HomeMy WebLinkAboutCFR-09.02.2015-Georgetown Trans Pac' Tawe F=fhirc (nmmizqinn Rn Rny 12070 Austin. Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
SPECIFIC -PURPOSE COMMITTEE
FORM SPAC
CAMPAIGN FINANCE REPORT
COVER SHEET PG I
1 ACCOUNT#
2 Total pages filed:
The SPAC Instruction Guide
explains how to complete this form.
(Ethics Commission Filers)
3 COMMITTEE NAME
OFFICE USE ONLY
GI e-0 rY �O^V,1114
Date Received
�4r,
4 COMMITTEE
ADDRESS / PO BOX; APT / SUITE #; CITY: STATE; ZIP CODE
ADDRESS
I & p4lk
F—] change of address
Geor�41
Date Hand -delivered or Postmarked
Receipt#
Amount
5 CAMPAIGN
TREASURER
MS/MRS IMIR FIRST Ml
Date Processed
7r, �Z be, rf
NAME
............
NICKNAME LAST SUFFIX
Date Imaged
bo61 15;yll, t, +
6 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT/SUITE#: CITY; STATE;
ZIP CODE
TREASURER'S
"
STREET ADDRESS
(residence or business).
G
7 CAMPAIGN
STREET OR PO BOX; APT / SUITE #; CITY; STATE;
ZIP CODE
TREASURER'S
'
MAILING ADDRESS
F—] change of address
Georlelbovv.All 7'�,
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
(
9 REPORT TYPE"
F-1 January 15 ❑ 30th day before election ❑
Exceeded: 00 limit
El July 15 Q 8th day before election [P--Drssolution
(attach PAC -DR)
1:1 Runoff F-1
10th day after campaign treasurertermination
10 PERIOD
Month Day Year
Month Day Year
COVERED
of lloli5— THROUGH
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
/0
E] Primary El Runoff
1:1 General Special
GO TO PAGE 2
www. ethics. state.tx. us Revised 07/28/2014
-11avnc F=thir,- C.nmmiz-_inn PC) Rnyi?n7n Austin_Texas78711-2070 (512)463-5800 (TDD 1-800-735-2989)
SPECIFIC -PURPOSE COMMITTEE REPORT: FORM SPAC
PURPOSE AND TOTALS COVER SHEET PG 2
12 COMMITTEE NAME
ACCOUNT # (Ethics Commission Filers)
13 COMMITTEE
CANDIDATE / OFFICEHOLDER NAME
PURPOSE
(Attach lists on plain
paper to complete this
report if necessary,)
El CANDIDATE
ISUPPORT
2<Ul
F� OFFICEHOLDER
OFFICE SOUGHT (candidate) OFFICE HELD (officeholder)
(Candidate or Measure)
OPPOSE
(Candidate or Measure)
BALLOT IDENTIFICATION / # ELECTION DATE
Month Day Year
ASSIST
(Officeholder)
Le"MEASURE
DESCRIPTION -rhf, j5t!�L-IAAiCe eo-r 0105,_060,000
14 CONTRIBUTION
1.
TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
$
TOTALS
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
2.
TOTAL POLITICAL CONTRIBUTIONS
$
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
3.
TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED
$
EXPENDITURE
TOTALS
4.
TOTAL POLITICAL EXPENDITURES
$ 16, 3, 1 Z
CONTRIBUTION
5,
TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
BALANCE
OF THE REPORTING PERIOD
OUTSTANDING
6.
TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS ASOFTHE
$
LOAN TOTALS
I
LAST DAY OF THE REPORTING PERIOD
15 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 Campaign Treasurer
AFFIX NOTARY STAMP 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 07128/2014
POLITICAL CONTRIBUTIONS
SCHEDULE A
OTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this form.
1 Total pages Sc1hedule A:
2 FILER NAME
7
3 ACCOUNT# (Ethics Commission Filers)
4 Date
5 Full name of contributor El out- q -state PAC (113#:
7 Amount of 8 In-kind contribution
contribution ($) description (if applicable)
6 Contributor City; Sate; Zip
address;
(if travel outside of Texas, complete Schedule T)
9 Principal occupation / Job title (See Instructions)
1� Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC (ID#:—
Amount of In-kind contribution
contribution description (if applicable)
Contrib utoraddress; City; State; Zip Code
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor El out-of-statePAC(l
Amount of In-kind contribution
contribution description (if applicable)
Contributor address; City; State; Zip Co e
(if travel OULWUe of , complete Schedule T)
Principal occupation! Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor El out-of-state PAC(1 3,9: ----)
Amount of In-kind contribution
contribution ($) I description (if applicable)
Co ntrib utoraddress; City; State; Zip -le
(if travel out.— of Texas, complete Schedule T)
Principal occupation I Job title (See Instructions)
Employer (,-Ril-elinstructions)
Date
Full name of contributor El .\.f -state PAC (I #.'.
