholder name Office sought Office held expenditure to benefit CiOH ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED www. ethics state. tx.us Revised 44/19/2013 Texas Ethics Commission P.0, Box 12070 Austin, Texas 713711--2070 (512) 403-5800 ("I"DD 1.800-735-2989) POLITICAL. EXPENDITURES SCHEDULE C FADE FROM PERSONAL FUNDS EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Gift/Awards/Tviemorials Expense SalariesiWages.<Contract tabor Loan Repay mcnt/Reirnbursement Accountingi6anking legal Services So€icitationiFundraising Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Travel in district ContributionsiConations 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 NAlv1E 1312COD 3 ACCOUNT # (Ethics Commission Filers) 4 Date}5 Payee name u t I 6 Amount (S) 7 Payee address; City; State; Zip Code reimbursement from �� politicat contributions rr, � � 9 V u s T -P' r s , y� t { _ �q V � f t intended � � W� � PURPOSE (a° a) Category (See categories listed at the top of this schedule) (io) Description {tt trav mi outsde at Texas ompiete Schedule Tt OF s EXPENDITURE ( { _ l� �e-r2is�' L` Date Payee name} ,✓ 4 �'�''7 L� j �'�`� sic.. l`` �t A--�•i --' Amount (S) Payee address; City; State; Zip Code Reimbursement from contribuGcn< political tntosded E w .,..r._.___._ ._,__.._..._ ___.,.uw,._..,.______�.__,.__._._,._._._....� __._......._.............m,..w� PURPOSE Category (See eafego es listed at the top of this schedule) Description (if travel outside of "Texas, complete Schedule 'T) OF EXPENDITURE �r Dated� I Payee name q[(j� A p �yf 4 �'" C4, Amount ($) Payee address; City; State; Zip Code 4 Reimbursement from cortrbutans l( �7 8�'l Lf 0 q � a ` ( t Jq Com00 710 4, intended ` PURPOSE Category (See categories listed at the top of this schedule) Description Of travel outside of Texas. complete Schedule T) OF � EXPENDITURE 1 Date Payee name Amount ($) Payee address; City; State; Zip Code Reimbursement from 0 political contributions intended mCategory PURPOSEry (See categories listed at the top of this schedule) Description (If travel outside of Texas. cornpiete Schede€e T) OF EXPENDITURE ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED www. ethics .state.tx.us Revised 04/19f2013 Texas Ethics Commission Ptd. Box 12070 Austin, Texas 78711-2070 (512)463-.5800 { FDD 1-800-73.5-2989) www.ethics.state.tx us Revised 04/19/2013 PAYMENT FROM POLITICAL CONTRIBUTIONS SCHEDULE H TO A BUSINESS OF C/OH _,.EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Gift`AwardslMemonals Expense Salaries/Wagestcontract Labor Loan Repayment/Reimbursement AccountinglBanking 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/OfficehoidertPoiitical 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 Fl: 12 V FILER NAME 3 ACCOUNT # (Ethics Commission Filers) € 4 Date i 5 Business name 6 AmountS {) j 7 Business address: City: State: Zip Code € i p� $ PURPOSE (a) Category (see categories Listed at the top of this schedule) (b) Description of travel outside of Texas complete Schedule T) OF EXPENDITURE 9 Complete Q,f iLy if direct Candidate 1 Officeholder name Office sought Office field expenditure to benefit CION Date Business name Amount (S) 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 Cog' Y if direct Candidate ` Officeholder name Office sought Office held expenditure to benefit CtOH Date Business name Amount (S) Business address; City; ~ State; Zip Code s PURPOSE ; Category (See categories listed at the top of this schedule) Description ilf travel outside of Texas, complete Schedule T} OF EXPENDITURE Complete 9Nt Y if direct Candidate / Officeholder name Office sought Office held expenditure to benefit CIOH ^ Date Business name —� Amount (S) Business address; City; State; Zip Code PURPOSE Category {sea categories listed at the top of this schedule) Description (if travel outside of Texas, complete Schedule Tj OF EXPENDITURE - Complete ONLY if direct w— Candidate t Officeholder name Office soughtW ry Office held�+Wvvmm expenditure to benefit CION ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED www.ethics.state.tx us Revised 04/19/2013 Texas Ethics Commission P.O. Box 12070 Austin, Texas 75711-2.070 (512) 463-5800 (TDD 1-800-735-2989) www.ethics.state.tx us Revised 0411312013 NON-POLITICAL EXPENDITURES SCHEDULE I ADE FROM POLITICAL CONTRIBUTIONS The Instruction Guide explains how to complete this farm. 1 Total pages Schedule 11 2 FILEN NAME 3 ACCOUNT t ('cthiiCS C'ortirriSSion Fitersl I 4 Date 5 Payee name 6 Amount (S) 7 Payee address; City; State; Zip Code I 8 PURPOSE (a)Category (see instructions for examples; of acceptable (b) Description (See instructions regading type of mformattan F categories) required.) EXPENDITURE i .Payee Date name Amount {S) Payee address; City; State; Zip Code v PURPOSE^y (a) Category (See Instructions for examples of acceptable (b)Description (See instructions regarding type of information OF categories) required.) EXPENDITURE ! Date_,__��._._.a_._...