HomeMy WebLinkAboutJay Bender 01142015Texas Ethics Commission P.O. Box 12070 Austin Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
CANDIDATE t OFFICEHOLDER
CAMPAIGN FINANCE REPORT DORIGINAL
1 ACCOUNT #
The C/OH Instruction Guide explains how to complete this form. (EthIcS Commission Filers)
3 CANDIDATE I MS/MRS/MR FIRST MI
OFFICEHOLDER .f'I\ )A~( ANAME ..
NICKNAME LAST SUFFIX
13E IV ~ c t'1..
4 CANDIDATE I ADDRESS I PO BOX: APT I SUITE #: CITY: STATE. ZIP CODE
OFFICEHOLDER
MAILING
ADDRESS
D change of address
5 CANDIDATEI AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER (C(71) 9(7-JB5DPHONE
6 CAMPAIGN MS/MRS/MR FIRST MI
TREASURER Jvl{( ~Vl"".JNAME ..
NICKNAME LAST SUFFIX
LJA~~ILL
7 CAMPAIGN STREET ADDRESS (~O PO BOX PLEASE): APT ISUITE #: CITY: STATE:
TREASURER 20 ~ S'. K-(lIt ~hr S~lo ,ADDRESS
(residence or business)
7'9J~ (~l{,L K l VI tl -e Y I ( L rcA S
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER (L-t(e1 ) l~,et -.~ 2-'1PHONE
9 REPORT TYPE t?J January 15 D 30lh day before eleclion D Runoff
D JUly 15 D 8th day before election D Exceeded $500
limit
10 PERIOD Month Day Year Month
COVERED / /ICe// 1'-\ THROUGH
11 ELECTION ELECTION DArE ELECTION TYPE
Month Day Year D Primai)' D Runoffl (/4 /// L(
12 OFFICE OFFICE HELD (if any) ') I[
COVI/l'l "--(
13 OFFICE SOUGHT (If k~n)J VOL:.£) .....'-' lV\ ~ u~ C::rC. \
COUR-I aA LA~ -8 L<eSU IU: A
GO TO PAGE 2
FORM CtOH
COVER SHEET PG 1
2 Total pages filed:
\\
OFFI~\~\IJS,t:;,8!1!LY
i~'~ L's.'·~·'~i~'
f~ ~(r
i \'iJ if··'\ ......... ,~ ...... ..
~4f~torpos~.¢~>"
I I' ·~'I~.~··.··~~""U
Receipt # ···"""r~uni
Date Processed
/..,,14 ..t'S
Dale Imaged
1-J~ -/5
RECEIVED JAN 142015
ZIP CODE
D
15th day after campaign
treasurer appointment
(officeholder only)
D Final report (Attach C/OH . FR)
Day Year
/ /IS-/IS
D Spedal~ General
-c [{.I/\
~
II\. 't-7V
(--~ i4. {y
www.ethics.state.tx.us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
CANDIDATE t OFFICEHOLDER REPORT: FORM CtOH
SUPPORT & TOTALS ORIGINAEOVER SHEET PG 2
14 CtOH NAME
16 NOTICE FROM
POLITICAL
COMMITTEE(S)
o additional pages
17 CONTRIBUTION
TOTALS
EXPENDITURE
TOTALS
CONTRIBUTION
BALANCE
OUTSTANDING
LOAN TOTALS
18 AFFIDAVIT
15 ACCOUNT # (Ethics Commission Filers)
THIS BOX IS FOR NonCE OF POLITICAL CONmlBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITIEES TO SUPPORT THE
CANDIDATE J OFFiCEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
CONSENT. CANDIDATES AND OFFiCEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEE NAME
COMMITTEE TYPE
RECEIVED JAN 142 5D GENERAL
COMMITTEE ADDRESS
D SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
PLEDGES. LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $
;6
2. TOTAL POLITICAL CONTRIBUTIONS $(OTHER THAN PLEDGES. LOANS. OR GUARANTEES OF LOANS) ¢
.n:l
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS. UNLESS ITEMIZED $ 130
.:::.-0
4. TOTAL POLITICAL EXPENDITURES $ 13u
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY $OF REPORTING PERIOD I ~Lf 19 3/
6 TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
z:t')
LAST DAY OF THE REPORTING PERIOD
$ LfX)
I swear, or affirm, under penalty of perjury, that the accompanying report
is true and correct and eludes all information required to be reported by
me under' 5, Electi Code.
