HomeMy WebLinkAbout110412 - Campaign Finance Report - Julie SchultzTexas Ethics Commission P.O. Box 12070 Austin, Texas 78711·2070 (512) 463-5800 (TOO 1·800-735-2989)
CANDIDATE I OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 ACCOUNT # 12 Total pages filed:
The CIOH Instruction Guide explains how to complete this form. (Ethics Commission Rlars) ,
'3 CANDIDATE I I MS/MRS/MR FIRST MI OFFICE USE ONLY
I OFFICEHOLDER U1tS. JlAlle.t\A~ri0.~l~NAME Dale Received
,
"
NICKNAME LAST SUFFIX
I
, S:c...hU trz,
4 CANDIDATE I
! 3;~'BBOIf\r\A;Tt;:~ CITY; STATE: ZIP CODE
OFFICEHOLDER CI1c..te....MAILING Dale Hand~delivered or Postmarked
ADDRESS
I Coll¥ ~ht~st\:Ix 'l{8tf~o change of address Receipt # I Amount
5 CANDIDATE! AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER ~'7Lf 1B4<o
Date Processed
PHONE ~~'7 )
s CAMPAIGN MS/MRS/MR FIRST MI Date Imaged
TREASURER \Tr:.NAME
I
. . . . . . . ......
NICKNAME LAST SUFFIX
JoJts::5
7 CAMPAIGN STREET ADDRESS INO PO BOX PLEASE): APT I SUITE #: CITY; STATE; ZIP CODE
TREASURER t'~ 'WilloW Loot>ADDRESS
(residence or business) Coll~<-Q-at~OI\ l~ l184-J
8 CAMPAIGN AREA CODE -...J PHONE NUMBER EXTENSION
TREASURER (11~ ) 7-2-, ~ ~.b63PHONE
9 REPORT TYPE D Janual)' 15 j5i:f 30th day before eleclion Runoff 15th day after campaign treasurer
appoinlment (officehold ... only)
D July 15 8th day before election D Exceeded $500 limit Final repor1lAttach CIOH -FR)
10 PERIOD Month Day Year Month Day Year
ICOVERED ~ /3 THROUGH if /1'1 I I11
11 ELECTION ELECTION DATE I ELECTION TYPE
Month Day Year ¢ General5" '14/11 I
o Primal)' D Runoff Special
,
12 OFFICE OFFICE HELD (If any) 13 OFFtCE SOUGHT (ff known)
I C..AI'5e. 5f~ollY\o V\ e" Cl:\;;o CO"'-l'\c.~ I el~C.L S
14 NOTICE DIRECT CAMPAIGN EXPENDITURES ARE CAMPAIGN EXPENDITURES MADE BY OTHE\S WITHOUT THE CAN~IDATE'S PRIOR CONSENT OR APPROVAL
,
OF DIRECT ICAMPAIGN CANDIDATES ARE REClUIRED TO DISCLOSE THIS INFORMATION ONLY IF THEY RECEIVE NOTIFICATION OF THE DIRECT CAMPAIGN EXPENDITURE.
EXPENDITURE
BY OTHER Name
tiot16INDIVIDUALS
Address I PO Box: Apt I Buile~: City; Stat.: Zip Corle
I
lldditional pages I
GOTOPAGE2 I
www.ethics.state.tx.us Revised 04/21/2010
Texas Ethics Commission PO. Box 12070 Austin Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
CANDIDATE t OFFICEHOLDER REPORT: FORM CtOH
SUPPORT & TOTALS COVER SHEET PG 2
15 C/OH NAME J " M~rr\(i~1 ! S:ch~ltz... 116 ACCOUNT # (Ethics Commission Filers)
Ule. I
L
17 NOTICE THIS BOX IS FOR NOTICE ~F POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THEIFROM CANDIDATE 1OFFICEHOLDER. THESE EXPENDITURES MAY HAVE SEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
POLITICAL CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEE(S)
COMMITTEE NAME
JOJe-COMMITTEE TYPE
GENERAL
COMMITTEE ADDRESS
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
18 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN b'JO. ~TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $
2. TOTAL POLITICAL CONTRIBUTIONS $ /l2~O. OD
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF lOANS) -
I · . . . .....
