Loading...
HomeMy WebLinkAbout141006 - Campaign Finance Report - Julie SchultzTexas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989) CANDIDATE / OFFICEHOLDER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 1 I ACCOUNT# 2 Total pages filed: The C/OH Instruction Guide explains how to complete this form. Ethics Commission Fliers) 3 CANDIDATE / MS/MRS/MR FIRST MI OFFiC( U I EON (i OFFICEHOLDER ti i,.• - NAME IT5. .SU..LlIs 1 cI DateRecelved ( 6( NICKNAME LAST SUFFIXIlk 0 A II.....rZ 4 CANDIDATE / ADDRESS/PO BOX; APT/SUITE#; CITY, STATE; ZIP CODE i°'m° OFFICEHOLDER . 3205 u m "" 1 00 1.1 MAILING S Date Hand-delivered or Postmarked ADDRESS Receipt M - Amountchangeofaddress __ m^ _.... EXTENSION l4 7',rsT't 5 CANDIDATE/AREA CODE PHONE NUMBER OFFICEHOLDER Date Processed r PHONE l 6 CAMPAIGN MS/MRS/MR FIRST MI Date Imaged TREASURER l-ri _ NAME NICKNAME LAST SUFFIX i 7 CAMPAIGN STREET ADDRESS(NO PO BOX PLEASE); APT/SUITE#;CITY; STATE; ZIP CODE TREASURER —1(4,... \.J L LOOtiJ L_OofADDRESS residence or business) L-. S7.1:%7c`Oal t C -1-1 6 c_L_S--- 8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE L• 11 /(91') 221 - qG, ' 9 REPORT TYPE D January 15 I30th day before election Runoff 1 15th day after campaign treasurer appointment officeholderonly) El July 15 El 8th day before election n Exceeded$500 ri Final report(Attach C/OH-FR) limit 10 PERIOD Month Day Year Month Day Year COVERED 1 / / 14- THROUGH 1 / 4.. / m t. 11 ELECTION ELECTION DATE ELECTION TYPE Month Dry Year Primary 0 Runoff General El Spedal 1l / 14 / 1 12 OFFICE OFFICE HELD(If any) 13 OFFICE SOUGHT (If known) 1-,0..1. GOTO PAGE 2 www.ethics.state.tx.us Revised 07/28/2014 Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070- (512)463-5800 (TDD 1-800-735-2089) CANDIDATE / OFFICEHOLDER REPORT SUPPORT & TOTALS COVER SHEET PG 2 m 1614C/OH cm NAMEACCOUNOUNT# (Ethics Commission Filers uolA i' p Q—LIlbe 16 NOTICE FROM THIS BOX IS FOR NOTICE OF POUTICAL CONTRIBUTIONS ACCEPTED OR POUTICAL EXPENDITURES MADE BY POUTICAL COMMITTEES TO SUPPORT THE POLITICAL CANDIDATE I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE IMTHOUT THE CANDIDATE'S OR OFFICEHOLDERS KNOWLEDGE OR COMMITTEE(S) CONSENT.CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES. COMMITTEE NAME COMMITTEE TYPE n GENERAL COMMITTEE ADDRESS n SPECIFIC COMMITTEE CAMPAIGN TREASURER NAME additional pages COMMITTEE CAM mm,.._, PAIGN TREASURER ADDRESS 17 TOTALS PLEDGES, CONTRIBUTION 1 OTAL LITICAL CONTRIBUTIONS OF LOANS,OR GUARANTEES 0$ LO OR LESS CINLESSETHAN R ITEMIZED $98,11j 2. TOTAL POLITICAL CONTRIBUTIONS OTHER THAN PLEDGES,LOANS,OR GUARANTEES OF LOANS) aSt ,. EXPENDITURE 1 TOTALS 3. TOTAL POLITICAL EXPENDITURES OF$100 OR LESS,UNLESS ITEMIZED 4. TOTAL POLITICAL EXPENDITURES CONTRIBUTION 5 TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY BALANCE OF REPORTING PERIOD OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE $ LOAN TOTALS LAST DAY OF THE REPORTING PERIOD 343W m 61 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 Oynk,, ,cw,r,Ir h Fie n yafJ ,rr r » r, me uppdd(r title 15, Election Code. CORNELIUS ,,,i1 1I Not Public, ate of Texas i Lit 1 !' My Commission Expires is ' i!' i Ii i , Signature of tceh¢Vder AFFIX NOTARY STAMP/SEAL ABOVE r Sworn tLok.o and subscribed before me, by the said t twVIrt "DC-AN-u-1 " this the t-day of :, 20 Ilk , to certify which, witness my hand and seal of office. g_ .._._.._.... Sign officer administering oath_ _....,P ted name of officer admini sterin oath Title of officer d vl/„fi e _. a ailgn arrt of adrrlancsts;ri oath 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 SCHEDULE A OTHER THAN PLEDGES OR LOANS The Instruction Guide explains how to complete this form. 11 Totaa_ . l pages Schedule A. 2 FILER NAME 3 ACCOUNT# (Ethics Commission Filers) U L kiev .. „ 7 R.1 II L=rz si/A- o_.._._n_ i r 6_.. D# ...... 