Amount of In-kind contribution
contribution description (if applicable)
Contributor address; City; State; Cop e
ip Cc
(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. et h i cs. st ate.tx. us Revised 07/28/2014
TPY2- Fthir-- 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.
I Total pages Schedule B:
1
2 FILER NAME
3 ACCOUNT# (Ethics Commission Filers)
4 TOTAL —'(OF UNITEMIZED PLEDGES:
5 Date
_
6 Full name of pledgorout-of-state PAC (IDl
Amount of 19 In-kind description
A--dge
(if applicable)
.. . . . . . . . .
7 Pledgor address; City; Stat Zip ode
L(if
travel outside of Texas, complete Schedule T)
10 Principal occupation I Job title (See Instructio s)
11 14mployer (See Instructions)
Date
Full name of pledger E] out-of-state PAC (0t,
Amount of in-kind description
pledge (if applicable)
. . . . . .. . . . . . . .
Pledgor address; City: State; Zip Cc de
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of pledgor El out-of-state PAC (to#:
I
Amount of I In-kind description
pledge O I (if applicable)
Pledger address; City; State; Zip C ode
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) LI
Employer (See Instructions)
Date
Full name of pledgor El out-of-state PAC (ID#:
Amount of I In-kind description
pledge (if applicable)
Pledgor address; City; State; Zip Co e
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of pledger E] out-of-state P A, (I
Amount of In-kind description
pledge ($) (if applicable)
. . . . . . .
Pledgor address: City; State-, Zip
(if travel outside of Texas, complete Schedule -0
(if travel outside of Texas, complete Schedule T)
Principal occupation I Job title (See Instructions)
_Lkpplyer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS NEEDED
If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
www.ethics.state.tx.us Revised 07/28/2014
T-ypq Fthir--, (-.r)mmiqRinn Pn- Rnx 12070 Austin. Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CORPORATE OR LABOR ORGANIZATION
SCHEDULE C
CONTRIBUONS OTHER THAN PLEDGES OR LOANS
TI
The Instruction Guide explains how to complete this form.
I Total pages Schedule G.
2 FILER NAME
3 ACCOUNT# (Ethics Commission Filers)
4 Date
5 Corporation/ Labor Organization name
7 Amountof 8 In-kind contribution
LdAJ(f 1A)C_
contribution (S) description (if applicable)
6 Corporation/ Labor Organization address; City; State; Zip Code
ti
:31)
�jm,mlh 1-4"- 7
1
(If travel outside of Texas, complete Schedule T)
Date
Corporation/ Labor Organization name
Amount of In-kind contribution
contribution description (if applicable)
Corporation Labor Organization address; City; State; Zip Code
(if travel outside of Texas, complete Schedule T)
Date
Corporation/ Labor Organization name
Amount of In-kind contribution
contribution description (if applicable)
. . . .. . . . . . . . * . . . . . . . . . . .
Corporation / Labor Organization address; City; State; Zip Code
(if travel outside of Texas, complete Schedule T)
Date
Corporation/ Labor Organization name
Amount of In-kind contribution
contribution description (if applicable)
Corporation'/ Labor Organization address; City; State'; Zip Code
(If travel outside of Texas, complete Schedule T)
Date
Corporation/ Labor Organization name
Amount of In-kind contribution
contribution description (if applicable)
Corporation Labor Organization address; City; State; Zip Code
(If travel outside of Texas, complete Schedule 1)
Date
Corporation I Labor Organization name
Amount of In-kind contribution
contribution description (if applicable)
Corporation t Labor Organization address; City; State Zip Code
(if travel outside of Texas, complete Schedule T)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS NEEDED
www. et h i cs. s t ate.tx. us Revised 07/28/2014
Texas Ethics Commission
PLEDGED CORPORATE OR LABOR ORGANIZATION
SCHEDULE D
CONTRIBUTIONS
I Total pages Schedule D:
The Instruction Guide explains how to complete this form.