EXPENDITURE $TOTALS 3. TOTAL POLITICAL EXPENDITURES OF $50 OR LESS, UNLESS ITEMIZED 0
4 . TOTAL POLITICAL EXPENDITURES $ 0 · . . . . . . . ,. .
CONTRIBUTION
.1
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY DD
BALANCE OF REPORTING PERIOD $ /,2:;0-:
· . ....... , .
OUTSTANDING I
LOAN TOTALS
1
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE $ 0LAST DAY OF THE REPORTING PERIOD
19 AFFIDAVIT
I swear, or affirm, under penalty of pe~ury, that the accompanying report
is true and correct and includes all information required to be reported by
~~JEANNE D SNOW m'""(:Z~"~COd'~ ~, I d~I * Notary Public
STATE OF TEXAS A/i.W My Comm. Exp. 011'17/2014 ( Signature of Candidate or Officeholder d
AFFIX NOTARY STAMP I SEAL ABOVE -S~~I t-Z.SVv'om to Q;)d subscribed before :TIe, by the said :J~l\"v , this the
\ 'l. 11.. day ~20~ to certify which, witness my hand and seal of office.
(1~A 1 SIl ow/ 1.OQ;t !lrf,j jq" I)). __\.)~Q'1" <U.
;1nature of officer administering oath Printed name of officer administering oath TItle of officer administering oath
wKw.ethics.state.tx.us ReVised 04/21/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
POLITICAL CONTRIBUTIONS
SCHEDULE AOTHER THAN PLEDGES OR LOANS
Tolal pages Schedule A:
The Instruction Guide explains how to complete this form. 11 1
3 ACCOUNT # (Ethics Commission Filers) 2 FILER NAME J
""lie lA€Xr~(i -e I J.. ~~(+Z-
7 Amount of 18 In-kind contribution
contribution ($) I description (if applicable)
4 Date 5 Full name of contributor o oul·of·slale PACiID#:__. )
IS Contributor address; City; State; Zip Code
I
www.ethics.slale.tx.us Revised 04/21/2010
-1 ~p..:r-TA~
I (If travel outside of Texas, complete Schedule T)
9 Principal occupation I Job title (See Instructions)
1
10 Employer (See Instructions)
Date Full name of contributor o OUI·of·slale PAC (ID#: ) Amount of I In-kind contribution
contribution ($) I description (if applicable)
. . .. IContributor address; City; State; Zip Code
I
i
,
(If travel outside of Texas, comolete Schedule Tl
Principal occupation I Job title (See Instructions)
I
Employer (See Instructions)
Date Full name of contributor o oul·of-slalo PAC (10#: ) Amount of I In-kind contribution
contribution ($) , description (if applicable)
Contributor address; City; State; Zip Code I
i I
I (If travel outside of Texas, complete Schedule T)
I
Principal occupation I Job title (See Instructions) Employer (See Instructions)
1
Date Full name of contributor o oul-of·slatoPAC(ID#: ) Amount of I In-kind contribution
contribution ($) I description (if applicable)
Contributor address; City; State: Zip Code I ,
I
!If travel outside of Texas, comolete Schedule T) I
Principal occupation I Job title (See Instructions) Employer (See Instructions)
I
Date Full name of contributor o out-of·Slale PAC (10#: ) I Amount of I In-kind contribution
I : conlribution ($) , description (if applicable)
Contributor address; City; Stale; Zip Code I
I
I (If travel outside of Texas, comolete Schedule Tl
I
J
Principal occupation I Job title (See Instructions) i Employer (See Instructions)
I
ATTACH ADDITIONAL COPIES OF THIS SCHEDU LE AS NEEDED
If contributor is out-oi-state PAC, please see instruction guide foradditional reporting requirements.
