Political Party Report Regarding Funds From Corporations And Labor Organizations {PTY-CORP}

Revised 10/28/2016www.ethics.state.tx.usForms provided by Texas Ethics Commission GO TO PAGE 2 Form PTY-CORP Instruction Guide explains how to complete this form.Filer ID (EthicsCommission Filers)12Total pages filed:3 POLITICAL PARTYNAMEOFFICE USE ONLYDate Received Date Imaged Receipt #Amount $ Date ProcessedDate Hand-delivered or Date Postmarked 4STATE ORCOUNTY PARTY 5POLITICAL PARTYTYPE( Party name ) 6ADDRESS / PO BOX;APT / SUITE #;CITY;STATE;ZIP CODEPOLITICAL PARTYMAILING ADDRESSChange of Address7TITLEFIRSTMINICKNAMELASTSUFFIXPOLITICAL PARTYCHAIR 8ADDRESS / PO BOX;APT / SUITE #;CITY;STATE;ZIP CODEChange of AddressCHAIR MAILINGADDRESS9STREET ADDRESS (NO PO BOX PLEASE);APT / SUITE #;CITY;STATE;ZIP CODECHAIR STREETADDRESSAREA CODEPHONE NUMBEREXTENSION()10CHAIR PHONE11REPORT TYPE12PERIOD COVERED County State Democratic Republican Other: (Residence or Business) 8th day before primary election 50th day before general election January 15 July 15 MonthDayYearTHROUGH MonthDayYearPOLITICAL PARTY REPORT REGARDINGFUNDS FROM CORPORATIONS AND LABORORGANIZATIONSFORM PTY-CORP COVER SHEET PG 1 American LegalNet, Inc. www.FormsWorkFlow.com Revised 10/28/2016www.ethics.state.tx.usForms provided by Texas Ethics Commission 14 AFFIX NOTARY STAMP / SEAL ABOVE13POLITICAL PARTY NAMEI swear, or affirm, under penalty of perjury, that the accompanyingreport is true and correct and includes all information required tobe reported by me under Title 15, Election Code. Signature of Political Party Chair 16AFFIDAVIT $$1.TOTAL CONTRIBUTIONS FROM CORPORATE ORLABOR ORGANIZATIONS(OTHER THAN LOANS OR GUARANTEES OF LOANS)2.TOTAL EXPENDITURES FROM CORPORATE ORLABOR ORGANIZATION CONTRIBUTIONS TOTALSA political party must file a report on Form PTY-CORP for any reporting period during which the party accepts corporate orlabor organization contributions, maintains corporate or labor organization contributions, or makes expenditures fromcorporate or labor organization contributions.$3.TOTAL CONTRIBUTIONS MAINTAINED AS OF THE LASTDAY OF REPORTING PERIOD15Sworn to and subscribed before me, by the said , this the day of, 20, to certify which, witness my hand and seal of office. Signature of officer administering oathTitle of officer administering oathPrinted name of officer administering oathFiler ID (Ethics Commission Filers)POLITICAL PARTY REPORT:TOTALS AND AFFIDAVITFORM PTY-CORP COVER SHEET PG 2 American LegalNet, Inc. www.FormsWorkFlow.com Revised 10/28/2016www.ethics.state.tx.usForms provided by Texas Ethics Commission SUBTOTALS - PTYCORP SCHEDULE SUBTOTALSNAME OF SCHEDULESUBTOTALAMOUNT 19FORM PTY-CORP COVER SHEET PG 3POLITICAL PARTY NAMEFiler ID (Ethics Commission Filers)17181.2.4.5.3.SCHEDULE C1: MONETARY CONTRIBUTIONS FROM CORPORATION OR LABOR ORGANIZATIONSCHEDULE C2: NON-MONETARY (IN-KIND) CONTRIBUTIONS FROM CORPORATION OR LABORORGANIZATIONSCHEDULE E: LOANS SCHEDULE D: PLEDGED CONTRIBUTIONS FROM CORPORATION OR LABOR ORGANIZATION$$$$$$SCHEDULE F1: EXPENDITURES MADE FROM CORPORATE OR LABOR ORGANIZATIONCONTRIBUTIONS $ SCHEDULE F2: UNPAID INCURRED OBLIGATIONS6.7. SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD American LegalNet, Inc. www.FormsWorkFlow.com Revised 10/28/2016www.ethics.state.tx.usForms provided by Texas Ethics Commission MONETARY CONTRIBUTIONS FROMCORPORATION OR LABOR ORGANIZATIONSCHEDULE C1 47ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED 1Total pages Schedule C1:The Instruction Guide explains how to complete this form. 56 aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaCorporation / Labor Organization nameAmount of contribution ($)Corporation / Labor Organization address; City; State; Zip Code aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaCorporation / Labor Organization nameAmount of contribution ($)Corporation / Labor Organization address; City; State; Zip Code aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaCorporation / Labor Organization nameAmount of contribution ($)Corporation / Labor Organization address; City; State; Zip Code aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaCorporation / Labor Organization nameAmount of contribution ($)Corporation / Labor Organization address; City; State; Zip Code aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaCorporation / Labor Organization nameAmount of contribution ($)Corporation / Labor Organization address; City; State; Zip Code DateDateDateDateDate2FILER NAME3Filer ID (Ethics Commission Filers) American LegalNet, Inc. www.FormsWorkFlow.com Revised 10/28/2016www.ethics.state.tx.usForms provided by Texas Ethics Commission NON-MONETARY (IN-KIND) CONTRIBUTIONS FROMCORPORATION OR LABOR ORGANIZATIONSCHEDULE C2 45ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED2FILER NAME The Instruction Guide explains how to complete this form. 1Total pages Schedule C2:3Filer ID (Ethics Commission Filers)Corporation / Labor Organization name Corporation / Labor Organization name Corporation / Labor Organization nameIn-kind contributiondescriptionAmount ofContribution $aaaaaaaaa Check if travel outside of Texas. Complete Schedule T. aaaaaaaaaa Check if travel outside of Texas. Complete Schedule T. aaaaaaaaaCheck if travel outside of Texas. Complete Schedule T. Check if travel outside of Texas. Complete Schedule T. Check if travel outside of Texas. Complete Schedule T. In-kind contributiondescriptionAmount ofContribution $aaaaaaaaaaIn-kind contributiondescriptionAmount ofContribution $aaaaaaaaaa78DateDateDateCorporation / Labor Organization nameIn-kind contributiondescriptionAmount ofContribution $DateCorporation / Labor Organization nameIn-kind contributiondescriptionAmount ofContribution $Date6Corporation / Labor Organization address; City; State; Zip CodeaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaCorporation / Labor Organization address; City; State; Zip CodeaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaCorporation / Labor Organization address; City; State; Zip CodeaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaCorporation / Labor Organization address; City; State; Zip CodeaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaCorporation / Labor Organization address; City; State; Zip Codeaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa American LegalNet, Inc. www.FormsWorkFlow.com Revised 10/28/2016www.ethics.state.tx.usForms provided by Texas Ethics Commission ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED PLEDGED CONTRIBUTIONS FROM CORPORATIONOR LABOR ORGANIZATIONSCHEDULE D2FILER NAME4The Instruction Guide explains how to complete this form.871Total pages Schedule D:3Filer ID (Ethics Commission Filers)56 DateIn-kind contributiondescriptionAmount ofContribution $aaaaaaaaa aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaCorporation / Labor Organization nameCorporation / Labor Organization address;City; State; Zip Code Check if travel outside of Texas. Complete Schedule T. aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa DateIn-kind contributiondescriptionAmount ofContribution $ Corporation / Labor Organization nameCorporation / Labor Organization address;City; State; Zip CodeCheck if travel outside of Texas. Complete Schedule T. DateIn-kind contributiondescriptionAmount ofContribution $ Corporation / Labor Organization nameCorporation / Labor Organization address;City; State; Zip Code Check if travel outside of Texas. Complete Schedule T. DateIn-kind contributiondescriptionAmount ofContribution $ Corporation / Labor Organization nameCorporation / Labor Organization address;City; State; Zip Code Check if travel outside of Texas. Complete Schedule T. DateIn-kind contributiondescriptionAmount ofContribution $ Corporation / Labor Organization nameCorporation / Labor Organization address;City; State; Zip Code Check if travel outside of Texas. Complete Schedule T. aaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa American LegalNet, Inc. www.FormsWorkFlow.com Revised 10/28/2016www.ethics.state.tx.usForms provided by Texas Ethics Commission SCHEDULE ELOANS2FILER NAME4TOTAL OF UNITEMIZED LOANS$13The Instruction Guide explains how to complete this form. 5768910111416171820211213 GUARANTORINFORMATION15 Description of Collateral Principal occupation / Job title (See Instructions)Employer (See Instructions) Name of guarantoraaaaaaaaaaaaaaaaaaaaaaaaaaaaaa