1
2 FILER NAME
6, / 5
3 ACCOUNT # (Ethics Commission Filers)
4 Date
5 Corporation Labor Organization name
7 Amount of I a in-kind description
pledge (if applicable)
6 corporation Labor 0 anizati n City, to; 1p Code
/ ad s;
(if travel outside of Texas, complete Schedule T)
Date
Corporation Labor Organization name
Amount of In-kind description
pledge (if applicable)
Corporation I Labor Organization address; City; State; Zip Code
(if travel outside of Texas, complete Schedule T)
Date
Corporation / Labor Organization name
Amount of In-kind description
pledge (if applicable)
. .. . . . . . . . . . . .
Corporation'/ Labor Organization addres, 'City; State; . . . Zip Code"
(if travel outside of Texas, complete Schedule T)
Date
Corporation/ Labor Organization name
Amount of In-kind description
pledge ($) (if applicable)
0 City: State; Zip Code
Corporation I Labor Organization addre Vs-;
(if travel outside of Texas, complete Schedule T)
Date
Corporation P Labor Organization name
Amount of In-kind description
pledge (if applicable)
Corporation l Labor Organization dtlrE ss; city; State; Zip Code
(if travel outside of Texas, complete Schedule T)
Date
Corporation/ Labor Organization me
Amount of In-kind description
pledge (if applicable)
Corporation P Labor Organization ad s City; State; Zip Code
(if travel outside of Texas, complete Schedule T)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www. ethics. state.tx. us Revised 07/28/2014
LOANS SCHEDULE E
I Total pages Schedule E:
The Instruction Guide explains how to complete this form.
1
2 FILER NAME3
ACCOUNT # (Ethics Commission Filers)
exo IPA( c-lXw1g) IrIq N
4
TOTAL OF LIN ITEMIZED LOANS:
5 Date ofloan
7 Name oflender NVI I E] ou tate PAC (1
8' Lender address; Cit te;- Cocle-
9 Loan Amount ($)
6 Is lender
10 Interest rate
a financial
Institution?
11 Maturity date
Y N
12 Principal occupation / Job title (See Instructions)
13 EImtoyer (See Instructions)
14 Description of Collateral
El none
15 GUARANTOR
16 Name of guarantor
18 Amount Guaranteed ($)
INFORMATION
17 Guarantor address; city; State; Zip Code
F-1 not applicable
19 Principal Occupation (See Instructions)
20 Imployer (See instructions)
Date of loan
Name of lender E] out -of- ate PAC (ID#: yLoan
...................
Lender address; city; State; Zip C de
Amount ($)
Is lender
Interest rate
a financial
Institution?
Maturity date
Y N
Principal occupation / Job title (See Instructions)
mployer (See Instructions)
Description of Collateral
❑ none
GUARANTOR
Name of guarantor
Amount Guaranteed ($)
INFORMATION
Guarantor . address; City;\tate; Zi Code
F-1 not applicable
Principal Occupation (See Instructions)
. I-
p
\1 T yer (See Instructions)
N39 ----
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If lender is out-of-state PAC, please see instruction guide for additional reporting requirements.
www. et h i cs. state. tx. us Revised 07/28/2014
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 Salaries/WagesiContract Labor Loan Repayment/Reimbursement
AccountinglBanking Expense Solicitation/Fundraising Expense Transportation Equipment & Related
Consulting Expense Legal Services Travel In District Expense
Event Expense Food/Beverage Expense Travel Out Of District Contributions/Donations Made By
Fees Polling Expense Office Overhead/Rental Expense Can d idate/Officeholde riPolitica I Committee
Printing Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
I Total pages Schedule F:
2 FILERNAME
AC
COUNT # (Ethics Commission Filers)
ZrIl A1,5 i 5-
4 Date
5 Payee name
6 Amount
7 Payee address; City; State; Zip Code
ol 5, A u5 `4 Ave-, 70
8
(a) Category (See categories listed at the top of this
(b) Description (if travel outside of Texas, complete Schedule T)
PURPOSE
OF
schedule).170
ell<fGt
EXPENDITURE
t'l I ; "'t'e&
7)
—.5
0 Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
6-14 1 c lov"q
Amount
Payee address; City; State; Zip Code
q6
3:�) Geoi &—�6iVAI
PURPOSE
Category (see categories listed at the top of this
Description (if travel outside of Texas, complete Schedule T)
OF
schedule)
/Keefimq
EXPENDITURE
Ep o
El Check if Austin, TX, officeholder living expense
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
PURPOSE
Category (See categories listed at the top of this
Description (if travel outside of Texas, complete Schedule T)
OF
schedule)
EXPENDITURE
E] Check ifAustin, TX, officeholder living expense
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
PURPOSE
Category (See categories listed at the top of this
Description (if travel outside of Texas, complete Schedule T)
OF
schedule)
EXPENDITURE
I
[:j Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate I 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 07/28/2014
PAYMENTFROM POLITICAL H
SCHEDULE
CONTRIBUTIONS TO A BUSINESS OF C/OH
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense GiftlAwardsIMemorials Salaries/Wages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Expense Solicitation/Fundraising Expense Transportation Equipment & Related
Consulting Expense Legal Services Travel In District Expense
Event Expense Food/Beverage ExpenseTravel Out Of District contributions/Donations Made By
Fees Polling Expense Office Overhead/Rental Expense Candidate/Officeholder/Political Committee
Printing Expense OTHER (enter a category not listed above)
The instruction Guide explains how to complete this form.