POLITICAL CONTRIBUTIONS
OTHER THAN PLEDGES OR LOANS
Jullie Merrifield Schultz
College Station City Council Place 5
Schedule A ( supplemental)
Contribution
------_. ---...... --~
4/12/11 Mark Kristen 1501 Independence Bryan 77803 individual $300.00
4/12/11 Peggy Calliham 1013 Holt CS 77840 individual $100.00
4/12/11 Tim Jones 716 Willow Loop CS 77845 individual $200.00
Total for 4114111 report $600.001
I
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
PLEDGED CONTRIBUTIONS SCHEDULE B
I
The Instruction Guide explains how to complete this form. 11 Total pages Schedule B: t
2 FILER NAM:J U-ex~i£lQld 1
3 ACCOUNT # (Ethics Commission Filers)
Ul\e S~l-r~
...
1$4 TOTAL OF UNITEMIZED PLEDGES: 9 9 ~ c::> 9
5 Date
1.6
Full name of pledgor o out-of-stale PAC (10#: ) 8 Amount of 19 In-kind description
pledge ($)
I (if applicable)
-* 17 Pledgor address; City; State; Zip Code I
I
NoJE; !
I
(If travel outside of Texas, complete Schedule T)
10 Principal occupation I Job tille (See Instructions) 111 Employer (See Instructions)
Date i Full name of pledgor o out-of-slate PAC (10#: ) I Amount of I In-kind description
pledge ($) I (if apptlcable)
Pledgor address; City; Slate; Zip Code
,
I
I
I
(If travel outside of Texas, complete Schedule T)
Principal occupation I Job tille (See Instructions)
I
Employer (See Instructions)
Date Full name of pledgor o out-of-slale PAC (ID#: ) Amount of , In-kind description
pledge ($) I (if applicable)
..
Pledgor address; City; State; Zip Code I
I
I
I
i (If travel outside of Texas, complete Schedule T)
Principal occupation I Job title (See Instructions)
i
Employer (See Instructions)
Date Full name of pledgor o out-ol-state PAC (ID#: ) Amount of I In-kind description
pledge ($) I (if applicable)
.. IPledgor address; City; State; Zip Code
I I
I
I
i (If travet outside of Texas. complete Schedule T)
Principal occupation I Job tille (See Instructions)
I
Employer (See Instructions)
Full name of pledgor o out·of-state :110#: \
I In-kind descriptionI , (if applicable)
i
Pledgor address; City; State; Zip Code
1
!
I
(If travel outside of Texas. complete Schedule T)
Principal occupation I Job lille (See Instructions)
I
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OFTHIS SCHEDULEAS NEEDED
If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements_
www.ethics.state.tx.us Revised 04121/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
LOANS SCHEDULE E
The Instruction Guide explains how to complete this form.
; Sched;l, E: {
2 FILER NAME I
Jvdi<:..
13 ACCOUNT # (Ethics Commission Filers) I
4
TOTAL OF UN ITEMIZED LOANS: $
5 Date of loan 7 Name of lender o out-of-state PAC (ID#:__________) 9 LoanAmount ($)
6 Is lender
a financial
Institution?
Y N
12 Principal occupation / Job title (See Instructions)
14 Description of Collateral
none
15 GUARANTOR
INFORMATION
o not applicable
16 Name of guarantor
17 Guarantor address;
19 Principal Occupation (See Instructions)
Date ofioaf'!
is lender
a financial
Institution?