� Payee name Amount {$) Payee address; City, state; Zip Code PURPOSE (a) Category (see instructions for examples of acceptable s (b) Description .;See instructions regarding type of Information OF categories) required.) EXPENDITURE s Date Payee name Amount (S) Payee address; City; state; Zip Code �I �(a) PURPOSE Category (see inshactions for examples of acceptable (is) Description (see instructions regarding type of information OF categories) irequired) EXPENDITURE i F ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED www.ethics.state.tx us Revised 0411312013 Texas Ethics Commission P.O. Box 12070 Austin,'r'exas 78711.2070 (512) 463-5800 (TDD 1-800-735--2089) INTEREST EARNED, OTHER CREDITS/GAINS/ SCHEDULE I� REFUNDS, AND PURCHASE ASE GP INVESTMENTS _.._.._.--_The —Total y�..._...,.._m�m_n__.. s.._... I pages Schedule rC Instruction Guide explains how to complete this form. 2 f=1t_ER NAME 3 ACCOUNT ;Ethics Commission Fliers) 4 Date 6 Name of person from whom amount is received „ 8 Amount 6 Address of person from whom amount is received; City;. State; Zip Code f 7 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 (S) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received i Date Name of person from whom amount is received Amount (S) €[ 1 Address of person from whom amount is received; City; State; Zip Code r e 6 F i i i i Purpose for which amount is received ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED www.ethics.state.tx us Revised 04/19/2093 Texas Ethics Commission P.O. Box 12070 Austin. )"exas 78711-2070 (512) x#03-5800 {TDD 1-800-735-2989) #WKIND CONTRIBUTION OR POLITICAL EXPENDITURE SCHEDULE T FOR TRAVEL OUTSIDE OF TEXAS The Instruction Guide explains how to complete this form. 1 Total pages Schedule 7 2 FILER NAME 3 ACCOUNT # (Ethics Commission Filers) 4 Name of Contributor i Corporation or Labor Organization / Pledgor I Payee S Contribution lExpenditure reported on: Schedule A Schedule B L'j Schedule C Schedule D Schedule F j Schedule G r Schedule H Schedule N COH-UC COH-T ❑ PAC-G PAC-E= 6 Dates of travel 7 Name of person(s) traveling �$ Departure city or name afdeparture 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 I Corporation or Labor Organization f Pledgor / Payee Contribution t Expenditure reported on, Fi Schedule A F i Schedule B Schedule G 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 t Corporation or Labor Organization i Pledgor f Payee Contribution/ Expenditure reported om Schedule A ll Schedule B Schedule GSchedule D Schedule F Schedule G L.J Schedule H ❑ Schedule N 0 COI-i-UC COH-T Ef PAC-C� PAG-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 04/19/2013 lexasLthlrsGorrimission I`'(Jl box 11UfU Austin, texas fti111-LUfU (t)Iz_)4tm-:)�25uU 1-0UU- CANDIDATE / OFFICEHOLDER REPORT: FORM C/OH - FR DESIGNATION OF FINAL REPORT The Instruction Guide explains how to complete this form. •+ Complete only if "Report Type," on page 1 is marked "Final Report" •+ ir1;t�7[1il:i�/=STI 2 ACCOUNT # (Ethics Commission Filers) I do not expect any further political contributions or political expenditures in connection with my candidacy. I understand that designating a report as a final report terminates my campaign treasurer appointment. I also understand that I may not accept any campaign contributions or make any campaign expenditures without a campaign treasurer appointment on file. Signature of Candidate t Officeholder 4 FILER WHO IS NOT AN OFFICEHOLDER " Complete A& B below only if you are not an officeholder. A. CAMPAIGN FUNDS Check only one: i I do not have unexpended contributions or unexpended interest or income earned from political contributions. I have unexpended contributions or unexpended interest or income earned from political contributions. I understand that I may not convert unexpended political contributions or unexpended interest or income earned on political contributions to personal use. I also understand that i must file an annual report of unexpended contributions and that I may not retain unexpended contributions or unexpended interest or income earned on political contributions longer than six years after filing this final report. Further, I understand that I must dispose of unexpended political contributions and unexpended interest or income earned on political contributions in accordance with the requirements of Election Code, § 254.204. B. ASSETS Chock only one: 0 1 do not retain assets purchased with political contributions or interest or other income from political contributions. I do retain assets purchased with political contributions or interest or other income from political contributions. € understand that I may not convert assets purchased with political contributions or interest or other income from political contributions to personal use. 1 also understand that I must dispose of assets purchased with political contributions in accordance with the requirements of Election Code, § 254.204. Signature of Candidate OFFICEHOLDER •• Complete this section only if you are an officeholder *• (� I am aware that I remain subject to filing requirements applicable to an of6cehokler who does not have a campaign treasurer on file. I am also aware that i will be required to file reports of unexpended contributions if, after filing the last required report as an officeholder, i retain political contributions; interest or other income from political contributions, or assets purchased with political contributions or interest or other income from political contributions. Signature of Officeholder www ethics, state. tx us Revised 0411912013