I Total pages Schedule H:
2 FILER NAME
ACCOUNT # (Ethics Commission Filers)
4 Date
5 business name
6 Amount
Stale( Zip de
7 Business address;City; V 7
8 PURPOSE
(a) Category (see catigories listed at the top of this
(b) escription (if travel outside of Texas, complete Schedule T)
OF
schedule)
EXPENDITURE
I
Ej Check ifAustin, TX, officeholder living expense
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 IN
Description (if travel outside of Texas, complete Schedule T)
OF
schedule)
EXPENDITURE
I
[—] Check if Austin, TK, officeholder living expense
Complete ONLY if direct Candidate / 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
Description (if travel outside of Texas, complete Schedule T)
OF
schedule)
EXPENDITURE
E] Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name
Office sought Office held
expenditure to benefit C/OH
Date
Business name
Amount
Business address; City;
1.) Code
PURPOSE
Category (See categories listed at the to
is
Description (If travel outside of Texas, complete Schedule T)
OF
schedule)
EXPENDITURE
F� Check IfAustin, TX, officeholder living expense
Complete ONLY if direct Candidate I 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 07/28/2014
Texas Ethics Commission P.O. BOX 12UIU AUstin, lexas 16111-2ulu (b12) 4bJ-bbUU
I Total pages Schedule 1
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
L 6) C!;l
e L
4 Date
6 Payee name
6 Amount
7 Payee address;
City; State; Zip Code
Ter -A Dow,
/eKb:J
8 PURPOSE
OF
EXPENDITUIRM
(a)Category (See instructions for examples of acceptable
categories)
(b) Description (See instructions regarding type of information
required.)
6-� FDAJJ--�� LIPC,';'J
D j'6,e,,o lo -�-/ c, �,j
Date Payee name
T�Q
Amount Payee address; City; State; Zip Code
t
Ce-,4iAr 1q&4'12nA) L J Gene-)Ljiv, 7�-< 7?/
PURPOSE (a) Category (See instructions for examples of acceptable (b) Description (See instructions regarding type of information
OF categories) required.)
EXPENDITURE le /I /ri 0 &� 6 ,,AJ V';j4r; bu+i6Pj -r r-vlAs up"j
Date Payee name
1-ec ke k -
T/7,
Amount Payee address; City; State; Zip Code
5-00. �Y, *.-';Z705 eedir Pbi(k,4x-1 90/tc
Date
Amount ($)
•
(a) Category (See instructions for examples of acceptable
categories)
bRri-641e, L4,,wj�r,'bviw
Payee name
Payee address; City; State; Zip Code
(a) Category (See instructions for examples of acceptable
categories)
(b) Description (See instructions regarding type of information
required.) ,
(b) Description (See instructions regarding type of information
required.)
410
www. ethics. state.tx. us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
POLITICAL CONTRIBUTIONS RETURNED
ISCHEDULE J
TO COMMTTEE
I Total pages Schedule J:
The Instruction Guide explains how to complete this form.
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
co t:ga
4 Date Returned
6 Original payee name
7 Amount Returned
6 Original payee addr Cs at ip Code
Date Returned
Original payee name
Amount Returned
Original payee address; City; State; Zip Code
Date Returned
Original payee name
Amount Returned
Original payee address; City; State; Zip Code
Date Returned
Original payee name
Amount Returned
Original payee address; City; Stat Zip Code
Date Returned
Original payee name
Amount Returned
. . . . . . . . . . . .