Y N
Name of lender
Lender address; City;
i
I
Principal """'"oation I Job title n ,~tructi", ,~)
Description of Collateral
none
State; ") Zip Code
City;
State;
13 Emp''»,e' (See Instructions)
State; Zip Code
I 20 Employer (See Instructions)
i
o out-ot-state PAC (1D#:_________l
Zip Code
Employe
1 0 interest rate
11 Maturity date
i
1 B Amount Guaranteed ($)
In terest rate
Mat~ritY date
r---'--------.------------------------------------~.,----------------,-----------------~Amount Guaranteed ($)GUARANTOR
INFORMATION
I
I
Name of guarantor
Guarantor address;
,al Occupation (See J ,,, ucl" 1S)
City: State; Zip Code
(See InstrUctions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If lender is out-of-state PAC, please see instruction guide for additional reporting requirements.
www.ethics.state.tx.us Revised 0412112010
I
Texas Ethics Commission PO. Box 12070 Austin, Texas 78711·2070 (512) 463-5800 (TDD 1-800-735-2989)
POLITICAL EXPENDITURES SCHEDULE F
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense GiftlAwardslMemorials Expense Salaries/Wages/Contract Labor
Accounting/Banking Legal Services Solicitation/Fundraising Expense
Consulting Expense Food/Beverage Expense Travel In District
Event Expense Polling Expense Travel Out Of District
Fees Printing Expense Office Overhead/Rental Expense
1 Total pages Schedule F: '2
\
The Instruction Guide explains how to complete this form.
FILER NAMEj • /. I.J. ('" A 1 I ,l+7 I 3 ACCOUNT # (Ethics Commission Filers) u.1 \~ M..(;rrlhe c .J(,AI\...,... '-
4 Date , 5 Payee name
--~
6 Amount ($)
! 7 P"lJ~~'.'. "~
~··:P~U~R:P~O~S~E~------r,(~a~)~C~a:t:e:g:o~~~(s~e=e~c~al~eg;~;I;es;;,s;'tee;;da~llrhe~t~DP~o~t~th:iS~S:C~h.~d~ul:e~)-~-YI~~~)~D~e:s:c:riP:t:io:n~(I~tt:ra~v=el~o~u~='~d~e=ot~T~ex~a=s~,c=o:mp=':e:te:s~c~he-d~ul~e:T~)-------i
OF
EXPENDITURE
9 Complete Qli\.X if direct
expenditure to benefit CIOH
Date
Amount ($)
PURPOSE
OF
EXPENDITURE
Complete Q!:,!J,.t if direct
expenditure to benefit C/OH
Date
Amount ($)
I
PURPOSE I
OF '
EXPENDITURE I
Complete QNl.Y if direct
expenditure to benefit CIOH
Date
Amount ($)
PURPOSE
OF
EXPENDITURE
I
Complete .Q.!:!.bY if direct
expenditure to benefit CIOH
www.ethicS.state.tx.us
i
Candidate I Officeholder name Office sought Office held I
Payee name
I
Payee address; City; State: Zip Code
Catego~ (See categories listed at the top of this schedule) ! Description (If travel outside ofTexa., complele Schedule T)
I
Candidate I Officeholder name Office sought Office held
Payee name
Payee address; City; State: Zip Code
Catego~ (See categories lis led at the lop of this schedUle) Description (If Ira vel outside of Texas, complete Schedule T)
i
Candidate I Officeholder name Office sought Office held !
Payee name
Payee address: Cfty: State; Zip Code
--
Catego~ I See ca,egories D,,~Y••",u~, {If travel outSide ofTexas, complete Schedule TI
Candidate I Officeholder name Office sought Office held
ATIACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Loan RepaymenUReimbursement
Transportation Equipment & Related Expense
Contributions/Donations Made By
Candidate/Officeholder/Political Committee
OTHER (enter a category not listed above)
Revised 04/21/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
POLITICAL EXPENDITURES SCHEDULE GMADE FROM PERSONAL FUNDS
r-
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gif11Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Funoraising Expense Transportation Equipment & Related Expense
Consulting Expense FOOd/Beverage Expense Travel In District Contributions/Donations Made By
Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
1 Total pages Sched ule G:
I
'2
The Instruction Guide explains how to complete this form.