Signatu~ of Candidate or Officeholder
AFFIX NOTARY STAMP I SEAL ABOVE
subscribed before me.
JO~ A,~,,---( ,this the
. to certify which, witness my hand and seal of office.
}
www.ethics.state.tx.us Revised 07/28/2014
Texas Ethics Commission PO. Box 12070 Austin Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
POLITICAL CONTRIBUTIONS
SCHEDULE AOTHER THAN PLEDGES OR LOANS
QORIGINAL
2
4
9
Date
Date
Date
Date
Date
The Instruction Guide explains how to complete this form.
FILER NAM:.-J Ay
AQA,--'\ &.Aj~-e:<
Full name of contributor o out-of-state PAC (10#: )5
6 Contributor address; City; State; Zip Code
1 Total pages Schedule A:
3 ACCOUNT # (Ethics Commission Filers)
7 Amountof 18 In-kind contribution
contribution ($) I description (if applicable)
I
I
I
(If travel outside of Texas, complete Schedule T)
Principal occupation I Job title (See Instructions) 10 Employer (See Instructions)
1
Full name of contributor o out-of-state PAC 110#: ) Amount of In-kind contributionI
contribution ($) description (if applicable)I
Contributor address: City; State; Zip Code I
I
I
(If travel outside of Texas. complete Schedule T)
Principal occupation I Job title (See Instructions) Employer (See Instructions)
I
Full name of contributor o out-of-state PAC (10#: ) Amountof I In-kind contribution
contribution ($) I description (if applicable)
Contributor address; City; State; Zip Code I
I
I
(If travel outside of Texas. complete Schedule T)
Principal occupation I Job title (See Instructions) Employer (See Instructions)
I
Amount of In-kind contributionFull name of contributor o out-of-slate PAC (10#: ) I
contribution ($) I description (if applicable)
Contributor address; City; State; Zip Code I
I
I
(If travel outside of Texas, complete Schedule T)
Principal occupation I Job title (See Instructions) Employer (See Instructions)
I
Amount of I In-kind contribution
contribution ($) I description (if applicable)
Full name of contributor o oul-of-5tate PAC (10#: )
Contributor address; City; State; Zip Code I
I
I
(If travel outside of Texas. comolete Schedule T\
Principal occupation I Job title (See Instructions) Employer (See Instructions)I
RECEIVED JAN 14201
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide foradditional reporting requirements.
www.ethics.state.tx.us Revised 07/28/2014
Texas Ethics Commission PO. Box 12070 Austin Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
PLEDGED CONTRIBUTIO
2 FILER NAME
4 TOTAL OF UNITEMIZED PLEDG
5 Date 6 Full name of pledgor
7 Pledgor address; City;
10 Principal occupation I Job title (See Instructions)
NS
ES:
Date Full name of pledgor
Pledgor address; City;
Principal occupation I Job title (See Instructions)
Date Full name of pledgor
Pledgor address; City;
Principal occupation I Job title (See Instructions)
Date Full name of pledgor
Pledgor address; City;
Principal occupation I Job title (See Instructions)
Date Full name of pledgor
Pledgor address; City;
Principal occupation I Job title (See Instructions)
The Instruction Guide explains how to complete this torm.
¢ ¢ ¢¢¢ ¢
n ORIGINAL
1 Total pages Schedule B:
3 ACCOUNT #
SCHEDULE B
1$
hics Commission Filers)(Et
In-kind description
(if applicable)
In-kind description
(if applicable)
In-kind description
(if applicable)
In-kind description
(if applicable)
In-kind description
(if applicable)
Amount ofo out-ol·state PAC (ID#: I 8 19
pledge ($)
I
State; Zip Code I
I
I
(If travel outside of Texas, complete Schedule T)
11 Employer (See Instructions)
1
Amount ofo out-ol-state PAC (100: ) I pledge ($) I
Slate; Zip Code
I
I
I
(If travel outside of Texas, complete Schedule T)
Employer (See Instructions)
I
Amountofo out-ol-stale PAC (100: ) I
pledge ($) I
ISlate; Zip Code
I
I
(If travel outside of Texas. complete Schedule T)
Employer (See Instructions)
I
Amount ofo out-ot-state PAC (tOO: ) I
pledge ($) I
I
I
I
Slate; Zip Code
(If travel outside of Texas, complete Schedule T)
Employer (See Instructions)
I
I
I
I
I
I
o out-ol-slate PAC (fOO. 1 Amount of
pledge ($)
State; Zip Code
(If travel outside 01 Texas. complete Schedule T)
Employer (See Instructions)
I
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
It contributor is out-ot-state PAC, please see instruction guide tor additional reporting requirements.
www.ethics.state.tx.us Revised 07/28/2014
RECEIVED JAN 141015
Texas Ethics Commission P.O. Box 12070 Austin Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
LOANS
2 FILER NAME
4
5 Date of loan 7
6 Is lender 8
a financial
Institution?
y N
12
14 Description of Collateral
OralE!
