Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) FORMER CANDIDATE FOR SPEAKER OF THE TEXAS HOUSE OF REPRESENTATIVES: ANNUAL REPORT OF UNEXPENDED CONTRIBUTIONS 1 ACCOUNT # See SPK-UC Instruction Guide for detailed instructions. 3 FORMER SPEAKER CANDIDATE NAME TITLE FIRST MI FORM SPK-UC COVER SHEET 2 Total pages filed: OFFICE USE ONLY Date Received NICKNAME LAST SUFFIX 4 FORMER SPEAKER CANDIDATE MAILING ADDRESS ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE 5 FORMER SPEAKER CANDIDATE TELEPHONE NUMBER 6 PERIOD COVERED AREA CODE PHONE NUMBER EXTENSION ( Month ) Day Year Month Day THROUGH 7 VERIFICATION I swear, or affirm, that the accompanying report is true and correct and includes all information required to be reported by me under Chapter 302, Texas Government Code. Signature of Former Speaker Candidate 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 GO TO SCHEDULE A www.ethics.state.tx.us Revised 01/12/2004 American LegalNet, Inc. www.FormsWorkFlow.com Date Hand-delivered or Postmarked Receipt # Date Processed Amount Date Imaged Year Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) FORMER SPEAKER CANDIDATE REPORT OF UNEXPENDED CONTRIBUTIONS: FORM SPK-UC A CONTRIBUTIONS See SPK-UC Instruction Guide for detailed instructions. 2 FORMER SPEAKER CANDIDATE NAME SCHEDULE 1 Total pages Schedule A: 3 ACCOUNT # 4 Date 5 Full name of contributor 7 Amount / Value of contribution ($) 8 In-kind contribution description (if applicable) 6 Contributor address; City; State; Zip Code Date Full name of contributor Contributor address; City; State; Zip Code Date Full name of contributor Contributor address; City; State; Zip Code Date Full name of contributor Contributor address; City; State; Zip Code Date Full name of contributor Contributor address; City; State; Zip Code Date Full name of contributor Contributor address; City; State; Zip Code ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED www.ethics.state.tx.us Revised 01/12/2004 American LegalNet, Inc. www.FormsWorkFlow.com Amount / Value of contribution ($) In-kind contribution description (if applicable) Amount / Value of contribution ($) In-kind contribution description (if applicable) Amount / Value of contribution ($) In-kind contribution description (if applicable) Amount / Value of contribution ($) In-kind contribution description (if applicable) Amount / Value of contribution ($) In-kind contribution description (if applicable) Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) FORMER SPEAKER CANDIDATE REPORT OF UNEXPENDED CONTRIBUTIONS: FORM LOANS See SPK-UC Instruction Guide for detailed instructions. 2 FORMER SPEAKER CANDIDATE NAME SPK-UC SCHEDULE B 1 Total pages Schedule B: 3 ACCOUNT # 4 Date of loan 5 Amount of Loan ($) 6 First reporting Previously reported but still unpaid Paid during period covered by this report 7 Name of lender 9 Names of responsible parties, other than former speaker candidate 8 Lender address; City; State; Zip Code 10 Addresses of responsible parties, other than former speaker candidate: Address; City; State; Zip Code 11 Payment(s) made on note Yes No (continue at right) (go to next loan or schedule) 12 Amount of Payment(s) 13 Source of Payment(s) Date of loan Amount of Loan ($) First reporting Previously reported but still unpaid Paid during period covered by this report Name of lender Names of responsible parties, other than former speaker candidate Lender address; City; State; Zip Code Addresses of responsible parties, other than former speaker candidate: Address; City; State; Zip Code Payment(s) made on note Yes No (continue at right) (go to next loan or schedule) Amount of Payment(s) Source of Payment(s) ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED www.ethics.state.tx.us Revised 01/12/2004 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) FORMER SPEAKER CANDIDATE REPORT OF UNEXPENDED CONTRIBUTIONS: FORM SPK-UC C EXPENDITURES See SPK-UC Instruction Guide for detailed instructions. 2 FORMER SPEAKER CANDIDATE NAME SCHEDULE 1 Total pages Schedule C: 3 ACCOUNT # 4 Date 5 Payee name 7 Amount ($) 6 Payee address; City; State; Zip Code 8 Purpose of expenditure Date Payee name Payee address; City; State; Zip Code Purpose of expenditure Date Payee name Payee address; City; State; Zip Code Purpose of expenditure Date Payee name Payee address; City; State; Zip Code Purpose of expenditure ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED www.ethics.state.tx.us Revised 01/12/2004 American LegalNet, Inc. www.FormsWorkFlow.com Amount ($) Amount ($) Amount ($)