FILER NAMJu. .{t ~"\Ihlie M€.lrl Ie \ cL
13 ACCOUNT# (Ethics Commission Filers)
I
4 Date 5 Payee name
-~-I
6 Amount ($) 7 P'YMGD:Z~' !
Reimbursement from
political contributions
intended
8 PURPOSE (a) Category (See categories listed at the top of this schedule) I (b) Description (If travel oulside of Texas, complete Schedule T)
OF
EXPENDITURE
;.----.
Date Payee name
I
i
Amount ($) Payee address; City; State; Zip Code
0 Reimbursement from
polilical contributions
intended
PURPOSE Category (See categories listed at the lOP ofthis schedule) i Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
I
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Reimburs ement from
political conlributions
,ntended
PURPOSE Category (See categories listed at the top of this schedule) Description (If travel outside of Texas, complete SChedule T)
OF
EXPENDITURE
I
Date Payee name
Amount ($) City; Stale; Zip Code
D Reimbursement "U","•• , ..ii,
t-
PURPOSE C"",o~ "",,"__''''00 " .0 .""'"'~O",oo"io, 'Ii ''''"..,;,n."."m,~ <>~" "
OF
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDU LE AS NEEDED
www.elhicS.stale.lx.us Revised 04/21/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDO 1-800-735-2989)
PAYMENT FROM POLITICAL CONTRIBUTfONS SCHEDULE HTO A BUSINESS Or:: CtOH
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense GiftlAwards!Memorials Expense Salaries/Wages/Contract Labor Loan RepaymentlReimbursement
Accounting/Banking Legal Services Solicitation/Fund raising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made By
Event Expense Polling Expense Tra vel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
2 FILERNAME~ !3 ACCOUNT # (Ethics Commission Filers) 1 Total pages Schedule H:
lie. U&n£~--'J S'ch"ull:.-z\ i
4 Date 5 Business name \ i
6 Amount ($) , 7 B~I(d~~~;;'.~Zipr
~/
(a) Category (See calegonas IS eo al the lop of Inis schedule) i (b) Description (If Ira vel oulslde ofTexas, complete Schedule T)PURPOSE
OF
EXPENDITURE
B
I
Candidate I Officeholder name Office sought Office held9 Complete QIiI.Y if direct
expenditure to benefit C/OH
i
Business nameDate
Amount ($) Business address; City; State; Zip Code
I Category (See categories listed at the top aflnis scnedule) Description (If travel outside of Texas. complete Scnedule T)
OF I
PURPOSE
EXPENDITURE
Candidate I Officeholder name Office soughI Office heldComplete QtjL;( if direct
expenditure to benefit CtOH
Business nameDate
lusiness address; City; State; Zip CodeAmount ($)
Category (See categories listed at the lop of this schedule) Description (If travel outside of Texas. complete Schedule T)PURPOSE
OF
EXPENDITURE
Candidate t Officeholder name Office sought Office heldComplete Qtlb'( if direct
expenditure to benefit C/OH I
Business nameDate I
Busi'1e"" City; State; Zip CodeAmount ($)
i
Description (tf Ira vel outside of Texas, complete Schedule T)Category (See calegories listed at the lOp of this schedule)I>URPO'lE
;::: ,~ .~..,..I I
Candl ,/Officeholdel name Office soug ht Office heldComplele Q!I!1Y if direct Iexpenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS NEEDED
www.ethics.state.tx.us Revised 04/21/2010
---
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
NON-POLITICAL EXPENDITURES SCHEDULE IMADE FROM POLITICAL CONTRIBUTIONS
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contrac! Labor Loan RepaymentfReimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made By
Event Expense Polling Expense Tra vel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
2 FILER NAME 3 ACCOUNT # (Ethics Commission Filers) 1 Tolal pages Schedule I:
1
\ paye2~~l ~ Me.crt{ie Ic! f c.,lt.t 1+ Z-
4 Date 5
7 'Payee address; Zip Code6 Amount ($) --~~ c~J~Js
(a) Category (See categories listed at the top of this schedule) (b) Description (See instructions regarding type of information reQuired.)8 PURPOSE
OF
EXPENDITURE
Payee nameDate
Amount ($) Payee address; City; State; Zip Code
Category (See categories listed at the lOP of this schedule) Description (See instructions regarding type of information required.)PURPOSE
OF
EXPENDITURE
I
I
Dale
Payee name
Amount ($) Payee address; City; State; Zip Code
Category (See categories listed at the top of this senedule) Description (See instructions regarding type of information reQuired.)PURPOSE
OF
EXPENDITURE
Payee nameDate
Payee address; City; Slate; Zip CodeAmount ($)
Category (See categories listed at the top of this senedule) Description (See ir.~truction~ regarding type of information required,) PURPOSE
OF I
I EXPENDI11JRE~
AITACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.elhics.slaie.lx.us Revised 04/21/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CREDITS (optional) SCHEDULE K I
!