16 GUARANTOR
INFORMATION
o not applicable
Date of loan
Is lender
a financial
Institution?
y N
Description of Collateral
0 none
GUARANTOR
INFORMATION
o not applicable
SCHEDULE E
fl n tU r.: 11\11\ 1
1 Total pages Schedule E:
The Instruction Guide explains how to complete this form.
3 ACCOUNT # (Ethics Commission Filers)
TOTAL OF UNITEMIZED LOANS: c:> c:> c:> c:> c:> c:> $
Name of lender D out-ol-state PAC (10#: ) 9 LoanAmount ($)
Lender address; City: State: Zip Code 10 Interest rate
11 Maturity date
Principal occupation I Job title (See Instructions) 13 Employer (See Instructions)
15 Check if personal funds were deposited into political account
0
17 Name of guarantor 19 Amount Guaranteed ($)
18 Guarantor address; City: State; Zip Code
20 Principal Occupation (See Instructions) 21 Employer (See Instructions)
Name of lender o oUI-ol-slate PAC (10#: ) Loan Amount ($)
Lender address: City: State; Zip Code Interest rate
Maturity date
Principal occupation I Job title (See Instructions) Employer (See Instructions)
Check if personal funds were deposited into political account
D
Name of guarantor Amount Guaranteed ($)
Guarantor address; City: State; Zip Code
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.
RECEIVED JAN 142015
Revised 07/28/2014www.ethics.state.tx.us
Texas Ethics Commission PO Box 12070 Austin Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
Advertising Expense
Accounting/Banking
Consulting Expense
Event Expense
Fees
1 Total pages Schedule F: 2
4 Date
10'" 8'-/3
6 Amount ($) 7
0
I 3c
8 PURPOSE
OF
EXPENDITURE
9 Corrplete w.Y if direct
expenditure to benefit ClClH
Date
Amount ($)
PURPOSE
OF
EXPENDITURE
Corrplete w"y if direct
expenditure to benefit ClClH
Date
Amount ($)
PURPOSE
OF
EXPENDITURE
Corrplete w"y if direct
expenditure to benefit ClClH
Date
Amount ($)
PURPOSE
OF
EXPENDITURE
Complete ONLY if direct
expenditure to benefit C/OH
POLITICAL EXPENDITURES SCHEDULE F
'fl nnl~11\11\I
EXPENDITURE CATEGORIES ~ BOX 8(a)
GiftlAwards/Memorials Expense SalarieslWages/Contract Labor Loan RepaymentiReimbursement
Legal Services Solicitation/Fund raising Expense Transportation Equipment & Related Expense
Food/Beverage Expense Travel In District Contributions/Donations Made By
Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
FILE~, NAME A, 13 ACCOUNT # (Ethics Commission Filers)
L\ ,-/' ~lIlA. 6e~d-v
5S~~~;a!L 60K Sk 0+00-'
Payee addN,~; City; State; Zip Code
Po C:>,)~ /f'7"2 ML k. r ~ <1 't YI
(I< 75b~q
(a) Category (See categories liSled althe lop of Ih,s schedule) (b) Description (If travel oulslde of Texas, complete Schedule T)
EVE.JJT /~P vl~ o Check if Austin, lX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Payee name
Payee address; City; State; Zip Code
Category (See categories listed althe top of this schedule) Description <If travel outside of Texas. complete Schedule T)
o Check ifAustin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Payee name
Payee address; City; Slate; Zip Code
Description (If trevel outside of Texas, complele SChedule T) Category (See categones I,Sled at the top of this schedule)
o Cheek ifAuslin, TX. officeholder living expense
Candidate / Officeholder name Office soug ht Office held
Payee name
Payee address; City; Slate; Zip Code
Description (If travel outside of Texas, complete Schedule T)Category (See categories listed at the lOP of this schedule)
o CheckifAuslin,TX. officeholder liVing expense
Candidate / Officeholder name Office sought Office held
A TIACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 07/28/2014
RECEIVED JAN 14 2015
Texas Ethics Commission P.O. Box 12070 Austin Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
POLITICAL EXPENDITURES
SCHEDULE GMADE FROM PERSONAL FUNDS lJ ORIGINAL
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan RepaymenVReimbursement
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 Commillee
Fees Printing Expense OHice 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 FILJNAME /J. \:Jv'\ .N\ beVLd~ 1
3 ACCOUNT # (Ethics Commission Filers)
_ A-r
4 Date S Payee name
