HomeMy WebLinkAboutCFR-02 thru 04.2012-HammerlunTexas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CANDIDATE / OFFICEHOLDER REPORT: FORC/OH
SUPPORT & TOTALS OVER SHEET Pta
14 C/OH NAME
15 ACCOUNT # (Ethics Commission Filers)
16 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE
POLITICAL
CANDIDATE / OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE vS OR OFFICEHOLDER'S 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
GENERAL
COMMITTEE ADDRESS
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
TOTALS
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS
gownsowwm
$
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
qzt;
EXPENDITURE
TOTALS
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED
4, TOTAL POLITICAL EXPENDITURES
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
07
OF REPORTING PERIOD
OUTSTANDING
6.
LOAN TOTALS
TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LAST DAY OF THE REPORTING PERIOD
18 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the accompanying report
is true and cor ct and includes all information required to be reported by
me under Tit '15, Election Code.
Umove J
go'StaftofTexag
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eve {Q°8
OFT.
Exp. 1-2015
oqeSignature of Candidate or Officeholder
AFFIX NOTARY STAMP / SEAL ABOVE
0 r
Sworn to and subscribed before[t me, by the tJ� V LA. t this the
{said
day of vt ! 20 # to cer y which, witness my hand and seal of office.
Sig at e of officer ad roistering oath Printed name of officer administering oath TitIL of officer administe(rinA oath
www.iics.state.tx.us Revised 09/28/2011
www.ethics.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
POLITICAL CONTRIBUTIONS
OTHER THAN PLEDGES OR LOANS
SCHEDULE
The instruction Guide explains how
to complete this form.
1 Total pages Schedule A:
2 FILER NAME
a
3 ACCOUNT # (Ethics Commission Filers)
4 Date
5 Fuli ame of do n ut r
1 -of -state PAC ID#: )
7 Amount of
8 In-kind contribution
a
contribution ($)
I description (if applicable)
6 Contributor address; City;
State; Zip Code
Ck6V
(If travel outside
of Texas, complete Schedule T)
9 Principal
occupation / Job title (See lnstructi
10 Employer (See Instructions)
Date
Full name of contributor ❑
out-of-state PAC(ID#: )
Amount of
In-kind contribution
contribution ($)
I description (if applicable)
Contributor address; City;
State; Zip Code
!f travel outside
of Texas, complete Schedule
Principal
occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor ❑
out-of-statePAC (tD# )
Amount of
In-kind contribution
contribution ($)
I description (if applicable)
Contributor address; City;
State; Zip Code
(if travel outside
of Texas, complete Schedule T)
Principal
occupation / Job title (See Instructions)
Employer (See
Instructions)
Date
Full name of contributor ❑
out-of-state PAC(ID#.
Amount of
In-kind contribution
contribution {$)
I description (if applicable)
Contributor address; City;
State; Zip Code
If travel outside
of Texas, complete Schedule T
Principal
occupation / Job title (See instructions)
Employer (See
Instructions)
Date
Full name of contributor ❑
out-of-state PAC(ID#:
Amount of
In-kind contribution
contribution ($)
I description (if applicable)
Contributor address; City;
State; Zip Code
!f 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 foradditionai reporting requirements.
www.ethics.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (5121463-5800 (Tnn I-R0n_7'VF_9QRM
c
Complete ONLY if direct
expenditure to benefit C/OH
Date
Amount ($)
Complete ONLY if direct
expenditure to benefit C/OH
Date
Amount ($)
Complete ONLY if direct
expenditure to benefit C/OH
Candidate /
Payee name
Payee address; City; State; Zip Code
Category (See categories listed at the top of 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
Office soug
travel outside of TWxaV cors fete Schedule
Description (If travel outside of Texas, complete Schedule T)
Office sought
Office held
Description (If travel outside of Texas, complete Schedule T)
Office sought
Office held
www. ethics. state. tx.us Revised 09/28/2011