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HomeMy WebLinkAboutJacqueline Hamilton 01152014Texas E1hics Commission p...0 Sox 12070 Austin, Texas 78711-2070 (512) 463-0800 (TOO 1-800-735-2969) CANDIDATE I OFFICEHOLDE'b FORM C/OH CAMPAIGN FINANCE REPOR-" ORIGINAL COVER SHEET PG 1 1 ACCOUNT # 2 Tolal PQll<l$ lilOd: Tho ClOH Instruction Guide explains how to comple. thb fQrm. ('EtNas: co",,,,It1:lo" R""') ~ 7\\I\i'''U''''f'-h~ 3 CANDIDATI; / MS I MRS IMR FIRST !II " OFFICEHOLD~R .~~s-.,y~l.IVl.~. b . ,,"~..~~' ..... " NAME _ .' d II ....~~ . . . ... , . . .. . . . . . . ,.~~ .NICKNAME lAST SU~I'lX ~~., ........ s b Q-'" ~ s..e... H Cl\.M; t+O\o1 = { ~ ~ll!\ /D! ~U)\ §4 CANDIDATE / IIODRIiSS IPOBO.l(; APT I sum:_: CITY: STATE; 2lPCODE ~«\' ~~lOFFICEHOLDER P'.O. tso><. &~O:2B'3 ~. . IMAILING ~ '.' ~~ ADDRESS ~\a.V'o, -l~s '50U'-D2.~3.C: ~ \" ... o C1'l,.,gll of ad<!J@'" ~.... 'tI,/ "",\'\ . ~"C8fpl • I_ S CANDIDATE:! AREACOOE PHONE NUMBER r.xTENI;lION OFFICEHOLDER DaIllPmeeaed ("0 . JtfPHONE (~ 1,.0{) 5G:2.. -S53..6 / . 8 CAMPAI~N IlS/MRSIMFl FIRST MI OAIolmagod 1-rb "/'1­TREASURER .~Q.y;J. M . NAME , , .... . .. I • I •••• - • . . . . . . NI~ LAST SUffiX SW\:+h 7 CAMPAIGN STREET IIOORESS !No pO BOX Pt.eA6E); ,l,PT ISUITEt: CITY: STAle; ZIPOOOE TREASURI;R ADDRESS to I E. ~c~rk B.\vd., :::;'+e ,(00) ~la.lAo..TRxa~ 75071­(rwldence or busln89S) 8 CAMPAIGN I>FIEACODE PHONE NUMBER EXlnISION TREASURER ("'17.:2) 5 \G . "3.&..tfqPHONE --'" ~'r If1.­ '-­- 9 REOI'ORT TYPE [2l Janu:aty 1S 0 ~th ~y b~(_ .."'ell"" 0 Runoff 0 151h day IIf.r cempllign .;;e; In!88<nr appaln"""nl -~ (""""oIYlldwcrly) W 0 July 15 0 8lh day bet"", rokK:tfcn 0 I::"""od<>cf $600 D roM! ~ <_CIOH •~Fll.o nmll :::J: r 11 10 PERIOD v­""""'" ~ ':-:' ~ :Jftlonfl Dof 'IIw COVEREO t {/20/;2.,() 13 THROUGH 1;:2./3 1/~O \ 3­Ul \.0 11 EL.ECTION ELECTlON [;lATE ELECllO!'In"PE Mcrtk O>r 'lb:lr o Pm1~ 0­G2l Goftnl o Spodol I I/O~ /.2..0 1"t 12 OFFICE 0I"F1CE: HELD (fa",) 13 OrncI;iSO~ (111m"""" T u ~+:I c.e?-01' -\-L--~ ~~c..c2. .i ~r-e-",\ "'1 e t­'3 .. t" l a. c e.­;2.... GO TO PAGE 2 www.ethiG5.5tate.bc.us Revised OGt2612011 T~S Ett1lcs CQmmission P.O. Box 12070 Austin, iexas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989} CANDIDATE I OFFICEHOLDER RIIiL---"~"'" FORM C/OH SUPPORT & TOTALS GINAL COVER SHEET PG 2 15 AC<;;OUNT' (Ethics CommIalIIon ~)14 CJOH NAME "'J""~ 16 NOTICE FROM POLITICAL COMMITTEE(S) o s!idlnona! ~ 17 CONTRlaUTION TOTALS EXPENDITURE TOTALS CONTRIBUTION BALANQ;; OUTSTANDING LOANTQTAlS 18 AFFIDAVIT 1llIB _IS RlR NOlIl:.I! OF PCUlIl'AL lXlNTIlIIU1IONI-...:IOIlI ~EXI'I!NIlmIlI!A MAIl£ ~ P<ll.J1'Il:AL co.