6 Amount ($) 7 Payee address, City, State; Zip Code
D Rein1:lurserrent frcm
political mntrltJu!jons
Inta-ded
8 PURPOSE (a) Category (See ca,egories listed at the top of 'his schedule) (b) Description (If travel outside of Texas, complete SchedUle T)
OF
EXPENDITURE
D Check if Austin. TX. officeholder living expense
Date Payee name
Amount ($) Payee address; City, State; ZipCode
D Reirrb.Jrserrent from
political contributions
IntalCled
PURPOSE Category (See Cdtegories listed at the top of this schedUle) Description (If travel outside of Texas. complete Schedule TI
OF
EXPENDITURE o Check ifAustin. TX. officeholder living expense
Date Payee name
Amount ($) Payee address. City; State; Zip Code
D Reimbursement from
political contributIons
Intended
PURPOSE Category (See celegories listed at the top of this schedule) Description (If travel outside of Texas. compiele Scheduie T)
OF
EXPENDITURE
D Check. if Austin. TX, officeholder llvmg expense
Date Payee name
Amount ($) Payee address City, State; Zip Code
D ReirrtJurserrent frOO1
poIitica a:ruritJu!jons
inta-ded
PURPOSE Category (See categories listed at the top of this schedule) Description (If travel outside ofTexas. comple'e Schedule T)
OF
EXPENDITURE
D Check it Austin, TX. officeholder living expense
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 07/28/2014
RECEIVED JAN 14 2015
8
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
PAYMENT FROM POLITICAL CONTRIBUTIONS SCHEDULE H
TO A BUSINESS OF C/OH
Advertising Expense
Accounting/Banking
Consulting Expense
Event Expense
Fees
1 Total pages Schedule H:
4 Date
6 Amount ($)
PURPOSE
OF
EXPENDITURE
9 Corrpiete ~ if direct
n ORIGINAL
EXPENDITURE CATEGORIES FOR BOX 8(a)
Gift/Awards/Memorials Expense SalarieslWages/Contract Labor Loan Repayment/Reimbursement
Legal Services Solicitation/Fund raising Expense Transportation Equipment & Related Expense
Food/Beverage Expense Travel In District ContributionslDonations Made By
Polling Expense Travel Out Of District Cand idate/Officeholder/Political Com mittee
Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
2 J 13 ACCOUNT # (Ethics Commission Filers)FILER NAME
,..-4'--( A'l:JAW\ 6-evtcfe/
5 Business name
7 Business address; City; State; Zip Code
(a) Category (See categories listed al the lap of this schedule)
Candidate / Officeholder name
expenditure to benefit CJQ-l
Date Business name
Amount ($) Business address; City; State; Zip Code
Category (See categories listed allhe lap of this schedule)
OF
EXPENDITURE
PURPOSE
Corrpiete ~if direct Candidate / Officeholder name
expenditure to benefit CJQ-l
Date Business name
Amount ($) Business address; City; State; Zip Code
Category (See categories listed at the top of this schedule)
OF
EXPENDITURE
PURPOSE
Candidate / Officeholder name
expenditure to benefit CJQ-l
Date
Corrpiete w.Y if direct
Business name
Amount ($) Business address; City; State: Zip Code
Category (See calegories listed at the top of this schedule)
OF
EXPENDITURE
PURPOSE
Corrpiete ~if direct Candidate / Officeholder name
expenditure to benefit CJQ-l
(h) Description (Illravel outside of Texas. comptete Schedule T)
D Check if Austin, TX, officeholder liVing expense
Office sought Office held
Description (If Iravel outside of Texas. complete SChedule TI
o Check if Austin. TX. officeholder living expense
Office sought Office held
Description (If Iravel oulside of Texas. complete SChedule T)
D Check if Austin, TX. officeholder living expense
Office sought Office held
Description (Il travel outside of Texas. complete Schedule T)
D CheCk if Austin, TX, officeholder Ilving expense
Office sought Office held
ATIACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 07/28/2014
RECEIVED JAN 142015
Texas Ethics Commission P.O. Box 12070 Austin Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
NON-POLITICAL EXPENDITURES
MADE FROM POLITICAL CONTRIBUTIONS
1 Total pages Schedule I:
4 Date
6 Amount ($)
8 PURPOSE
OF
EXPENDITURE
Date
Amount ($)
PURPOSE
OF
EXPENDITURE
Date
Amount ($)
PURPOSE
OF
EXPENDITURE
Date
Amount ($)
PURPOSE
OF
EXPENDITURE
SCHEDULE I
n "PI~ll\ldL_.
