HomeMy WebLinkAbout191001 - Campaign Finance Report - Karl P. MooneyMONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
The Instruction Guide explains how to complete this form. 1 Total pages Schedule Al
2 FILER NAME `erg 3 Filer ID (Ethics Commission Filers)
4 Date Full name of contributor ❑ ou -of-state PAC (to#: Amount of contribution ($)
6 Contributor address; City; State; Zip Code
8 Principal occ pation / Job title (See Instructions) 9 Em toyer (Se,� Instructions)
Date Full.naTTM of contributor ❑ out-of-state PAC (to#: Amount of contribution ($)
li� s./ C)o utor address; City; Sta Zip Code '2
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Princ�accupat� b ee In tructi ns) f E Io eee Instructions)
Date
Full name of con utor ❑ out-of-state PAC (ICE#:
A ount of contribution ($)
Contributor. address; City; State; Zip Code
a
Principp�l occupation / Job title (See Instructions) Emlo e ee Instructions)
Date Fu name of contributor > ❑ out-of-state PAC tloTM: Amount of contribution ($)
F; Contributor address; City; State: Zip Code
Principal occupation job tit e (See Instructions) Er
t�ploy�e'r (Seeii Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
MONETARY POLITICAL CONTRIBUTIONS
SCHEDULE Al
The Instruction Guide explains how to complete this form. 1 Total pages Schedule At__7
2 FILER NAME /ten 3 Filer ID (Ethics Commission Filers)
c
,/ rX /1
4 Date 5 Full nam of contri utor out-of-state PAC (ID#: 7 Amount of contribution ($)
,,
6 Contributor address; City; State; Zip Code
8 Principal occupation / Job titl (See I ctions) `g Employer k8yj Instru ns)
4ull rDate name of cont ibuto ❑ out-of-state PAC (ID#: Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor ❑ out-of-state PAC (ID#:
. . . . . . . . . . .
Contributor address; City; State; Zip Code
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor ❑ out-of-state PAC (ID#:
Contributor address: City; State; Zip Code
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Amount of contribution ($)
Amount of contribution ($)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
SUBTOTALS - C/OH
FORM C/OH
COVER SHEET PG 3
19 FILER NAME 20 Filer ID (Ethics Commission Filers)
� �/ , r
21 SCHEDULE S BTOTALS / SUBTOTAL
NAMEOFSCHEDULE ff AMOUNT
1. 14�SCHEDULEAI: MONETARY POLITICAL CONTRIBUTIONS $�S�
2- F_/fr SCHEDULE A2: NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS $ 0
3. f" SCHEDULE B: PLEDGED CONTRIBUTIONS $
4. SCHEDULE E: LOANS $ C
5. SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $
6. �' SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $
7" SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $
i
8" SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $
i
9. SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS $
10. SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $
r-�
11. SCHEDULE 1: NON -POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ /
12 '�SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS
$ RETURNED TO FILER
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
NON -MONETARY (IN -KIND) POLITICAL
CONTRIBUTIONS
SCHEDULE A2
The Instruction Guide explains how to complete this form. 1 Total pages Schedule A2:
F
2 -f f f Ethics Commission Filers
FILER NAME ,% 3 Filer ID F �� ( )
4 TOTAL 0( UNITEMIZED IN -KIND POD, ICAL CONTRIBUTIONS
5 Date 6 Full name of contributor ❑ out-of-state PAC (IDF: 8 Amount of 9 In -kind contribution
Contribution $ description
. . . . . . . . . . . . . . . . . .
7 Contributor address; City; State; Zip Code
❑Check if travel outside of Texas. Complete Schedule T.
10 Principal occupation / Job title (FOR NON -JUDICIAL) (See Instructions) 11 Employer (FOR NON-JUDICIAL)(See Instructions)
12 Contributor's principal occupation (FOR JUDICIAL)
14 Contributor's employer/law firm (FOR JUDICIAL)
16 If contributor is a child. law firm of parent(s) (if any) (FOR JUDICIAL)
Date Full name of contributor ❑ out-of-state PAC (IDii:
13 Contributor's job title (FOR JUDICIAL) (See Instructions)
15 Law firm of contributor's spouse (if any) (FOR JUDICIAL)
. . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Principal occupation / Job title (FOR NON -JUDICIAL) (See Instructions)
Contributor's principal occupation (FOR JUDICIAL)
Contributor's employer/law firm (FOR JUDICIAL)
If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL)
Amount of In -kind contribution
Contribution $ description
Check if travel outside of Texas. Complete Schedule T.