~ 10 ~1M! CANDlDlll~I OF~ THEBE E1lf'£IIDfTIJRF,S ....... IIAVfl_....~ ~1l'fIOIJTTH£ COlWlllWlnt" OR o~'s~.r;OR C«tmfT. ~....,<lFFlCBl<UIERIlARJ; ~101'I!PCAT'IHIG N'ORMA'TlCINl»C' FllJ'Y lle;a\II; NOllCEOI' SUCH!lCPEIGTUl£9. c:ow.wrTEE TYPE o GENERAl. o SPECIFIC COMMmEE NAME COMMITTE~ADDR~SS COMMln~~ CAMPAIGN TREAI>I,lR~R NA.,,,, COMMITT~~ CAMPAIGN TR~ASI.JR~R AOO~E$$ 1. TOTAL POLlnCAL CONTflIBUTIONS OF no OR LESS (OTHER THAN PLEDGES. LOANS. OR GUARANTEES OF LOANS). UNLESS ITE:MIZED 2. TOTAL POLITICAL CONTRIBUTIONS (OTHE:R THAN PLEDGES. LOANS. OR GUARANTEES OF LOANS) 3. TOTAL POLITI CAL EXPENDITURES OF $100 OR LESS. UNLESS ITeMIZCD 4. TOTAL POLITICAL EXPENDITURES s. TOTAL POLITICAL CONTRIBUTIONS MAINT,a,INED AS OF THE LAST DAY OF REPORTING PE~'OD 6. TOTAL PRINCIPAl. AMOUlIIT OF ALL OUTSTANDING LOANS AS OF THE LAST OAY OF Tt-IE REPORnNG PERIOD Ul Cl $ -D­ $ 0~S.OO $ ~5.00 $ \7\0.00 $ 83.0.00 $ .2..~o ,00 I swear. or 8 • under pIlnlllty of perjUl)I, ltl8t the acrompanylng report is true B ffi!e:t and inell,l(le$ all infcrmaUcn mqulred to be reporteCl by ~ .... ~"5,E"""'Cod., 1M Signature 01 Candidate or Dmcehald"r AI'''lX NOTARY STAMP I $£A~ AeOVE swo:.n to and stJb~cribed before me, by the said ,s1Iph,o./v\.J.e bCVr!h my~~ 5rn f1-..hiS the (,/5? day of \.\.0.-, 20 ~• to certifY which, witness my hand and seal of office. www.ethi(;s.~tat(Ux.us Re~ 09128120'1 Tcxar. Etl,ics Commission PO ~ox 1:2070 Austin Texas 78711-2070 (S12) 463-5800 1-600-nS-8506 SCHEDULE A In-kind "ont1\1:>l.ItionI d08crtptJon (If Bppllcabl~) ."'.,J... .... ,...... ""­ In-I<in~ontn--Sl.ltion deacrlpllon (If appll=bl",) lit ~ol oulslde of Toxll5, complete Schedull> T\ POLITICAL CONTRIBUTIONS OTHER THAN PLEDGES OR LOANS [] I L 1 Tolar p"g~. So""'d"l~ A; 1Th4 InstrUl;Ue>n Guide llxplains how to complete this ferm, 2 FILER NAME ::r9 [, we. I III e... ~eMts:e.. Ho..\M~ 1+0\-\ 3 ACCOUNT ~ (Ell""" Co"""'..)on nl....l 4 Dat~ 5 Full na""e of contributo, D ....a·<l.t.PM:. 001; I 7 Amount 01 Is eOl'ltrtbLJtion ($) I~/~~ ~~I.'\~k ,~.~UlA~. , ..... .. I;2.0'.:3 6 Contributor dd",,~,: Cily; Slat~: Zip Codo SW,OOI q~/.2. S~1.Il ~rjve. I 9 l="'.. i :s:c..e ~4S. P,'nop", OCCUP311ol'\ I Job IIII~ (See Insthlctlona) Ii..A ,I a.;rQ ~........ L-""If' IS03.S~ ~C>S6 110 Employ~, (S~~ t...L...... 4.-1... (If travol oul!llde of Texas, comple'.. Sehedulo T) ~=-( ,.Lor;:, M IMtru<Oti~r) DlIta Full name Qfcontributor o OlJ><ll-olt'" PAC <tOOl; ) Arnoul'\tof II I'2./:2.Y -:r~j u ~ t,L1.t? ~eA.o\ I~e... H~W\II.to V1. contribution ($) ,2.013­C:ontrib 0' lI~d"'~~: p:...O, ~O'?C City; SllIt..: Zill Code ~602.'&"3 S.DOI I ~ La VI 0 I T C2..X4.S 750&fO··02..&'3. I Amountol I In-kind contribution contnoulion ($) I description (If "ppllcable) , 30.00, I (II travel ou~1d<! 01 ~n$, comptotl> $chCd\lle n An'Tounl Qf I In-kind contribution conlrlbutlon (S) I de"crlpllon (If :.pplic;Qble) too,OO I I flf trlIvel outside of TCU$ eoml:lloto Schedule T\ Amount or I In-I<ind contribuUon contributIon ($) I descrl"tlon (ir ~"'i>licable) .J' I <­ii!::::. I I --1::= (If Ir;\vel ol/t$ide 01 Texas comp"'t& Sch4d~ n ~ "'0 ::x .".. ~ f 11 U1 c::> 1- '"D Prlnclp~1 ocwpaLJon , Job title (S~ In:;(Nr;tions) F-mPIOY.:f-(See Instructions)R:. ~~ l +-0 ... I ~e.l Oal'" Full n"rno 01 contributor o <M-<'!"'3leP/£(IOC: 1 \\/9..7( .::ro.<7-j'.u.~ ll~.e-.~e..I.o':\~e..t{Cr~:1 \{CV\ COntributor add""....: City; Stale: Zip Cod'"~O\~ f>.O. Be>)'.. 'gc;=.O:2."8.3 ~ l a lA.O~ l~l4.S (S6~G" 02.&3. Principal OCCUP<\li~J~r~~nstrucUon", EmPIOye',fee ,Instructions) I Se.'( O",te Full name ot =nltibutor o 0U\-d....1. PAC 00ll: > 1-:2.(10/ ,H~ ro.ld. C~~~ e..r. Contril:>utor addre~,,; Clly; State; Zip Code:2..0\3­''3.000 W· 1-='~ r ke..t-~d.." s..-te..200 P laV\o, T '€-'lG:4.S ISO{~ Principal oc<:up"tion I Job tille (Sae Inslru~i¢ns) k I Employer (See In~tructi<lrle) {<..'l!..(\.( ~S-kL~ ·1S.t-c :t2.r s.e.l+ D,"", full name of contributor o ~8la1! PAC 00#: ) Contributor addreu: City; Slale; Zip Code "',i,,<;ipal occ~pation I JOb litre (S~ JI'I$lruclions) c:mployer (See In"tn.Je1;on~> I ATTAGHADOITIONALCOPIES OF THIS FORMAs NEEDED II contributor is ouI"of-staHI PAC, pl9;159 se" fn!Jtrvction guide forll.ddltional reporting reqLllrgmllnts. Texas Ethics Commission RO Box 12070 Austln Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) LOANS 0 IGI L SCHEDULE E The. Instruction GuIde eXfllll(ns how 10 complete this forll1, 1 Total PQgGS Sehodulo E: :2- 2 FIL.ER NAME :3 ACCOUNT # (Ethics Comml!;l;lon Fil81'$) -=s-(XC q w ~l \VI e... ~e V\-\ S.-e-.. ~L~~. ""'" ~ 1t C;) \1. 4 TOTAL OF UNITEMIZED LOANS: ~ ~ ~Q Q Q $ 5 DeteoflOan 7 Nameoflandar o OVw,{·SlMfl PAC 0011' } 9 Loen Amount ($) \\ / :z .,/20 I 3. ~ Q, \.M '1 l {ov\.~~~.'1~~/.~."".~. ~eVl . . , is€... , ... , •• 20.00 . .... . . I , 6 la lender 8 Lender addre&a; City; stete; Zip COda 10 IrW~r'('..$t r~te a financial ~.o, Box % CO 02.'&3-V10L1~In,,~tutlon? 11 Maturity date y eEl ~ l Ql.1.0, \-e..xa.S 7.s.0~6-O~~~ V\/c.... 12 Principal occupaUon I Job title (See In8tru.,oon8) 13 Employer (See tnatructlona) ~e.al+o\'"" se-~-t 14 Description of Collatsn31 15 Checl< It personal tlJnds were deposited Into polillclll ;)(;count [i1noM [l( 16 GUARANTOR 17 NI!l1'l"lQ or gUI'l ....mlor 19 Amount Guaranteed ($) INFORMATlON . . . . . . . . . . . .. -. . . -. . . . ....... 18 ~uc\l(lntor~dd""~,,,: City: State: Zip Code mno, ~IlPII(::1lbIO 20 i='rlnclpat OCCuPation (S<:!q InWt"eii"O"$) 21 Employer (See Instruction.) D3t0 of lo~n Neme oflend.... D OU!·or-sbto Pl\C (10#: ) Lo an Amount ($) l2./OG/:2.0 l':3 .:=\~~q.L?~~ ~\'l.~. ~.~~~~€;-.HC?-~~ l+~.~ . SO,oO . . . Is lendar Lender addn3ss: City: State: Zip Code Inlf}r('$tl"1l11\\ a finanelal ~.O. ~O)(: '8.0 02~:S In. 0\1\ ~ Instltutlon? (t!) PlaV((), l~a.S -rSO&6-O:2..~~ Maturity date y "ta.. Principal occupation I Job till" (S~ 1r'lt,bVettoM) Employer (S<IQ In~trv¢\l(m9) 'R. e.C\ l-\-0 V"-s.-e. t{- l:lasCl1ptlon of Collateral Che<>1< if ~qrsonal fundS were deposited Inlo polltlcslaccoUnt I}(none eM' GUARANTOR Name ofguarnn1Dr Amount Guaranleed.(i) lNFORMAnON -l:-- .... • • • , • . . . . . . . . -..... . ... , ..... -a C- ::boo ~oolappllcllble Guarantor address; City; St>,rt(!; Zip Coda -w Prlnelp:l:l OccupRtlon (Sil!'9 In8VUet.lcn"I~) employer (s .... In"truc:tlon~) -0 ~ ~ I'\.) )j ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS NEEDED en :! If lender Is out-Of.stOlte PAC. plea!!.t! lies instruction gt,llda for additions I rOllorting rllqulrllmenta. C> ", www.ethles.stata.lx.us. Revised 09~612011 1:::­~ ~C~ 1 " l-! ~:c:y' I'" " Texas EthiC9 ComrniS$ion PO Box12070 Austin Te)(as 78711·2070 (512) 463-5800 (TOI:l1-800-73S-2989) LOANS 11 fGfNAL SCHEDULE E The Instruction Guld9 explains how to l;ornpletl;' this fOrm. 1 TOlel pages $eM<Me EO, '2 2 FILER NAME 3 ACCOUNT /I (EthiCS GemmlssiOil FilS'S) --:::r 0..c. oy u eJ , Vl e... ~e...\A', l-t Ct \oM; l{ov\..'S.e.- 4 TOTAL OF UNITEMIZED LOANS: c:> ~ Q c:> ¢ «> $ 5 Oete 01' loan 7 N",mf;> of lender o ouloof••t;,10 PAC (IDll' 1 9 Loan Amount ($) l2../1 \/2.0L3 .~~~,~~l~~.~..... . . . . · . . ~ . . ~ e-L'\-\ ~~.. l-{ It( \oM I ~ +l!l \-'\ \ GO, 00 6 Is 1~nc1~r 8 L6I'1dor ",ddre3s; City; State; Zip Code 10 Intere~t rllte afinancitll ~.O. ~K BG0283-~Ol..\Q..Institution? ~\CtV\O, \€-)oC~.s. 750&((,;;' O:z.'2~ 11 Mst1Jrlty dete y ® v. 1 0.... 12 Princlpel occupation f Job lItl" (S.... lM!TvQtl(>fl"J 13 Employer (S"e InelfUolJonB) ~e.A t+or-~....l~ 14 OEl~crip\ion of COlIlll<:'l1"!l1 15 Cht;lck 11 par,\:onlll lunds were deposited Into polltl",,1 account Mncne ~ 16 GUARANTOR 17 Ntlma of gllltrllnlQr 19 Amount GuarltntEllJd ($) ,INFORMATION · .. . . . . . ... . , . . rnno( ~ppli<:<lble 1 a C1.ltolrllnlor ::lddress: City; StEne; Zi",CodG> 20 Princip<ll OeCVP<ltlon (S~~ IMtru~Ong) 21 Employer CSM In~tructlon,,) O<l\(l c>fJo.,n Name OflElndflf D out.of-.btD PAC QDM' ) Loan Amount($} . . .. . . . . · ... . . . ... . . . . Is lender Lender eddress: City: ~t<l; Zi",COCl13 Int"r"Bl rete a flnenclel InatituUon? Maturity dete y N I'rinclp,,1 occup:oUon I Job titl" (SCI .. In"'tructJon~) =mp1oy",' (.s_ In.wellons) DesCliptlon of Collateral ChGel< if personal funds were deposited Into political acoount 0 nons 0 - GUARANTOR Name of guarnntor Amount GU<lrant~) INFORMATION .. . . . . . .. . .. ;z: GU<lr<lntor "'Cldro~s: City; St:ltQ; Zip Cede -o not applletlble W .:£ ~ ~rlnclp81 Occupst1o." (Sea Instruction,.) Employer (See InSlructlons) 1 ~ ~ CJ1 0 OJ' ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED If lendlH is out-of-state I'AC. pleasll se.. In6tructlon guide for additional reporting rC!qulrl;lmQnts. www.ethics.stllte.tx.us Revised 09l2B/2011 11• ~ ill 1::[ TeX<ls Ethics Commission F'. O. Box 12070 Al"Istin, Texas 78711-2070 (512) 463-5800 1-800-325-8506 POLITICAL EXPENDITURES SCHEDULE F[] RIGINAL EXPENDITURE CATEGORIES FOR BOX sCa) Advertl!llng ~pens" GiflJAwardalMemorlslB Expense Sllari~ag9s1COntnlct Labor Loan J'lepllymentlRelmb~rS9mQnt AceourrtinglBsnklng Legal Servi~s Sollcilatlonl'FundralBlng e:~pen~e Tr<1MpOrte~on Equipmenl &. "elated Expense COn9ulling El(pen~ Food/Baver;Jge ExpenBe Tr~vel In District C0f11rlblJ~on$/Don~\ions Mada By E;vent i:xpEInae Polling expense Tn'lvel Oul Of Dlalrlcl C8ndldlil(IUOffic;.eholder/Politi~1 Commiltee Foos Printing Expenso Otrlce OverhaadJRenl.ll1 Expen~e OTHER (erner I.l ClltegOry nollistad abOVe) The Inetruction Guide e)[Il'alns how to complotQ this form. 1 Tolal pages SGh0dule F: 2 FIl.cRNAME 1 3 ACCOUNT 1# <=tI'Iic:s CommissiOr1 File",)H '\{­~Q..CQI,.)e..lllAe.... DeV\"t..s..e... AVV\ I bvt 4 Dsle i S I'>ay .... ns~e \~Cfl::zo l3. NG~ VAN 7 Payee add",,.,,; CitY; State: Zip Code6 Amount (:5) \ \O( {S... t",. s.+\'~e+ NW, S\.)i-t~ SOD\50:>,00 \Na..s:k; -1 C\ +0 IA he... :2,0005. ~CoIIlegOry (5.e ':.I.QOI1~Iiale<l 5' tilek 01 !hi. SetledlllO d8 PURPOSE ~) Cle.."r1ption ~r."",~. or Tci comPle,e SC~dUI' TI { OF d.iGi -kt I VI f c.. ,. \.I \.H e.... ,..., ~ .ce.O (j ....{.; ""~ ~S.a ..... 'j ""~ Quo.eXPENOllUR.e ·A.rt .. -h~)\A4 F_i<"Ae.0.4S::e.. ~~-k. d",~c.~', t'vI b we... Q....... ..,.l \ 9 Comple\e QW.Y if dirE>CI Candida Ie I Offi~Old(jr name Office Bought Oflil:O hGld expandl!l.lr8 to bEJOllfil GJOH I"ayee "ollmeOtlte Amount ($) Payee addre .....; City: Stale; Zfp Code DeSC!'lpllon (II t-.I 0I11el<l. ofrexa., complete S~dul.1) OF C"legClry (S ... calltllOfle. ~ll\9d.' 1M lOP oflhl. scI'\!<Iule)PURPOSE EXPENDITURe Complete ~ If dlreel Candidate I Officeholder name Office eought 0Il1cp. h<3ld expsnditure to benefit C/O H i='ayee. "~"'eDal" Amount ($) Payee a""~~: City; SIBle; Zip Code Descrlpllon (It """"I olJtlll<l. 01 TllX8a, colllplelo Sd>I>duI. T) 01" Category (1<:•• c.,.gOfl •• Hm.d .1 1M 10j> of Ih'" .chndul.) PURPOSl:: EXPENOI'rURe Complete Q.!:!LY if direct C",ndidaoo f Officeholder name OffIce !lought Offlceh"'d "xpenditure to bene~l C/OH Q;;Ib3 Peyeensm" --t. ..... AmauN ($) Payae add"",.!!,; City; SIBle; Zip CO(Ie L :b --I!".::IO ~I~ -W CAltAgQ'Y rslJ";:J I:iOIOICI0rlOSllIlSltlKS,lIt v,~ ICl~Q' tl'11.5 5CNed'ula) DesCf1puon (,n"""" outl;~e ofT...., temp''''. Scl>.~ OF PUR."'O::l~ ~ EXpeNOITURE: n, CornplCll9 'lli.1.:l: if dlreel Candld,ne I Officeholder n3me om..e sought Office he1" ~ exp"ndllure 10 bene"t CIOM en ..- D ATTACH ADOITIONAL COPIES OF THIS SCHEDULE AS NEeDED Ro",••d01"-112010 Texas Ethics Commission PO Box 12070 Austin Texas 78711-:2070 (512) 483-5800 (TDO HlOO-735-2969) I POLITICAL EXPENDITURES SCHEDULE G MADE FROM PERSONAL FUNDS [J ORIGINAL EXPENDITURE CATEGORIES FOR BOX Sea} Advertising Expen~e GiftlAwardsiMemonal, ~nse Salar1esNVegas/CQnlraet Labor I.olln RepayrnenllRe1rnbulliernant Legal Services SolicitationiFundraising Expense Tmnl!JportaliQn I;qulprnen1 & Rel~ted ExpMBll Consulting Exp9ns~ FOOCllBev"rsga EXp&nsQ Tnl"el In District ContrlbutJon8lDonaUon~ M8<le By Event ~pense Polling Exp"'nse Travel Out Of O\"'lriet AccountJnQlBanklng Candr~aleJOfficeholderIPolltlC81 Committee Faea Printing Expen~ Of1lce OverheaQlR,;mtal Expense OTHER (enter a clrte(lO!)l nOl listed abOvC) The Instnlctlon Guide exphllna how to complete tltls form. 13 ACCOUNT '/I (EthIcs Commission Fliers) 1 11btal pa~M Senedule <3: 2 FILER NAME ~o..cq \oJ el \lit E.... ~-e...\..1.·t.s..e.... Hl:'.""'" l +0\"1­ 5 Peyeem1me40'llt" , , /30(:2ol ~ ~e...vi c:l M. Sw.~-l-l, 8 Amount ($) 7 Payee "ddresa; City; State; Zil)Code 5.0.0D lO l t=., ~k~k fslvd. / s.te.. GOO " ~la.L10 lX -T'S.O{~o ~.lnlbtJ~am6n( lrom po/l1l""t ""ntrlbuU...,s ifl1en<led (bJ Description (I' travel outeld. of'Tlo •••• oomplele 5chedul. 1)Ga) Category (SM catllgorln.lI,t"d ., Ih<llllp onnl• .mOdulS)13 PURPOSE: OF CO loV'M-~ ~~ f:. \..IalA C!.~EXPENDll'UR.e Ac..c.C>VLA+·'~/~c..I'\\.c\l.1~ ~e.~Ot+ -.re-t---et.l( q,{.i 0 V( Dale ~ayal:lname -r{"ocl.L3~()l\G\~\ tg\13 -~-a.M ­ Amount ($). Pay~r,) I1lddres,,"; City; ~~; Zip Code 75.00 a.S80 c.eu II) ('(le.-\<. LIl n~ PlG~ o RelmblJroomonl 'rom pollU",,1 """tn_a.... Intended (y) t~~\ \)G -, 5010 !J<'!tcrlptlon lIP tNlvei outside 01 Tllxee, cctllploto Sd'!oduJe 1]Cllt"90ry (Seo eal&qOrtes nstB<1 .Ulo4. top 01 \hI> .<.hodtJla)PURPOSE OF exPENDITURE Ad ver-4-t s,,', V\~ Ey r-:e-\,.ls:.e. to~o de...s.\;\V\ Ddte Payeoll n<ll11o Amount ($) Payee addrass; City; State; ZIp Code RoImI>tJr1lemonl from 0 poIll1eo1 conilibutf..." Int.n<fed Category (500 catotlOf1es Relet! at tile top 01 lIti. ,d1adulo) Deacription (II 1"""'1 O1Jl$I"" clTo."., complole StMdulO 1) OF EXPENDmJRE PURPOSe 0 ..", Peyee nama ,...­ ::=..-~p..=-= lOA..I~Amount ($) I'>sy"" ...ddres9; City; state; Zip COda ­W -0 n ~o RslmlllJlBBIllent flllm :r "'ondcd palHI=' a><lMbutlon. 1"\., . = fa.Category (5<1. cologcrl".I1"'"d.t thO topOl/hi' oolledulo) Description (II travel OUlDllle Orl1!"'8. compielB 50Md0ifPURPOSE OF C> ­E:XPcNOITURE ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED www.ethlcs.state.lx.us Revised 0412112010