The Instruction Guide explains how to complete this form.
2 FILER NAME
6ertd-v-
3 ACCOUNT # (Ethics Commission Filers)
-lA'-f Au~-
5 Payee name
7 Payee address; City; State; Zip Code
(a) Category (See instructions for examples of acceplable (b) Description (See instructions regarding Iype of information
categories) required.)
Payee name
Payee address; City; State; Zip Code
(a) Category (See Inslructions for examples of acceptable (b) Description (See instructions regarding type of ,nformatlon
categories) required.)
Payee name
Payee address; City; Slate; Zip Code
(a) Category (See Instnuctions for examples of acceptable (b) Description (See instructions regarding type of information
categories) required)
Payee name
Payee address. City; Stale; Zip Code
(a) Category (See Instructions for examples of acceptable (b) Description (See instruclions regarding type of information
categories) required.)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised 07/28/2014www.elhics.slale.lx.us
RECEIVED JAN 14 Z0l5
Texas Ethics Commission P.O. Box 12070 Austin Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
INTEREST EARNED, OTHER CREDITS/GAINS/
REFUNDS, AND PURCHASE OF INVESTMENTb SCHEDULE K
ORIGINAL
1 Total pages Schedule K:The Instruction Guide explains how to complete this form.
3 ACCOUNT # (Ethics Commission Filers) FILER NA:J2
A-r AOPl0-1 b-Pv, rf.r</
8 Amount
($)
4 Date 5 Name of person from whom amount is received
6 Address of person from whom amount is received; City; State; Zip Code
7 Punpose for which amount is received
Date AmountName of person from whom amount is received
($)
Address of person from whom amount is received; City; Slate; Zip Code
Punpose for which amount is received
AmountDate Name of person from whom amount is received
($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
AmountDate Name of person from whom amount is received
($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 07/28/2014
RECEIVED JAN 142015
Texas Ethics Commission PO Box 12070 Austin Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
IN-KIND CONTRIBUTION OR POLITICAL EXPENDITURE SCHEDULE TFOR TRAVEL OUTSIDE OF TEXAS n nl:)I~II\11\ I
~lal pages Schedule T:"The Instruction Guide explains how to COfT1'Iete this fonn.
2 FILER 3 ACCOUNT # (Ethics Commission Filers) ----lNAME
>4 '-/-A~AW\ ?J~Y[ c!-if
4 Name of Contributor 1 Corporation or Labor Organization 1 Pledgor 1 Payee
5 Contribution 1 Expenditure reported on:
Schedule A Schedule B Schedule C Schedule DD D D Schedule F Schedule GD D D
Schedule H Schedule N COH-UC COH-T PAC-C PAC-ED D D D D D
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
10 Means of transportation 11 Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor 1 Corporation or Labor Organization 1 Pledgor 1 Payee
Contribution 1 Expenditure reported on:
D Schedule A D
D Schedule H D
Schedule B
Schedule N
D
D
Schedule C
COH-UC
D
D
Schedule D
COH-T
D
D
Schedule F
PAC-C
D
D
Schedule G
PAC-E
Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation
Dates of travel
Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor 1 Corporation or Labor Organization 1 Pledgor 1 Payee
Contribution 1 Expenditure reported on:
D Schedule A D Schedule B D Schedule C D Schedule D D Schedule F D Schedule G
D Schedule H D Schedule N D COH-UC D COH-T D PAC-C D PAC-E
Dates of travel Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation Purpose of travel (including name of conference, seminar, or other event)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 07/28/2014
RECEIVED JAN 141015