Texas Ethics Commission
POBox 12070
Austin
Texas
78711 ~2070
(512) 463-5800
CANDIDATE / OFFICEHOLDER
CAMPAIGN FINANCE REPORT
1-800-325-8506
FORM
C/OH
COVER SHEET PG
1
==~~~----~'-===========T====~:====================~
Total pages filed:
I.
The C/OH Instruction Guide explains how to complete this form.
I2
1 ACCOUNT #
i
(Ethics Commission filers)
I
i
3
MI
FIRST
MSiMRSiMR
CANDIDATE I
OFFICEHOLDER
NAME
SANDRA
D
Dare Received
LAST
NICKNAME
OFFICE USE ONLY
,. ,
SUFFIX
ELLIS
f----~-~~~___+-.---~-.~~--~------.-~-~--~-__I
4
CANDIDATE /
OFFICEHOLDER
~;6~~~s
o
5
ADDRESS IPOBOX;
APTISUITE#;
CITY;
ZIP CODE
Dallas, IX 75231
9227 Moss Trail
!
STATE:
Date Hand-delivered or D~tr Postmarked.
CI1ange of Addressi
CANDIDAT--E-/~---]I~A-R-E-A-C-O-D;---~~~P--H-O-N-E-N-U-M-B-E-R~~~~~~~~E--X-T-EN-S-IO-N~-~~--Ih==~_~~Ti',,:-,,"),=~~-~-1
~~61~~HOLDER ! (214)
236 1330
_____________ /tR;;;;"C;;-,'i;;;Pt;;#;;-;;;;j--'-IApm-:d-'",_'N--__I
~~~~ -~-If__---~~~--~-~~~--~-
--6~Z~MPAIGN
-
TREASURER
NAME
[I
MSllvll~SIMR
i
N!CI(NAME
Re~T
i,
f---7
CAMPAIGN
TREASURER
ADDRESS
I
.
I
_
9
APT i SUITE #:
STREET ADDRESS (NO PO BOX PLEASE);
CITY;
ZIP CODE
Dallas, TX 75205
4227 Winsor
AREA
STATE;
CODECC_--~~--:P-H--:O-NE::-:N:'-U:'-M=BER:.----~--~~EX~TE~N~SIO~N---~
~~~~~UR~: _ ___+I-(-2"~4-)---7-5-0-8-5-5-5.--~-"-----____________~____-I
REPORT TYPE
~---__
11
I
SUFFIX
Prospere
(Residence or buslness)1
~CAMPA"iG'N
Date Processed
MI
FIRST
i
n
[]
January 15
30th day before eiectlOn
[J
Runoff
[]
15th day after campaign treasurer
appointment (officeholder only)
8th day before eleclion
LJ
Exceeded $500 limit
[J
Final report (Attach CIOH "FR)
7
"" ____ ~f-i___ ~=~'"'"=~____ --,--------~ ______.__________________ _
ELECTION
I
EU:;CTIONDATE
Month
Day
/1
:
Year
.2 //0
I
ELECTION TYPE
i 0
P;lm'~
i_.J
Runoff
o
Special
--120F"FIC-E---- -'~~-r--OFFICE C'-EL~. ;~-'-------L-..-~~-""~--~~\-13~-O--FF-,C-E~SO-U-G-H-T-1-'t-kP-C-W-P-)--~- ---~~-~--~-------"-~--14 NOTICE
-_._"-""-
OF DIRECT
CAMPAIGN
~~~~~~~URE
i
JUSTICE OF THE"----~-~-PEACE 3-2
--+--"------"-----
i
---'--~----"---------~------I
I
[""
Direct campaign expenditures are campaign expenditures made by others without the candidate's prior consent or approval.
Candidates ,ne required to disclose this InfannatlOn only If they receive notification of the direct campaign expenditure, ••
:[r"
N8n18
-~,,-
" .., , - , , - - - - - - - - - - - -
INDIVIDUALS
!
o
A(fclreS5 I PO 80x.
Apt! SUIte #;
SWiS.
i
C)"l(Jibonal pa(JOS
I
GOTO PAGE 2
Revised Oll125!200S
Texas Ethics Commission
P.O. Box 12070
Austin,
Texas
78711-2070
(512) 463-5800
CANDIDATE I OFFICEHOLDER REPORT:
SUPPORT & TOTALS
1-800-325-8506
FORM
C/OH
2
COVER SHEET PG
16 ACCOUNT # (EthiCS Commission Filers)
15 C/OH NAME
'SAAJD 12 A
17 NOTICE
FROM
POLITICAL
COMMITTEE(S)
nilS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTlONS ACCEPTED OR POU'llCAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE
CANDiDATE I OFFiceHOLDER. THESE EXPENDfTURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
CONSENr. CANDIDATES AND OFFICEHOLDERS AREREQUIREO TO REPORT THIS INFORMATION ONLY IF THEY RECEI\IE NO'llCE OF SUCH EXPENDITURES.
COMMITTEE NAME
COMMITTES TYpe
o
GENERAL
COMMITTEE ADDRESS
D
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
o
additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
18 CONTRIBUTION
TOTALS
1.
2.
EXPENDITURE
TOTALS
TOTAL POLlT!CAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
TOTAL POLITICAL CONTRIBUTIONS
$
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
$--0
3.
TOTAL POLITICAL EXPENDITURES OF $50 OR LESS. UNLESS ITEMIZED
$
4_
TOTAL POLITICAL EXPENDITURES
$
()
CONTRIBUTION
BALANCE
5.
TOTAL POLITICAL CONTRIBUTIONS MAINTAINEDAS OF THE LAST DAY
OF REPORTING PERIOD
$ --
0
OUTSTANDING
LOAN TOTALS
6.
TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LAST DAY OF THE REPORTING PERIOD
$
0
19 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the accompanying report
DONIT'
'(NARD
NotalY PLfil:C J c,lJ(e of Texas
My Comrnlssion Expires
:.~::: ;z:x~""~r~"
~:"",,"[),E:• ~C'cE.MBEH 05, 2010
Signature of Candidate or Officeholder
AFFIX NOTARY STAMP I SEAL ABOVE
j)
Sworn to and subscribed before me, by the said
1V't
1;
-f(jJQ:;-","LfXLJ",7t,,,,-,,a4./~d.'£';';)"'~"""&<'.L________ '
, 20 ~I~C~/,-)__ , to certify which,
this the
witness my hand and seal of office.
Revised 04f21f2010
PO. Box 12070
Texas Ethics Commission
Austin,
Texas
(512) 463-5800
78711-2070
POLITICAL CONTRIBUTIONS
OTHER THAN PLEDGES OR LOANS
SCHEDULE
1
The Instruction Guide explains how to complete this form.
2
FILER NAME
4
Date
9
3
5
Full name of contributor
6
Contributor address;
o
City;
/10
o
Full name of contributor
Contributor address;
City;
ACCOUNT # (Ethics Commission Filers)
t 8
7 Amount of
contribution ($)
!
In-kind contribution
descriptfon (if applicable)
I
I
I
(If travel outside of Texas, complete Schedule T)
Employer (See Instructions)
)
out-of-state PAC(lD#:
state;
A
Total pages Schedule A:
Zip Code
Principal occupation J Job tale (See Instructions)
Date
)
out-of-state PAC(ID#:
state;
1-800-325-8506
Amount of
contribution ($)
Zip Code
I
I
I
I
I
In-kind contribution
description (if applicable)
I
In-kind contribution
description Ot applicable)
__ {If travel outside of Texas corDplete Schedule 31
Principal occupation I Job title (See Instructions)
Date
o
Full name of contributor
.
.
Contributor address;
City;
I
Employer (See Instructions)
)
out-of-state PAC(ID#:
state;
Amountot
contribution ($)
!
I
I
I
Zip Code
(If travel outside of Texas, complete Schedule T)
I
Principal occupation I Job title (See Instructions)
Date
Full name of contributor
Contributor-address;
o
City;
out-or-statePAC (100.
State;
FuJI name of contributor
Contributor address;
o
City;
Principal occupation J Job title (See Instructions)
)
J
State;
!
!
In-kind contribution
description (if applicable)
Employer (See Instructions)
)
out-or-state PAC(ID#;
Amount of
contribution ($)
I
I
I
If travel outside of Texas ccmolete Schedule T\
Zip Code
Principal occupation J Job title (See Instructions)
Date
Employer (See Instructions)
Amount of
contribution ($)
I
I
In-kind contribution
description (if applicable)
I
I
I
Zip Code
I
(If travel outside of Texas comoiete Schedule T)
Employer (See Instructions)
ATIACH ADDITfONALCOPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide foradditional reporting reqUirements.
ReVised 04/21120 10
Texas Ethics Commission
Austin,
P. O. Box 12070
Texas
(512) 463-5800
78711-2070
PLEDGED CONTRIBUTIONS
SCHEDULE
The Instruction Guide explains how to complete this form.
2
FILER NAME
4
5
TOTAL OF UNITEMIZED PLEDGES:
Date
6
Full name of pledgor
o
1-800-325-8506
'"
'"
'"
1
Total pages Schedule B:
3
ACCOUNT # (EthicS Commission Filers)
'"
'"
out-of-state AO.C(ID#'
)
8
'"
B
1$
Amount of
pledge ($)
19
In-kind description
(if applicable)
1
7
Pledgor address;
City;
State;
Zip Code
1
1
1
(If travel outside of Texas, complete Schedule T)
10 Principal occupation I Job title (See Instructions)
Date
Full name of pledgor
o
111
Employer (See Instructions)
out-or-state PAC(ID#".
)
Amountof
pledge ($)
1
In-kind description
(if applicable)
1
Pledgor address;
City;
State;
1
Zip Code
1
1
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
I
Date
Full name of pledgor
o
out·of-state PAC (10#:
)
Amountot
pledge ($)
..
Pledgor address;
City;
State;
1
In-kind description
(if applicable)
1
1
Zip Code
1
1
Principal occupation I Job title (See Instructions)
Date
Full name of pledgor
o
I
(If travel outside of Texas, complete Schedule T)
Employer (See Instructions)
out-of-state PAC(ID#:
I
Amount of
pledge ($)
1
In-kind description
(if applicable)
1
Pledgor address;
City;
State;
I
Zip Code
1
1
(If travel outside of Texas. complete Schedule T)
I
Principal occupation I Job title (See Instructions)
Date
Full name of pledgor
Pledgor address;
o
City;
Employer (See Instructions)
out-ot-state PAc(lD#:
State;
)
Amount of
pledge ($)
,1
I
In-kind description
(if applicable)
1
Zip Code
1
1
(If travel outside of Texas, complete Schedule T)
Principal occupation I Job title (See Instructions)
Employer (See Instructions)
1
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-ot-state PAC, please see instruction guide
tor
additional reporting requirements.
Revised 0412112010
Texas Ethics Commission
Austin
PO Box 12070
Texas
78711-2070
(512) 463-5800
LOANS
1-800-325-8506
SCHEDULE
E
1 Total pages Schedule E:
The Instruction Guide explains how to complete this form.
2
3 ACCOUNT # (Ethics Commission Filers)
FILER NAME
4
TOTAL OF UNITEMIZED LOANS:
5
Date of loan
7
Name of lender
6
Is render
a financial
Institution?
8
Lender address;
y
'"
'"
'"
'"
'"
$
o out-of·state PAC (ID#:
City;
State;
}
Zip Code
9 LoanAmount ($)
10
interest rate
11
Maturity date
N
13
Principal occupation I Job title (See Instructions)
12
'"
Employer (See Instructions)
14 Description of Collateral
o
15
none
GUARANTOR
INFORMATION
18 Amount Guaranteed ($)
16 Name of guarantor
City;
17 Guarantor address:
D
Zip Code
State;
not applicable
20
19 Principal Occupation (See Instructions)
Date of loan
Name of lender
Is lender
a financial
Institution?
Lender address;
Employer (See Instructions)
o out-of-state PAC (10#:
City;
State;
)
LoanAmount ($)
Interest rate
Zip Code
Maturity date
y
N
Principal occupation I Job title (See Instructions)
Employer (See Instructions)
Description of CoUateral
o
none
GUARANTOR
INFORMATION
Name of guarantor
Guarantor address;
D
Amount Guaranteed ($)
City:
State:
Zip Code
not applicable
Principal Occupation (See Instructions)
Employer (See instructions)
AITACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If lender is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revlsed04{.2112010
Texas Ethics Commission
P.O. Box 12070
Austin,
Texas
78711-2070
(512) 463-5800
POLITICAL EXPENDITURES
1-800-325-8506
SCHEDULE
F
EXPENDITURE CATEGORIES FOR BOX 8(0)
Advertising Expense
Accounting/Banking
Consulting Expense
Event Expense
Fees
SalariesiWagesfContract Labor
Solicitation/Fundraising Expense
Travel In District
Travel Out Of District
Office Overhead/Rental Expense
GifVAwardsfMemorials Expense
Legal Services
Food/Beverage Expense
Polling Expense
Printing Expense
Loan Repayment/Reimbursement
Transportation EquiPment & Related Expense
Contributions/Oonations Made By
Candidate/Officeholder/Political Committee
OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F
2 FILER NAME
4 Date
5 Payee name
6 Amount ($)
7 Payee address;
8
PURPOSE
/3 ACCOUNT # (Ethics Commission Filers)
City;
state;
Zip Code
(a) Category (See categones listed althe top ofthis schedule)
(1)) Description (Iftravel outside ofTexas, complete Schedule T)
OF
EXPENDITURE
9 Complete 9.!:::!l.Y if direct
expenditure to benefit C/OH
Candidate / Officeholder name
Date
Payee name
Amount ($)
Payee address:
PURPOSE
City;
State;
Office sought
Office held
Zip Code
Category (See categories listed al the top of this schedule)
Description (If travel outside ofTexas, complete Schedule T)
OF
EXPENDITURE
Complete Qtll..Y If dIrect
expenditure to benefit CtOH
Date
Payee name
Amount ($)
Payee address;
PURPOSE
Office sought
Candidate / Officeholder name
City;
State;
Office held
Zip Code
Category (See categories listed atthe topol this schedule)
Description (iftrave\ outside of Texas, complete Schedule T)
OF
EXPENOlfURE
Complete Q1I1X if direct
expenditure to benefit C/OH
Candidate I Officeholder name
Date
Payee name
Amount ($)
Payee address',
PURPOSE
City',
State;
Office sought
Office held
Zip Code
Category (See categories listed althe top of this schedule)
Description Of travel outside of Texas, complete SChedule T)
OF
EXPENOlfURE
Complete ONLY if direct
expenditure to benefit e/OH
Candidate (Officeholder name
Office sought
Office held
ATIACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised 04f2112010
Texas Ethics Commission
Austin,
PO Box 12070
Texas
78711-2070
(512) 463-5800
POLITICAL EXPENDITURES
MADE FROM PERSONAL FUNDS
1-800-325-8506
SCHEDULE
G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Gift/Awards/Memorials Expense
Legal Services
Food/Beverage Expense
Polling Expense
Printing Expense
AdvertisinG Expense
Accounting/Banking
Consulting Expense
Event Expense
Pees
SalarieslWagesfConlract Labor
SolicitationfFundraising Expense
Travel In District
Travel Out Of District
Office Overhead/Rental Expense
Loan Repayment/Reimbursement
Transportation Equipment & Related Expense
ContrIbutions/Donations Made By
Candidate/Officeholder/Political Committee
OTHER (enter
a category
not iisted above)
The InstructIon Guide explains how to complete thIs form.
1 Total pages Schedule G
4 Date
[5
6 Amount
($)
3 ACCOUNT # (Ethics Commission Filers)
2 FILER NAME
Payee name
7 Payee address;
City;
State;
Zip Code
R&imbursement from
political contrlbutlons
intended
0
PURPOSE
8
(a) Category (See categories listed at tM top of thl.s schedule)
(b) Description Oftrallel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address;
City;
State;
Zip Code
Reimbursement from
polltical contribUtions
In!ended
0
PURPOSE
Category (See categories listed at the top ofthis schedule)
Description (Irttaveloutslde of Texas,
com~ete
Schedule T)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address;
0
City;
State;
Zip Code
Reimbursement from
political contributions
In!ended
PURPOSE
Category (See categories listed at the top of this schedule)
Descrtption (If travel outside ofTexas, complete SCMduie T)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address:
0
City;
State;
ZlpCode
Reimbursement from
political contributions
In!ended
PURPOSE
Category (See categories listed atthe top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS NEEDED
ReVised 04121/2010
Texas Ethics Commission
P.O. Box 12070
Austin,
Texas
78711-2070
(512) 463-5800
PAYMENT FROM POLITICAL CONTRIBUTIONS
TO A BUSINESS OF CtOH
1-800-325-8506
SCHEDULE
H
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense
Accounting/Banking
Consulting Expense
Event Expense
Fees
Gift/Awards/Memorials Expense
Legal Services
Food/Beverage Expense
Polling Expense
Printing Expense
SalariesJWages/Contract Labor
Soiicitation/Fundraising Expense
Travel In District
Travel Out Of District
Office Overhead/Rental Expense
Loan Repayment/Reimbursement
Transportation Equipment & Related Expense
Contributions/Donations Made By
Candidate/Officeholder/Political Committee
OTHER (enter a category not listed above)
The instruction Guide explains how to complete this form.
1 Total pages Schedule H
2 FILER NAME
4 Date
5 Business name
6 Amount ($)
7 Business address;
State;
ACCOUNT # (EthiCS Commission Filers)
Zip Code
(a) Category (Sea categories listed attha top ot this schedule)
PURPOSE
8
City;
13
~
Description (II travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
9 Complete .o.ru if direct
Candidate I Officeholder name
Office sought
Office held
expenditure to benefit C/OH
Date
Business name
Amount ($)
I
I
PURPOSE
Business address;
City:
State;
Zip Code
Category (See categories listed althe top 01 this schedule)
DescriptIon (iltravel outside of~xas, complete Schedule 1)
OF
EXPENDITURE
Complete .QW..X if direct
expenditure to benefit C/OH
Candidate / Officeholder name
Date
Business name
Amount ($)
Business address;
PURPOSE
City;
State:
Office sought
Office he!d
Zip Code
Category (See categories listed atthe top of this schedule)
Description (1ft/ave! outsIde of Texas. complete Schedule 1)
OF
EXPENDITIJRE
Complete ONLY if direct
expenditure to benefit C/OH
Candidate I Officeholder name
Date
BusinesS name
Amount ($)
Business address;
PURPOSE
City;
State;
Office sought
Office held
Zip Code
Category (See categories listed at tha top of this schedule)
Description (II travel outside o/Texas, complete Schedule 1)
OF
EXPENDITIJRE
Complete OOLX if direct
expenditure to benefit C/OH
Candidate / Officeholder name
Office sought
Office held
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised04121/2010
Texas Ethics Commission
PO Box 12070
Austin
Texas
78711-2070
(512) 463-5800
NON-POLITICAL EXPENDITURES
MADEFROMPOLITICALCONTruBUTIONS
1-800-325-8506
SCHEDULE
I
EXPENDITURE CATEGORIES FOR BOX 8(0)
Advertising Expense
Accounting/Banking
Consulting Expense
Event Expense
Fees
GiftlAwardsfMemoriais Expense
legal Services
Food/Beverage Expense
POlling Expense
Printing Expense
SalariesfWagesfContract labor
Solicitation/Fundraising Expense
Travel In Oistrict
Travel Out Of District
Office Overhead/Rental Expense
loan Repayment/Reimbursement
Transportation Equipment & Related Expense
Contributions/Donations Made By
Candidate/Officeholder/Political Committee
OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
13
1 Total pages Schedule I'
2
4 Date
5 Payee name
6 Amount ($)
7 Payee address:
8
<a) Category (See categories listed atthe top of ttlis schedule)
PURPOSE
FILER NAME
City;
State;
ACCOUNT' (Ethios Commi"ioo File,,)
Zip Code
(b) Description (See instructions regarding type of Information required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address;
PURPOSE
City;
State;
Zip Code
Category (See categories listed atthe top of this schedule)
Description (See Instructions regarding type of Intormatlon required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address;
PURPOSE
City;
state;
ZJp Code
Category (See categories listed atttle top of this schedule)
Description (See instruc/iens regarding type of Information required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address;
PURPOSE
City;
State;
Zip Code
Category (See categories listed atthe lop of this schedule)
Description (See instructJons regarding type of information required_)
OF
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised 0412112010
p. 0
Texas Ethics Commission
Box 12070
Austin,
Texas
78711-2070
(512) 463-5800
CREDITS (optional)
SCHEDULE
The Instruction Guide e)(plains how to complete this form.
2
FILER NAME
4 Date
Date
is
1-800-325-8506
1
Total pages Schedule K:
3
ACCOUNT # (Ethics Commission Filers)
Payor name
8
K
Amount
($)
6
Payor address;
7
Reason for credit
City;
State;
Zip Code
Payor name
Amount
($)
Payor address;
City;
state;
Zip Code
Reason for credit
Date
Payor name
Amount
($)
Payor address;
City:
state;
Zip Code
Reason for credit
Date
Paydrname
Amount
($)
Payor address;
City;
State:
Zip Code
Reason for E;redit
Date
Payor name
Amount
($)
Payor address;
City;
State;
Zip Code
Reason for credit
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised 0412112010
Texas Ethics Commission
Austin,
P. O. Box 12070
Texas
(512) 463-5800
78711-2070
IN·KIND CONTRIBUTION OR POLITICAL EXPENDITURE
FOR TRAVEL OUTSIDE OF TEXAS
-
SCHEDULET
1 Total pages Schedule T"
The Instruction Guide explains how to complete this form.
2
1-800-325-8506
3 ACCOUNT # (Ethics Com mission Filers)
FILER NAME
4 Name of Contributor I Corporation or Labor Organization I Pledgor / Payee
5 Contribution I Expenditure reported on:
0
0
Schedule A
Schedule H
6 Dates of travel
7
0
0
0
0
Schedule B
Schedule N
Schedule C
COH~UC
0
0
Schedule D
COH-T
0
0
Schedule F
PAC-C
0
0
Schedule G
PAC-E
Name of person(s) traveling
B Departure city or name of departure location
9 Destination city or name of destination location
11 Purpose of travel (including name of conference, seminar, or other event)
10 Means of transportation
Name of Contributor / Corporation or Labor Organization I Pledgor I Payee
Contribution I Expenditure reported on:
0
0
ScheduJe A
Schedule H
0
0
Schedule B
Schedule N
0
0
Schedule C
COH-UC
0
0
Schedule D
COH-T
Schedule F
D
PAC-C
0
0
Schedule G
PAC-E
Name of person(s) traveling
Dates of travel
Departure city or name of departure iocation
Destination city or name of destination location
Means of transportation
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:
0
0
Schedule A
U
Schedule B
Schedule H
0
Schedule N
Dates of travel
0
0
Schedule C
COH-UC
0
0
Schedule D
COH-T
0
0
Schedule F
PAC-C
0
0
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
Purpose of travel (induding name of conference, seminar, or other event)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revlsed 04(2112010
Texas Ethics Commission
PO Box 12070
Austin,
Texas
78711-2070
CANDIDATE I OFFICEHOLDER REPORT:
OESIGNATION OF FINAL REPORT
-
(512) 463-5800
FORM
1-800-325-8506
C/OH - FR
The Instruction Guide explains how to complete this form .
•• Complete only if "Report Type" on page 1 is marked "Final Report" ••
1
e/OH NAME
3
SIGNATURE
2 ACCOUNT # (Ethics Commission Filers)
r do not expect any further political contributions or political expenditures in connection with my candidacy. I understand that designating a
report as a final report terminates my campaign treasurer apPointment Jalso understand that I may not accept any campaign contributions
or make any campaign expenditures without a campaign treasurer apPointment on file,
Signature of Candidate I Officeholder
4
FILER WHO IS NOT AN OFFICEHOLDER
... Complete A & B below only If you are notan officeholder.••
A.
CAMPAIGN FUNDS
Check only one:
0
I do not have unexpended contributions or unexpended interest or income earned from political contrJbutions.
0
I have unexpended contributions or unexpended interest or income earned from political contributions. I understand that I may
not convert unexpended political contributions or unexpended interest or 'Income earned on political contributions to personal
use. I also understand that Jmust file an annual report of unexpended contributions and that I may not retain unexpended
contributions or unexpended interest or income earned on political contributions longer than six years after filing this final
report. Further, r understand that I must dispose of unexpended political contributions and unexpended interest or Income
earned on political contributions in accordance with the requirements of Election Code, § 254.204.
B.
ASSETS
Check only one:
0
0
! do not retain assets purchased with political contributions or interest or other income from political contributions.
I do retain assets purchased with political contributions or interest or other income from poJltlcal contributions. I understand that
! may not convert assets purchased with political contribUtions or interest or other income from political contributions to personal
use. I also understand that I must dispose of assets purchased with political contributions in accordance with the requirements
of Election Code, § 254.204.
.._-
Signature of Candidate
5
OFFICEHOLDER
•• Complete this section only if you aTe an officeholder ••
0
I am aware that I remain subject to tiling requirements applicable to an officeholder who does not have a campaign treasurer on file.
I am also aware that I will be required to file reports of unexpended contributions if, after filing the last required report as an
officeholder, I retain political contributions, interest orother income from political contributions, or assets purchased with political
contrlbutions or interest or other income from political contributions.
-------.-------Signature of Officeholder
Revised 04f21f2010