I
. 1 Total pages Schedule K;
\
i
The Instruction Guide explains how to complete this form.
2 FILER NAME JllHe MU\\g-e1 c S'c1 LA H--z
3 ACCOUNT # (Ethics Commission Filers)
4 Date 5 Payor name i8 Amount
($)
6 Payor address; City; State; Zip Code
~-~-
/ \
7 R'.'O"'O"~~OfJ.(::..-/
I
i
Date Payor name Amount
($)
Payor address; City; State; Zip Code
i
Reason for credit
i
Date Payor name Amount
($)
Payor address; City; State; Zip Code
Reason for credit
Date Payor name Amount
($)
Payor address; City; State; Zip Code
Reason for credit
: I
Date
i
Payor name Amount
($)
Payor address; City; Stale; Zip Code
i
Reason for credit
I I
!
ATTACH ADDiTIOh!AL COPIES OF THIS SCHEDULE AS NEEDED
www.ethicS.stale.tx.us Revised 04/21/2010
I
Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 (TDO 1-800-735-2989)
IN-KIND CONTRIBUTION OR POLITICAL EXPENDITURE SCHEDULE T
FOR TRAVEL OUTSIDE OF TEXAS
[1 Tolal pages Schedule T:The Instruction Guide explains how to complete this form.
!
12 FILER NAME Ju.\ ie AA.~t't0~IdS"c.kLA-l+--zi 3 ACCOUNT # (Ethics Commission Filers)
4 Name of Contributor I Corporation or Labor Organization I Pledgor I Payee
5 Contribution I Expenditure reported on:
SChedule A Schedule B C Schedule C D Schedule D Schedule F Schedule G
Schedule H D Schedule N C COH-UC COH-T PAC-C PAC-E
6 Dates of travel
I
7 Name of person(s) traveling / "CC-::CC::::::"'-"':::l~,
8 Departure city or name of departure location ( N.01lb '~
9 Destination city or name of destination location ---~i
10 Means of transportation 11 Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor I Corporation or Labor Organization I Pledgor I Payee
Contribution I Expenditure reported on:
D Schedule A D Schedule 8 Schedule C Schedule D C SChedule F D Schedule G
Schedule H Schedule N COH-UC D COH-T D PAC-C D PAC-E
Dates of travel i Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
-I
Means of transportation I Purpose of travel (including name of conference, seminar, or other event)
i
Name of Contributor I Corporation or Labor Organization I Pledgor I Payee
Contribution I Expenditure reported on:
Schedule A D Schedule B Schedule C Schedule D D Schedule F 0 Schedule G
nL...! Schedule H D Schedule N D COH-UC COH-T PAC-C PAC-E
Dates of '\_ . travelin!
Departure city or name of departure location
Destination city or name of destination location
Means ,,-,pvrt8tiw Purpose ofl . (irl<-Iudi, Iy name of conference, seminar, or other event)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 04/21/2010