7oAm u Amount description cnt. 4 Date 5 Full name of contributor 0 out-of-state PAC(ID#: Amount of 8 In-kindcontribution c iption (if applicable) 6 Contributor address; City; State; Zip Code If travel outside of Texas,complete Schedule T) 9 Principal occupation/Job title(See Instructions) m._.. s) 10 Employer(See Instructions) aP ... f contributor..----_ a ___....... ........ Date Full name'ocaEl out-of-state PAC(10# 1 Amount of q In-kind contribution contribution ($) description (if applicable) Contributor address; City; State; Zip Code fravel outside of Texas,com•lete Schedule Prine p cpaton/Job title(See Instructions) mrnptyer(See Instructions) DatAmount of 1 In-kind contribution contribution ($) description (if applicable) Full namd of-Contributor out-of-state PAC(IDN: 1 it Contributor address; City; State; Zip Code ry If travel outside of Texas,complete Schedule T) Principal occupation/Job title(See Instructions)Employer(See Instructions) Date Full name of contributor 0 out-of-state PAC(ID#: Amount of N In-kind contribution contribution ($) description (if applicable) Contributor address; Cit C.oCity:. State; Zip de If Texas,complete Schedule Tj_, Employer travel outside of Principal occupation/Job title(See Instructions) tSeeInstructions) ibut I contribution nfDateFullnameofcontributorout-of-state PAC(IFS desn- kiitioncontribution applicable) Contributor address; City; State; Zip Code If travel outside of Texas,complete Schedule T.)•__.. Seeoccupation/Job title (See Instructions)Employer S 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 07/28/2014 POLITICAL CONTRIBUTIONS OTHER THAN L LOANS Julie Merrifield Schultz College Station City Council Place 5 Schedule A ( supplemental) Contribution Date Contributor Address Cit Occu*ation Amount 8/5/14 W. A. Prewitt III 12302 Scotne CS 77845 individual 500.00 8/5/14 Rand French 4301 Cli•stone CS 77845 individual 1,000.001, 8/5/14 Chuck&Tedi Ellison 2902 Camille ICS 77845 individual 200.00 8/13/14 Hunter Goodwin 1011 L ceum CS 77845 individual 250.00 8/13/14 Casey Oldham 2003 Moses Creek Ct CS 77845 individual 250.00 8/13/14 Don Lewis 1511 South Texas Ave CS 77840 individual 500.00 8/15/14 Mike Holm.reen 5118 Bellevive Bend CS 77845 individual 500.00 9/5/14 Michael Schaefer 18599 Anasazi Bluff CS 77845 individual 500.00 9/5/14 Mark Hum•hre 4406 Re•al Oaks CS 77845 individual 250.00 9/26/14 Wallace & Dawn Phillies 4490 Castle.ate Dr CS 77845 individual 1,000.00 9/26/14 CS Professional Firefi•hters P.O. Box 10882 CS 77842 PAC 1,500.00 for Res•onsible Government 9/26/14 Bill & La ne Ave t 1009 Walton CS 77845 individual 200.00 9/26/14 Steve & Dorinda Arden 311 Cecilia Loo• CS 77845 individual 150.00 9/26/14 Ton Jones 1401 Sebesta Rd CS 77845 individual 200.00 9/26/14 Don Jones 6166 Im•erial Loo• Suite 10 CS 77845 individual 250.00 9/26/14 Bill Lero 4421 Nottin•ham B an 77802 individual 500.00 9/26/14 Kenn Mallard 819 Rosema B an 77802 l individual 100.00 9/26/14 Justin Whitworth 1027 Walton CS 77840 individual 100.00 9/26/14 Paul Mur•h 12633 St Hw 30 ICS 77845 individual 250.001 10/3/14 Joe&Janet Johnson P.O. Box 800 Coleman, TX individual 250.00' 10/3/14 Ivan Olson 3008 Coronado CS 77845 individual 150.00 10/3/14 Sue Ellen Davis 15120 E OSR B an 77808 individual 100.00 10/3/14 James P. Bo Miles 1 P.O. Box 10467 CS 77842 lindividuA 500.00 10/3/14 Rick Hill 5000 Con.sessional CS 77845 indrvidual 100.00 10/3/14 Mark Kirsten 1501 Inde•endence Ave B an 77803 individual 250.00, ummemommum Total for 10/6/14 re•ort 9,550.00 Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 11-800-735-2989) PLEDGED CONTRIBUTIONS SCHEDULE B tion Guide explains how to completeTheInstruction Schedule .. 1 Total pages B: p piete this form. 2 FILER NAME 3 ACCOUNT# (Ethics Commission Filers) II 1r it lid. l 6. rik 16 1 U ,.