Employer (FOR NON-JUDICIAL)(See Instructions)
Contributor's job title (FOR JUDICIAL) (See Instructions)
Law firm of contributor's spouse (if any) (FOR JUDICIAL)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
PLEDGED CONTRIBUTIONS
The Instruction Guide explains how to complete this form. 1 Total pages Schedule B:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF 6NITEMIZED PLEDGES
S Date 6 Full name of pledgor ❑ ou of -state PAC (ID#: 8 Amount 9 In -kind contribution
of Pledge $ description
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .A?
7 Pledgor address; City: State; Zip Code
❑ Check if travel outside of Texas. Complete Schedule T.
10 Principal occupation / Job title (See Instructions) 111 Employer (See Instructions)
Date Full name of pledgor ❑ out-of-state PAC (011: Amount In -kind contribution
of Pledge $ description
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pledgor address; City; State; Zip Code
❑ Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions) I Employer (See Instructions)
Date Full name of pledgor ❑ out-of-state PAC (ID#: Amount of In -kind contribution
Pledge $ description
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pledgor address; City; State; Zip Code
❑ Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of pledgor ❑ out-of-state PAC (ID#: Amount of In -kind contribution
Pledge $ description
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pledgor address; City; State; Zip Code
❑ Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions) I 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.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
LOANS SCHEDULE E
The Instruction Guide explains how to complete this form. 1 Total pages Schedule E
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF`UNITEMIZED LOANS $
5 Date of loan 7 Name of lender ❑ out-of-state PAC (IDff: 9 Loar� Amoun
� GG'
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Is lender 8 Lender address; City; State; Zip Code
10 Interest rate
a financial
Institution?
11 Maturity date
Y N
12 Principal occupation / Job title (See Instructions) 13 Employer (See Instructions)
14 Description of Collateral 15 Check if personal funds were deposited into political
account (See Instructions)
❑ none ❑
16 GUARANTOR 17 Name of guarantor 19 Amount Guaranteed ($)
INFORMATION
. . . . . . . . . . . . .
18 Guarantor address; City; State; Zip Code
❑ not applicable
20 Principal Occupation (See instructions)
Date of loan Name of lender
21 Employer (See Instructions)
❑ out-of-state PAC (ID#-.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is lender Lender address; City; State; Zip Code
a financial
Institution?
Y N
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Loan Amount ($)
Interest rate
Maturity date
Description of Collateral Check if personal funds were deposited into political
account (See Instructions)
❑ none ❑
GUARANTOR Name of guarantor Amount Guaranteed ($)
INFORMATION
Guarantor address; City; State; Zip Code
❑ not applicable
Principal Occupation (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If lender is out-of-state PAC, please see instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS
EXPENDITURE CATEGORIES FOR BOX $(a)
Advertising Expense Event Expense LoanRepayment/Reimbursement
Accounting/Banking Fees Office Overhead/Rental Expense
Consulting Expense Food/Beverage Expense Polling Expense
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1: 2 FILER NAME
4 Date 5 Payee name
6 Amount ($) 5 7 Payee address; City; State; Zip Code
PURPOSE
OF
EXPENDITURE
9 Complete ONLY if direct
expenditure to benefit C/OH
Date
Amount ($)
PURPOSE
OF
EXPENDITURE
Complete ONLY if direct
expenditure to benefit C/OH
Date
Amount ($)
PURPOSE
OF
EXPENDITURE
(a) Category (See Categories listed at the top of this schedule)
Complete ONLY if direct
expenditure to benefit C/OH
Candidate / Officeholder name
Payee name
Payee address; City; State; Zip Code
Category (See Categories listed at the top or this schedule)
Candidate / Officeholder name
Payee name
Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Candidate / Officeholder name
SCHEDULE F1
Solicitation/Fundraising Expense
Transportation Equipment & Related Expense
Travel In District
Travel Out Of District
Other (enter a category not listed above)
3 Filer ID (Ethics Commission Filers)
(b) Description
❑ Check if travel outside of Texas. Complete Schedule T.
❑ Check if Austin, TX, officeholder living expense
Office sought
Office held
Description
❑ Check if travel outside of Texas. Complete Schedule T.
❑ Check if Austin. TX, officeholder living expense
Office sought
Office held
Description
❑ Check if travel outside of Texas. Complete Schedule T.
