Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) CANDIDATE / OFFICEHOLDER SPECIAL SESSION REPORT 1 ACCOUNT # FORM C/OH-SS 2 Total pages filed: 3 CANDIDATE / OFFICEHOLDER NAME MS/MRS/MR FIRST MI OFFICE USE ONLY Date Received NICKNAME LAST SUFFIX 4 CANDIDATE / OFFICEHOLDER ADDRESS change of address ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE Date Hand-delivered or Postmarked 5 PERIOD COVERED Month Day Year Month Day THROUGH 6 OFFICE: HELD (if applicable) Governor Lt. Governor Attorney General Comptroller Land Commissioner Agriculture Commissioner Railroad Commissioner Supreme Court Justice Court of Criminal Appeals Judge State Senator: District #________________________ State Representative: District #__________________ Secretary of State 7 OFFICE: SOUGHT (if applicable) Governor Lt. Governor Attorney General Comptroller Land Commissioner Agriculture Commissioner Railroad Commissioner Supreme Court Justice Court of Criminal Appeals Judge State Senator: District #________________________ State Representative: District #__________________ 8 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the accompanying report is true and correct and includes all information required to be reported by me under Title 15, Election Code. Signature of Candidate or Officeholder AFFIX NOTARY STAMP / SEAL ABOVE Sworn 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 oath Printed name of officer administering oath www.ethics.state.tx.us Receipt # Date Processed Year Date Imaged Amount Title of officer administering oath Revised 09/01/2007 American LegalNet, Inc. www.FormsWorkFlow.com 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 The Instruction Guide explains how to complete this form. 2 FILER NAME 1 SCHEDULE A Total pages Schedule A: 3 ACCOUNT # (Ethics Commission filers) 4 Date 5 Full name of contributor out-of-state PAC (ID#:_________________________) 7 Amount of contribution ($) 8 In-kind contribution description (if applicable) 6 Contributor address; City; State; Zip Code 9 Principal occupation / Job title (See Instructions) 10 Employer (See Instructions) Amount of contribution ($) Date Full name of contributor out-of-state PAC (ID#:_________________________) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) (If travel outside of Texas, complete Schedule T) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#:_________________________) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#:_________________________) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#:_________________________) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements. www.ethics.state.tx.us (If travel outside of Texas, complete Schedule T) In-kind contribution description (if applicable) Amount of contribution ($) In-kind contribution description (if applicable) (If travel outside of Texas, complete Schedule T) Amount of contribution ($) In-kind contribution description (if applicable) (If travel outside of Texas, complete Schedule T) Amount of contribution ($) In-kind contribution description (if applicable) (If travel outside of Texas, complete Schedule T) Revised 09/01/2007 American LegalNet, Inc. www.FormsWorkFlow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) PLEDGED CONTRIBUTIONS 1 The Instruction Guide explains how to complete this form. SCHEDULE B-SS (FOR FORMS C/OH-SS AND SPAC-SS) Total pages Schedule B-SS: 2 FILER NAME 3 ACCOUNT # (Ethics Commission filers) 4 Date 5 Full name of pledgor out-of-state PAC (ID#:__________________________) 7 Amount of pledge ($) 8 In-kind description (if applicable) 6 Pledgor address; City; State; Zip Code 9 Principal occupation / Job title (See Instructions) 10 Employer (See Instructions) Date Full name of pledgor out-of-state PAC (ID#:__________________________) Pledgor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of pledgor out-of-state PAC (ID#:__________________________) Pledgor address; City; State; Zip Code Principal occupation / Job title (See Instructions) (If travel outside of Texas, complete Schedule T) Employer (See Instructions) Date Full name of pledgor out-of-state PAC (ID#:__________________________) Pledgor address; City; State; Zip Code Principal occupation / Job title (See Instructions) (If travel outside of Texas, complete Schedule T) Employer (See Instructions) Date Full name of pledgor out-of-state PAC (ID#:__________________________) Pledgor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements. www.ethics.state.tx.us Revised 09/01/2007 American LegalNet, Inc. www.FormsWorkFlow.com (If travel outside of Texas, complete Schedule T) Amount of pledge ($) In-kind description (if applicable) (If travel outside of Texas, complete Schedule T) Amount of pledge ($) In-kind description (if applicable) Amount of pledge ($) In-kind description (if applicable) Amount of pledge ($) In-kind description (if applicable) (If travel outside of Texas, complete Schedule T) Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1-800-325-8506 IN-KIND CONTRIBUTION OR POLITICAL EXPENDITURE FOR TRAVEL OUTSIDE OF TEXAS The Instruction Guide explains how to complete this form. 2 FILER NAME 4 Name of Contributor / Corporation or Labor Organization / Pledgor / Payee 1 Total pages Schedule T: 3 ACCOUNT # SCHEDULE T (Ethics Commission filers) 5 Contr