- w V ' 4 TOTAL OF UNITEMIZED PLEDGES:b b U 5 Date 6 Full name of pledgor 0 out or•etett PAC(IDS, 1 8 Amount of u 9 In-kind description pledge ($) I if applicable) 5 Pledgor address; City; State; ZtC:ode 1 I 11111 1 1 II IIIr 11 If travel outside of Texas,complete Schedule T) 10 Prundry al occupation l-.. w...-_._--.--__-_ Job title(See Instructions) Employer(See Instructions) Date Full name of pledgor 0 out-of-state PAC(D# Amount of In-kind description pledge ($) if applicable) Pledgor address; City; State; Zip Code I l If travel outside of Texas,complete Schedule T) Principal occupation/Job title((See Instructions) 1 Employer(See Instructions) Date 1 Full name of pledgor out-of-state PAC(ID# Amount of In-kind description pledge ($) if applicable) Pledgor address; City; State; Zip Code Iy If travel outside of Texas,complete Schedule T) Principal occupation/Job title(See.._.Instructions) Employer(See Instructions) mmIT Date Full name ofout-of-statepledgor PAC(6 Amoun...t of In-kind description I pledge ($) if applicable) Pledgor address; City; State; Zip Code If travel outside of Texas,complete Schedule T) Princial occupationon/Job title(See Instructions) L Employer See I nstructions) Date Full name of pledgor out-of-statePAC(IN Amount of In-kind description pledge ($) if applicable) 1 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 07/28/2014 Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TOD 1-800-735-2989) LOANS SCHEDULE E Total pages Schedule E: The Instruction Guide explains how to complete this form. E:1 2 FILER NAME 3 ACCOUNT# (Ethics Commission Filers) j ,„ Am11 " JfiJ1dIID-. ........_n i 4 TOTAL OF UNITEMIZED LOANS: b b b 5 Date of loan 7 Name of lender 0 out-of-state PAC(ID#:9 oan Amount(5) 6.. uwu i,,t,r p 10 m......_.... 6 Is lender 8 Lender address; City; State; Zi Code 10 Interest rate a financial Institution? 1 1. 11 Maturity date Y N o »»Il e,III If 12 Principal occupation /Job title (See Instructions) II 13 Employer (See Instructions) I ifCheckpersonal funds were deposited a.w.....__._...._........._., 14 Description of Collateral 15 posited into political account none 16 GUARANTOR 117 Name of guarantor 19 Amount Guaranteed($) INFORMATION 18 Guarantor address; City; State; Zip Code not applicable 20 Principal Occupation (See Instructions) 21 Employer (See Instructions) m ww.. .._....__ m..._...._.__._.m out-or-state PAC ID#._... w-...._.._. Loan Amount...Date of loan Name of lender Lender address; Is lender City; State; Zip Code Interest rate a financial Institution? Maturity date Y N Principal occupation /Job title (See Instructions) Employer (SeeInstst aructions) Description..........._.._ __....._._ a....,....m... a ......._. m. personalofCollateralCheckif funds were deposited into political account none GUARANTOR__....._.. _Name..._..,.,,.^., ww..._..._. _....m. ..V..........._.....m. ..m........, . of guarantor Amount Guaranteed($) INFORMATION Guarantor address; City; State; Zip Code not applicable Principal Occupation (See Instructions) Employer ( SeeInsttructtr.. ionnss) 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 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 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 $ 7addressPayee ZipCity;State; ipCode 8 PURPOSE a) Category(See categories listed at the top of this schedule) (b) Description (If travel outsidemmmmT) _.-. .otTexas,complete Schedule T OF EXPENDITURE D Check IfAustin,TX,officeholder living expense 9 Complete ONLY if directCandidate/Officeholder name. .-''•- Office sought Office held expenditure to benefit C/OH Date Payee n `e II II Pa ee actd ass;City; State; Zip CodeAmount $) Y m . r„ w,v,....._..m....... Category catecategories listed at the top of_._... .,.,.. w•..._. m m........_W..._.._......_.m PURPOSE 9 ry (See9this schedule) Description (If travel outside of Texas,complete Schedule T) OF EXPENDITURE 0 Check if Austin,TX,officeholder living expense1 Candidate/Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Amount ($) Payee address;City; State; Zip Code top schedule) Description (If travel outside of Texas,complete ScheduleattheofthissCategory(See categories listed Schedule T) PURPOSE OF EXPENDITURE Check ifAustinTX,officeholder living expense htholdOfficesought 66_.......... _.__.. ...... _._...._.m, Complete ONLY if direct Candidate/OfficeOfficeholder nameOffice held expenditure to benefit C/OH Date Payee name Amount ($) . ...... Payee address; ................City; State; Zip w.. ..._ ....... .. ......_..._., Code Category (See categories listed at the top of this schedule) Description (If travel outside of Texas,complete Schedule T) PURPOSE OF I_.. EXPENDITURE D Checkheck..ifAus.tin TX officeholder living expense CometONLY if direct Candidate/Officeholder name Office sought e Office held expenditure to benefit C/OH ATTACH ADDITIONAL COPIES OF THIS SCHEDULE_._._.._.._.._ mm_.._. . DII . AS NEEDED www.ethics.state.tx.us Revised 07/28/2014 Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989) POLITICAL EXPENDITURES SCHEDULE G MADE FROM PERSONAL FUNDS EXPENDITURE CATEGORIESORIES FOR BOX 8(a) Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement Accounting/Banking Legal Services SolicitationlFundralsing Expense Transportation Equipment&Related Expense Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made By Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee Fees Printing Expense Office Overhead/Rental Expense OTHER(enter a category not listed above) The Instruction Guide explains how to complete this form. 1 Total pages Schedule G: 2 FILER NAME 3 ACCOUNT# (Ethics Commission Filers) 4 Date 5 Payee name 6 Amount 7 Payee address;City; State; Zip Code,--' Reimbursement from political contributions 11intended 8 PURPOSE a)Category_._..See categories listed at the top of this sChule)t7) Description(If travgin ide of Texas,complete Schedule T) OF EXPENDITURE Check ifAustin,TX,officeholder living expense Date Payee name Amount ($) Payee address;City; State; Zip Code w w. ..____... LiReimbursement from political contributions Intended m ._._...— ,,.''_.....m.., Category(See categories listed at the 1.._.__.. LL _,.. ._.._ PURPOSE g ry op of this schedule) Description (If travel outside of Texas,complete Schedule T) OF EXPENDITURE Check If Austin,TX,officeholder living expense Date __.... Payee name Amount ($)Payee address;City; State; Zip Code Reimbursement from political contributions intended Category(See categories listed at the top of this schedule) Description (If travel outside of Texas,complete_ a......__ Cate.._..._..Schedule T) PURPOSE OF EXPENDITURE Check ifAustin,TX,officeholder living expense Date Payee name Amount ($) Payee address;City; State; Zip Code Reimbursement from Li political contributions intended Category(See categories listed at the top of this schedule) p Texas,completeDescription (If travel outside of com late Schedule T) PURPOSE OF EXPENDITURE Check IfAustin,TX,officeholder living expense 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 (TOD 1-800-735-2989) PAYMENT FROM POLITICAL CONTRIBUTIONS SCHEDULE H TO A BUSINESS OF C/OH 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/1(Ethics Commission Filers) L ak F Er-j--1) 4 Date 5 Business name City; Zip6Amount7Businessaddress; State; Code M\, categories pD _8. mITmm PURPOSE a) Category (See listed at the topof thisole) L... Des s, comS h . s b) es 'uptimn (Ifiraveloutsi¢s^:fTsxas.completeScheduleT) OF scu u EXPENDITURE Check i(Austin,TX,officeholder living expense 9 Complete ONLY if direct... ._.. Candidate/Officeholder name Office sought Office held expenditure to benefit C/OH Date .._...... a...,._......a a m.......