❑ Check if Austin, TX, officeholder living expense
Office sought
Office held
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
UNPAID INCURRED OBLIGATIONS
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense
Event Expense Lcan Repayment/Reimbursement
Accounting/Banking
Fees Office Overhead/Rental Expense
Consulting Expense
Food/Beverage Expense Polling Expense
Contributions/Donations Made By
Gift/Awards/Memorials Expense Printing Expense
Candidate/Officeholder/Political Committee
Legal Services Salaries/Wages/Contract Labor
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F2:
I 2
FILE 'ME
4 TOTAL OF UNITEMIZEUNPAID INCURRED ®BLIGAT NS
5 Date 6
Payee name
7 Amount ($)
9 TYPE OF
EXPENDITURE
10
PURPOSE
OF
EXPENDITURE
11 Complete ONLY if direct
expenditure to benefit C/OH
Date
Amount ($)
TYPE OF
EXPENDITURE
PURPOSE
OF
EXPENDITURE
Complete ONLY if direct
expenditure to benefit C/OH
8 Payee address; City; State; Zip Code
SCHEDULE F2
Solicitation/Fundraising Expense
Transportation Equipment & Related Expense
Travel In District
Travel Out Of District
Other (enter a category not fisted above)
3 Filer ID (Ethics Commission Filers)
Political Non -Political
(a) Category (See Categories listed at the top of this schedule) (b) Description
Check if travel outside of Texas. Complete ScheduleT.
Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Payee name
Payee address; City; State; Zip Code
El Political Non -Political
Category (See Categories listed at the top of this schedule) Description
ElCheck if travel outside of Texas. Complete Schedule T.
Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.:x.us Revised 9/8/2015
PURCHASE OF INVESTMENTS MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F3
1 Total pages Schedule F3:
The Instruction Guide explains how to complete this form.
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 fName of person from whom investment i urchased
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Address of person from whom investment is purchased; City; State; Zip Code
7 Description of investment
8 Amount of investment ($)
Date Name of person from whom investment is purchased
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom investment is purchased; City; State; Zip Code
Description of investment
Amount of investment ($)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense
Event Expense Loan Repayment/Reimbursement
Accounting/Banking
Fees Office Overhead/Rental Expense
Consulting Expense
Food/Beverage Expense Polling Expense
Contributions/Donations Made By
Gift/Awards/Memorials Expense Printing Expense
Candidate/Officeholder/Political Committee
Legal Services Salaries/Wages/Contract Labor
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F4:
2
FILER NAIYE 1
4 TOTAL OF UN ITEMIZED
EXPENDITURES CHARGED T CREDIT CARD
5 Date 6
Payee name I
7 Amount ($)
9 TYPE OF
EXPENDITURE
10
PURPOSE
OF
EXPENDITURE
11 Complete ONLY if direct
expenditure to benefit C/OH
Date
Amount ($)
TYPE OF
EXPENDITURE
PURPOSE
OF
EXPENDITURE
Complete ONLY if direct
expenditure to benefit C/OH
8 Payee address; City; State; Zip Code
SCHEDULE F4
Solicitation/Fundraising Expense
Transportation Equipment & Related Expense
Travel In District
Travel Out Of District
Other (enter a category not listed above)
3 Filer ID (Ethics Commission Filers)
$ (m on
❑ Political Non -Political
(a) Category (See Categories listed at the top of this schedule) (b) Description
❑ Check if travel outside of Texas. Complete Schedule T.
El Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Payee name
Payee address; City; State; Zip Code
❑ Political ❑ Non -Political
Category (See Categories listed at the top of this schedule) Description
❑ Check if travel outside of Texas. Complete Schedule T.
❑ Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
POLITICAL EXPENDITURES
MADE FROM PERSONAL FUNDS
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement
Accounting/Banking Fees Office Overhead/Rental Expense
Consulting Expense Food/Beverage Expense Polling Expense
Contributions/Donations Made By Glft/Awards/Memorials Expense Printing Expense
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAM -�
Vyr
4 Date 5 Payee na
6 Amount ($)
f.
t. G
❑Reimbursenentfrom
political contributions
intended
8
7 Payee address; City; State; Zip Code
(a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE ❑ Check if travel outside of Texas. Complete ScheduleT.
