JUDICIAL SPECIFIC-PURPOSE COMMITTEE CAMPAIGN FINANCE REPORT The JSPAC Instruction Guide explains how to complete this form. 3 COMMITTEE NAME FORM JSPAC COVER SHEET PG 1 1 Filer ID (Ethics Commission Filers) 2 Total pages filed: OFFICE USE ONLY Date Received 4 COMMITTEE ADDRESS Change of Address ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE Date Hand-delivered or Date Postmarked 5 CAMPAIGN TREASURER NAME MS / MRS / MR FIRST MI Receipt # Date Processed Date Imaged Amount $ NICKNAME LAST 6 CAMPAIGN TREASURER STREET ADDRESS (Residence or Business) STREET ADDRESS (NO PO BOX PLEASE); 7 CAMPAIGN TREASURER MAILING ADDRESS Change of Address STREET ADDRESS OR PO BOX; 8 CAMPAIGN TREASURER PHONE AREA CODE PHONE NUMBER ( ) January 15 July 15 30th day before election 8th day before election Runoff Exceeded $500 limit Dissolution (Attach JSPAC-DR) 10th day after campaign treasurer termination Month Day Year 9 REPORT TYPE 10 PERIOD COVERED Month Day 1 ELECTION 1 Month ELECTION DATE Day Year Primary General Runoff Special Forms provided by Texas Ethics Commission SUFFIX APT / SUITE #; CITY; STATE; ZIP CODE APT / SUITE #; CITY; STATE; ZIP CODE EXTENSION Year THROUGH ELECTION TYPE Other Description GO TO PAGE 2 www.ethics.state.tx.us Revised 9/1/2015 American LegalNet, Inc. www.FormsWorkFlow.com JUDICIAL SPECIFIC-PURPOSE COMMITTEE REPORT: PURPOSE AND TOTALS 12 COMMITTEE NAME FORM JSPAC COVER SHEET PG 2 13 Filer ID (Ethics Commission Filers) 14 COMMITTEE PURPOSE CANDIDATE CANDIDATE / OFFICEHOLDER NAME (Attach lists on plain paper to complete this report if necessary.) SUPPORT (Candidate) OPPOSE (Candidate) ASSIST (Officeholders) OFFICE SOUGHT (Candidate) / OFFICE HELD (Officeholder) OFFICEHOLDER 15 CONTRIBUTION TOTALS 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $ $ $ $ $ 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) EXPENDITURE TOTALS 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED 4. CONTRIBUTION BALANCE OUTSTANDING LOAN TOTALS TOTAL POLITICAL EXPENDITURES 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF THE REPORTING PERIOD 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORTING PERIOD $ 16 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 Campaign Treasurer 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 Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/1/2015 American LegalNet, Inc. www.FormsWorkFlow.com SUBTOTALS - JSPAC 17 COMMITTEE NAME FORM JSPAC COVER SHEET PG 3 18 Filer ID (Ethics Commission Filers) 19 SCHEDULE SUBTOTALS NAME OF SCHEDULE SCHEDULE A(J)1: MONETARY POLITICAL CONTRIBUTIONS (JUDICIAL) SCHEDULE A2 : NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS SCHEDULE B(J): PLEDGED CONTRIBUTIONS (JUDICIAL) SUBTOTAL AMOUNT 1. $ $ $ $ $ $ $ $ $ $ 2. 3. 4. 5. 6. SCHEDULE E(J): LOANS (JUDICIAL) SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F2: UNPAID INCURRED OBLIGATIONS SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH 7. 8. 9. 10. SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS 11. SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED TO FILER $ Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/1/2015 American LegalNet, Inc. www.FormsWorkFlow.com MONETARY POLITICAL CONTRIBUTIONS (JUDICIAL) The Instruction Guide explains how to complete this form. 2 FILER NAME SCHEDULE A(J)1 1 Total pages Schedule A(J)1: 3 Filer ID (Ethics Commission Filers) 4 Date 5 Full name of contributor out-of-state PAC ID#:__________________________) 7 Amount of contribution ($) 6 Contributor address; City; State; Zip Code 8 Contributor's principal occupation 9 Contributor's job title 10 Contributor's employer/law firm 1 Law firm of contributor's spouse (if any) 1 12 If contributor is a child, law firm of parent(s) (if any) Date Full name of contributor out-of-state PAC ID#:__________________________) Contributor address; City; State; Zip Code Contributor's principal occupation Contributor's job title Contributor's employer/law firm Law firm of contributor's spouse (if any) If contributor is a child, law firm of parent(s) (if any) Date Full name of contributor out-of-state PAC ID#:__________________________) Contributor address; City; State: Zip Code Contributor's principal occupation Contributor's job title Contributor's employer/law firm Law firm of contributor's spouse (if any) If contributor is a child, law firm of parent(s) (if any) ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission www.ethics.state.tx.us Amount of contribution ($) Amount of contribution ($) Revised 9/1/2015 American LegalNet, Inc. www.FormsWorkFlow.com NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS The Instruction Guide explains how to complete this form. 2 FILER NAME SCHEDULE A2 1 Total pages Schedule A2: 3 Filer ID (Ethics Commission Filers) 4 TOTAL OF UNITEMIZED IN-KIND POLITICAL CONTRIBUTIONS 5 Date 6 Full name of contributor $ 8 Amount of Contribution $ out-of-state PAC (ID#:______________________) 9 In-kind contribution description 7 Contributor address; City; State; Zip Code Check if travel outside of Texas. Complete Schedule T. 10 Principal occupation / Job title (FOR NON-JUDICIAL) (See Instructions) 12 Contributor's principal occupation (FOR JUDICIAL) 14 Contributor's employer/law firm (FOR JUDICIAL) 1 1 Employer (FOR NON-JUDICIAL) (See Instructions) 13 Contributor's job title (FOR JUDICIAL) (See Instructions) 15 Law firm of contributor's spouse (if any) (FOR JUDICIAL) 16 If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL) Date Full name of contributor out-of-state PAC (ID#: