Monthly Filing General-Purpose Committee Campaign Finance Report {MPAC}

Revised 10/28/2016 Forms provided by Texas Ethics Commission www.ethics.state.tx.us 3 2Total pages filed:COMMITTEE NAME4COMMITTEEADDRESSADDRESS / PO BOX;APT / SUITE #;CITY;STATE;ZIP CODE5CAMPAIGNTREASURERNAMEMS / MRS / MRFIRSTMINICKNAMELASTSUFFIX6CAMPAIGNTREASURERSTREET ADDRESS(Residence or Business) STREET ADDRESS (NO PO BOX PLEASE);APT / SUITE #;CITY;STATE;ZIP CODE STREET ADDRESS OR PO BOX;APT / SUITE #;CITY;STATE;ZIP CODE8CAMPAIGNTREASURERPHONEAREA CODEPHONE NUMBEREXTENSION( )MONTHLYREPORTFILING DEADLINE10 Dissolution (Attach PAC-DR)11PERIOD COVEREDGO TO PAGE 2 Change of AddressMonthDayYear MonthDayYearTHROUGH aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa MONTHLY FILING GENERAL-PURPOSECOMMITTEE CAMPAIGN FINANCE REPORT Change of AddressThe MPAC Instruction Guide explains how to complete this form. OFFICE USE ONLY Date ReceivedJanuary 5February 5March 5 April 5May 5June 5 July 5August 5September 5 October 5November 5December 5 FORM MPAC COVER SHEET PG 1 Date Imaged Date Processed Receipt #Amount $ Date Hand-delivered or Date Postmarked1Filer ID (Ethics Commission Filers)7CAMPAIGNTREASURERMAILING ADDRESS9REPORT TYPE 10th day after campaign treasurer termination Monthly American LegalNet, Inc. www.FormsWorkFlow.com Revised 10/28/2016 Forms provided by Texas Ethics Commission www.ethics.state.tx.us AFFIX NOTARY STAMP / SEAL ABOVE Signature of officer administering oathTitle of officer administering oathPrinted name of officer administering oathSworn to and subscribed before me, by the said , this the day of , 20, to certify which, witness my hand and seal of office.I swear, or affirm, under penalty of perjury, that the accompanying report istrue and correct and includes all information required to be reported byme under Title 15, Election Code. Signature of Campaign Treasurer (Attach lists on plainpaper to complete thisreport if necessary.)1. CandidatesMONTHLY FILING GPAC REPORT:PURPOSE AND TOTALS A. SupportedB. Opposed A. SupportedB. Opposed 2. Measures3. Officeholders Assisted(Identify by name or, if applicable,classify by party.)(Describe by dateand location ofelection andnature of issue.)(Identify by nameor, if applicable,classify by party.)12COMMITTEE NAMEFiler ID (Ethics Commission Filers)1315CONTRIBUTIONTOTALS EXPENDITURETOTALSTOTAL POLITICAL CONTRIBUTIONS(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)TOTAL POLITICAL EXPENDITURES OF $10 OR LESS, UNLESS ITEMIZED TOTAL POLITICAL EXPENDITURESOUTSTANDINGLOAN TOTALS aaaaaaaaaaaaaaaaaaaaaaaaaa CONTRIBUTIONBALANCEaaaaaaaaaaaaaTOTAL UNITEMIZED POLITICAL CONTRIBUTIONS(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)check here if this report qualifies for the higher itemization threshold 1.2.3.4.5.TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAYOF THE REPORTING PERIODTOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THELAST DAY OF THE REPORTING PERIOD6.$$$$$$16AFFIDAVITFORM MPAC COVER SHEET PG 214COMMITTEEACTIVITY American LegalNet, Inc. www.FormsWorkFlow.com Revised 10/28/2016 Forms provided by Texas Ethics Commission www.ethics.state.tx.us SUBTOTALS - MPAC COMMITTEE NAMEFiler ID (Ethics Commission Filers) SCHEDULE SUBTOTALSNAME OF SCHEDULESUBTOTALAMOUNT 11. 1.SCHEDULE A1: MONETARY POLITICAL CONTRIBUTIONS 2.SCHEDULE B: PLEDGED CONTRIBUTIONS 6.SCHEDULE E: LOANS7.SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS8.9.10.4.5.SCHEDULE D: PLEDGED CONTRIBUTIONS FROM CORPORATION OR LABOR ORGANIZATION3.SCHEDULE C1: MONETARY CONTRIBUTIONS FROM CORPORATION ORLABOR ORGANIZATION SCHEDULE A2 : NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONSSCHEDULE F2: UNPAID INCURRED OBLIGATIONSSCHEDULE C2 : NON-MONETARY (IN-KIND) CONTRIBUTIONS FROM CORPORATIONOR LABOR ORGANIZATION$$$$$$$$$$$$SCHEDULE C3 : MONETARY SUPPORT FROM CORPORATION OR LABOR ORGANIZATIONSCHEDULE C4 : NON-MONETARY SUPPORT FROM CORPORATION OR LABOR ORGANIZATION171918FORM MPAC COVER SHEET PG 3$ $ $SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNEDTO FILER15. SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS14. 12. SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS13. SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD American LegalNet, Inc. www.FormsWorkFlow.com Revised 10/28/2016 Forms provided by Texas Ethics Commission www.ethics.state.tx.us 47 MONETARY POLITICAL CONTRIBUTIONSSCHEDULE A1 2FILER NAMEThe Instruction Guide explains how to complete this form.ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.1Total pages Schedule A1:3Filer ID (Ethics Commission Filers) 89aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa Date Amount of contribution ($)Principal occupation / Job title (See Instructions)Employer (See Instructions)aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa Date Amount of contribution ($)Principal occupation / Job title (See Instructions)Employer (See Instructions) Date Amount of contribution ($)Principal occupation / Job title (See Instructions)Employer (See Instructions) aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa Date Amount of contribution ($)Principal occupation / Job title (See Instructions)Employer (See Instructions) 6Contributor address; City; State; Zip Code5Full name of contributor out-of-state PAC (ID#:)Full name of contributor out-of-state PAC (ID#:)Contributor address; City; State; Zip CodeaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaFull name of contributor out-of-state PAC (ID#:)Contributor address; City; State; Zip CodeFull name of contributorContributor address; City; State; Zip Code out-of-state PAC (ID#:) American LegalNet, Inc. www.FormsWorkFlow.com Revised 10/28/2016 Forms provided by Texas Ethics Commission www.ethics.state.tx.us NON-MONETARY (IN-KIND) POLITICALCONTRIBUTIONSSCHEDULE A2 2FILER NAMEThe Instruction Guide explains how to complete this form. ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements. 4 TOTAL OF UNITEMIZED IN-KIND POLITICAL CONTRIBUTIONS$56 1012141Total pages Schedule A2:3Filer ID (Ethics Commission Filers)7 out-of-state PAC (ID#:)Full name of contributorDate Contributor's principal occupation (FOR JUDICIAL) Contributor's employer/law firm (FOR JUDICIAL) 16If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL)aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaContributor address; City; State; Zip Code out-of-state PAC (ID#:)Check if travel outside of Texas. Complete Schedule T.Full name of contributorDate Contributor's principal occupation (FOR JUDICIAL) Contributor's employer/law firm (FOR JUDICIAL) In-kind contributiondescriptionAmount ofContribution $aaaaaaaIf contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL)aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaContributor address; City; State; Zip Code 98Check if travel outside of Texas. Complete Schedule T. In-kind contributiondescriptionAmount ofContribution $aaaaaaa (See Instructions)151113Contributor's job title (FOR JUDICIAL)Law firm of contributor's spouse (if any) (FOR JUDICIAL)(See Instructions)Employer (FOR NON-JUDICIAL) (See Instructions)Contributor's job title (FOR JUDICIAL)Law firm of contributor's spouse (if any) (FOR JUDICIAL)(See Instructions)Employer (FOR NON-JUDICIAL)Principal occupation / Job title (FOR NON-JUDICIAL)(See Instructions)Principal occupation / Job title (FOR NON-JUDICIAL)(See Instructions) American LegalNet, Inc. www.FormsWorkFlow.com Revised 10/28/2016 Forms provided by Texas Ethics Commission www.ethics.state.tx.usPLEDGED CONTRIBUTIONSSCHEDULE B 2FILER NAME ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.The Instruction Guide explains how to complete this form. 56710114TOTAL OF UNITEMIZED PLEDGES 1Total pages Schedule B:3Filer ID (Ethics Commission Filers)$98aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaPrincipal occupation / Job title (See Instructions)Employer (See Instructions) DateCheck if travel outside of Texas. Complete Schedule T. In-kind contributiondescriptionAmountof Pledge $Pledgor address; City; State; Zip CodeFull name of pledgo