OF
EXPENDITURE ❑ Check if Austin, TX, officeholder living expense
g Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
SCHEDULE G
Solicitation/Fundraising Expense
Transportation Equipment & Related Expense
Travel In District
Travel Out Of District
Other (enter a category not listed above)
3 Filer ID (Ethics Commission Filers)
Date Payee name
Amount ($) Payee address; City; State; Zip Code
❑Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE ❑ Check if travel outside of Texas. Complete Schedule
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 Payee name
Amount ($) Payee address; City; State; Zip Code
❑Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF Check if travel outside of Texas. Complete Schedule
EXPENDITURE ❑ Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
PAYMENT MADE FROM POLITICAL
CONTRIBUTIONS TO A BUSINESS OF C/OH SCHEDULE H
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense
Event Expense
Loan Repayment/Reimbursement
Solicitation/Fundraising Expense
Accounting/Banking
Fees
Office Overhead/Rental Expense
Transportation Equipment & Related Expense
Consulting Expense
Food'Beverage Expense
Polling Expense
Travel In District
Contributions/Donations Made By
Gift/Awards,/Memorials Expense
Printing Expense
Travel Out Of District
Candidate/Officeholder/Political Committee
Legal Services
Salaries/Wages/Contract Labor
Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explain%s tow to complete this form.
1 Total pages Schedule H: 2
FILER NAM.E , ,'%,
/ /
%%1/74
3 Filer ID (Ethics Commission Filers)
4 Date 5
/
v
Business 4a66.4.
_
/ j
/
6 Amount ($) 7
Business address; City; State;
Zip Code
/1
$ (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE ❑ CheckiftraveloutsideofTexas.CompleteScheduleT.
OF
EXPENDITURE 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 Business name
Amount ($) Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE ❑ Check if travel outside of Texas. Complete ScheduleT.
OF El Check if Austin, TX, officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Business name
Amount ($) Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE ❑ Check if travel outside of Texas. Complete Schedule T.
OF ❑ Check if Austin, TX. officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
NON -POLITICAL EXPENDITURES
MADE FROM POLITICAL CONTRIBUTIONS
The Instruction Guide explains how to complete this form.
a
1 Total pages Schedule I: 2 FILER N ,-
4 Date 5 Pay:ante
i
6 Amount ($) 7 Payee address; City; State; Zip Code
I�
8
(a)Category (See instructions for examples of acceptable
PURPOSE
categories.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See instructions for examples of acceptable
PURPOSE categories.)
OF
EXPENDITURE
Date Payee name
Amount ($) Payee address; City; State; Zip Code
PURPOSE Category (See instructions for examples of acceptable
OF categories.)
EXPENDITURE
Date Payee name
Amount {$) Payee address; City; State; Zip Code
Category (See instructions for examples of acceptable
PURPOSE categories.)
OF
EXPENDITURE
SCHEDULE
3 Filer ID (Ethics Commission Filers)
(b) Description (See instructions regarding type of information
required.)
Description (See instructions regarding type of information
required.)
Description (See instructions regarding type of information
required.)
Description (See instructions regarding type of information
required.)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us
Revised 9/8/2015
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER SCHEDULE K
The Instruction Guide explains how to complete this form. 1 Total pages Schedule K:
2 FILER NAME .,� 3 Filer ID (Ethics Commission Filers)
4
Date 5 ame of person from who Innount is eceived 8 Amount ($)
6 Address of person from whom amount is received; City; State; Zip Code
Date
Date
Date
7 Purpose for which amount is received Check if political contribution returned to filer
Name of person from whom amount is received Amount ($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
Name of person from whom amount is received
Check if political contribution returned to filer
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
Name of person from whom amount is received
Amount ($)
Check if political contribution returned to filer
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Amount ($)
Purpose for which amount is received 0 Check if political contribution returned to filer
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us
Revised 9/8/2015
IN -KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES
FOR TRAVEL OUTSIDE OF TEXAS SCHEDULE T
The Instruction Guide explainshowto complete this form.
2 FILER NAME4ribt.r
i J
4 Name of Con / Corporation or Labor Organization / /edgor/ Payee
5 Contribution / Expenditure reported on:
❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2
[]Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H
6 Dates of travel 7 Name of person(s) traveling
8 Departure city or name of departure location
9 Destination city or name of destination location
1 Total pages Schedule T:f
3 Filer ID (Ethics Commission Filers)
❑ Schedule D ❑ Schedule F1
❑ Schedule COH-UC ❑ Schedule B-SS
10 Means of transportation 11 Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
Contribution / Expenditure reported on:
❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1
❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COH-UC ❑ Schedule B-SS
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 I Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
Contribution / Expenditure reported on:
❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2
❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H
Dates of travel Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
❑ Schedule D ❑ Schedule F1
❑ Schedule COH-UC ❑ Schedule B-SS
Means of transportation I Purpose of travel (including name of conference; seminar, or other event)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015