Original payee address; City; Sta:e; Zip Code
Date Returned
Original payee name
Amount Returned
. . . . . . . . . . . . . . . . . . . . . .. i . . . . . .
zip
Original payee address; C Stat Zip Code
Date Returned
Original payee name
Amount Returned
. . . . . . . . . . . . . . . . .. . . . . . . . .
Original payee address; City; Stat Zip Code
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1-800-325-8506
INTEREST EARNED, OTHER CREDITS/GAINS/
SCHEDULE
REFUNDS, AND PURCHASE OF INVESTMENTS
The Instruction Guide explains how to complete this form.
I Total pages Schedule K:
2 FILER NAME
3 ACCOUNT# (Ethics Commission Filers)
4 Date
5 Name of person from whom amount i received
8 Amount
_t
6 Address of person from whom am un is /rcei d; /ity; at ip Co
V
7 Purpose for which amount is received
Date
Name of person from whom amount is received
Amount
Address of person from whom amount is receiv d; City; State; Zip Code
Purpose for which amount is received
Date
Name of person from whom amount is receive
Amount
Address of person from whom amount is recei ed: City; State; Zip Code
Purpose for which amount is received
Date
Name of person from whom amount is receive
Amount
Address I of . pers . on from whom amount \ieceiv d; VCi,: State; Zip Code
Purpose for which amount is received
ATrACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised 09/28/2011
~ .
` 'Texas Ethics Commission P.O.Box 12O7O Austin, Texas 78r11 -2O70 (512)453-58O0 (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.
I Total pages Schedule T.
2 FILER NAME I W /� 77 A- -7 ^ / '
3 ACCOUNT# (Ethics Commission Filers)
4 Name of Coni�nbutor / Corporation orLabor Organization / Pledgor / Payee
5 Contribution / Expenditure reported on:
Schedule A h le B Vh)..Ie C S hedule Schedule F Schedule G
Schedule HEJ 1. CC _U
11
1
8 Departure city or name of departure location
9 Destination city or name of destination to ation
10 Means oftransportat ��_7
11 Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization I Pledgor I ayee
Contribution / Expenditure reported on:
F—] Schedule A F—] Schedule B Sch ule C F—] Schedule D 0 Schedule F Schedule G
Dates of travel
Name of person(s) traveling . I
Departure city or name of departure locall on
Destination city or name of destination to tion
Means of transportation
Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledgo I Payee
Contribution / Expenditure reported on:
F—] Schedule A 0 Schedule B Sc edule C Schedule D F_� Schedule F D Schedule G
Dates of travel
Name of person(s) trN7g
Departure city or name of t ure localn
Destination city or name of clest n loc ion
Means of transportation
Purpose of travel (inc \ V n e of onference, seminar, or other event)
'q7 � I
-
ATTACH ADDITIONAL COPIM�TLHIS SCHEDULE AS NEEDED
°^mw.eimoo.wmg,.m.us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070
(512) 463-5800 (TDD 1-800-735-2989)
POLITICAL COMMITTEE FORMPAG - DR
AFFIDAVIT OF DISSOLUTION
The Instruction Guide explains how to complete this form.
Complete only if "Report Type" on page I is marked "Dissolution" --
COMMITTEE NAME
2 ACCOUNT# (Ethics Commission Filers)
3 Affidavit of Dissolution
1, the undersigned campaign treasurer, do not expect the occurrence of any further reportable activity by this
political committee for this or any other campaign or election for which reporting under the Election Code is
required. I declare that all of the information required to be reported by me has been reported. I understand
that designating a report as a dissolution report terminates the appointment of campaign treasurer. I further
understand that a political committee may not make or authorize political expenditures or accept political
contributions without having an appointment of campaign treasurer on file.
Signature 46f Ca(mpaig / a surer
DO NOT SIGN UNLESS
POLITICAL COMMITTEE IS TO BE DISSOLVED
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed it?efcfe me, by the said Y this the
day of 20 certify which, witness my hand and seal of office,
� e, / ��-� G� lel+� �---'
�office 2dnninisteringoath—
eg ature Printed name 'of 0 Icer adininistering oat Title of officer I'dministering oath
LEY
MARILLA DENLEY
EXPIRES
M my coMMISSION EXPIRES
YC
0
Y So, 6 17
September 16,2017
,2
j
v,fwv,l. ethics. state.tx. us Revised 07/28/2014