__._.._._. w.,......._.. Business name Amount ($) Business address; City; State; Zip Code W WWn PURPOSE Category (See categories listed at the top of this schedule)chde ofTe ascomm-.._ Cate ochedule) Description (If travel outside of Texas,complete Schedule T) OF EXPENDITURE Check if Austin,TX,officeholder living expense Complete ONLY if direct Candidate/Officeholder name ....._. __..... m.A.... ._.. Office sought Office held expenditure to benefit C/OH Date Business name Amount ($)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 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 ($). m._._ Business address; City; State; Zip Code Category (See categories listed at the topof this s-_..._ m e..a ........._........ .. ......^.. ..._m.,„ .... _ PUR POSE 9 ry 9chedule) Description (If travel outside of Texas,complete Schedule T) OF EXPENDITURE 0 Check if Austin,TX,officeholder living expense Candidate/OfficeholderCompleteONLYifdirect 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 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989) NON-POLITICAL EXPENDITURES SCHEDULE I MADE FROM POLITICAL CONTRIBUTIONS The Instruction Guide explains how to complete this form. 1 Total pages Schedule I: 2 FILER NAME 3 ACCOUNT#(Ethics Commission Filers) 4 Date 5 Payee name 6 Amount ($7 Pay ee address;City; State; Zip Co 1 8 PURPOSESE (a) categories) Category (See instructions for pof acceptable Q, scrIpi trLexamplesM+,Ion Safs.instriidions regarding type of information required.).. . EXPENDITURE Date Payee name Amount ($) Payee address;City; State; Zip Code PURPOSE a)Category (See Instructions for examples of acceptable b)Description (See instructions regarding type of information O F categories)required.) EXPENDITURE Date Payee name Amount ($) I Payee address;City; State; Zip Code PURPOSE a) Category (See instructions for examples of acceptable b)Description (See instructions regarding type of Information OF categories)required.) EXPENDITURE Date Payee name Amount ($) Payee address;City; State; Zip Code PURPOSE a)Category (See instructions for examples of acceptable b) Description (See Instructions regarding type of information O F categories)required.) EXPENDITURE 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 (TDD 1-800-735-2989) INTEREST EARNED, OTHER CREDITS/GAINS/ REFUNDS, AND PURCHASE OF INVESTMENTS SCHEDULE K The Instruction Guide explains how to complete this form. 1 Total pages Schedule K: 1 2 FILER NAME p 3 ACCOUNT# (Ethics Commission Filers) 4 4 Date 5 Name of person from whom amount is received8 Amount of pers,orr'rfom whom amount is" ceivr6Address d City;State;Zip Code for7Purpose amount is receivedwhich Date Name of person from whom amount is received 11 Amount I 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 I Purpose for which amount is received 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 (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) s.lr ... _ 4LFIL `rob 4104 4 Name of Contributor/Corporation or Labor Organization/Pledgor/Payee 5 Contribution/Expendit ure reported on: Schedule A IT Schedule B Schedule C Schedule D n Schedule F Schedule G n Schedule H n Schedule N n COH-UC n COH-T PAC-C PAC-E 6 Dates of travel 7 Name of person(s)traveling 8 Departure city or name of departure ocato+n 9 Destination city or name of destination location "' w 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: n Schedule A n Schedule B S• chedule C n Schedule D Schedule F Schedule G ET Schedule H n Schedule N n C• OH-UC COH-T n PAC-C PAC-E arsonof s _.___.. Dates of travel Name p ( )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 otherevent) Name of Contributor/Corporation or Labor Organization/Pledgor/Payee Contribution/Expenditure m._... ......_, _. w_.YY...__.._.... ereported on: n Schedule A n Schedule B n Schedule C n Schedule D Schedule F Schedule G n Schedule H Schedule N n C• OH-UC COH-T PAC-C n PAC-E Dates of travel m._.._. ._..._.. 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) II ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED www.ethics.state.tx.us Revised 07/28/2014