Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 FORM LA COVER SHEET LOBBY ACTIVITIES REPORT 1 Schedule A Filed: Number of Pages of Schedules Filed: Use the FORM LA INSTRUCTION GUIDE for assistance in filling out this form. (800) 325-8506 Yes No B ____ C ____ D ____ E ____ F ____ 3 ACCOUNT # PAGE # G ____ OFFICE USE ONLY 2 REGISTRANT NAME 4 REPORT TYPE EXCEEDED $1000 MODIFIED (Annual) 5 REGULAR (Monthly) FINAL (Attach Form TN) REPORT DEADLINE February 10 June 10 October 10 March 10 July 10 November 10 April 10 August 10 December 10 May 10 September 10 January 10 HD / PM Day / 7 EXPENDITURE TOTALS BY TYPE Totals ENDING BEGINNING Month Amount Legal 6 PERIOD COVERED Receipt # Year Month THROUGH / Day / Year / Date Processed Date Imaged Gifts (other than awards & mementos) $ ____________________ Food & Beverages $ ____________________ Awards & Mementos $ ____________________ $ ____________________ Political Fundraisers/Charity Events $ ____________________ Mass Media Communications 8 EXPENDITURE $ ____________________ Entertainment $0.00 Transportation & Lodging $ ____________________ $0.00 State Senators $ ____________________ Executive Agency Employees $ ____________________ State Representatives $ ____________________ Immediate Family of Legislative/ Executive Branch Member $ ____________________ Other Elected/Appointed State Officers $ ____________________ Events to Which All Legislators Are Invited $ ____________________ Legislative Branch Employees TOTALS BY PERSONS BENEFITTED $ ____________________ Guests $ ____________________ 9 INDIVIDUAL REPORTING EXPENDITURES FOR ENTITY YES NAME OF ENTITY ADDRESS OF ENTITY PHONE NO. OF ENTITY additional pages NO 10 SIGNATURE AMOUNT OF EXPENDITURES REPORTED FOR ENTITY To the best of my knowledge the accompanying document is true and correct and includes all information to be reported by me under Chapter 305, Government Code. I further affirm that, to the best of my knowledge, I have complied with Section 305.028, Government Code (Prohibited Conflicts of Interest). 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 Print name of officer administering oath Title of officer administering oath Revised 09/16/2008 American LegalNet, Inc. www.FormsWorkflow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (800) 325-8506 LOBBY ACTIVITIES REPORT FORM SUBJECT MATTER LA SCHEDULE A 1 PAGE # Use the FORM LA INSTRUCTION GUIDE for assistance in filling out this form. Attach additional copies of this form as needed. 3 ACCOUNT # 2 REGISTRANT NAME 4 SUBJECT MATTER CATEGORIES If your lobby communications pertained to subject matters not marked on your original lobby registration or on a previous amendment, check the appropriate boxes. 1 abortion 30 elections 58 oil & gas 2 aeronautics 31 energy 59 open records & open meetings 3 aging 32 environment 60 parks & wildlife 4 agriculture 33 ethics 61 political subdivisions 5 alcoholic beverage regulation 34 family issues 62 probate 6 alcoholism & drug abuse 35 fees & other non-tax revenue 63 product liability 7 aliens 36 financial institutions 64 property interests 8 amusements, games, sports 37 fire fighters & police 65 public lands 9 animals 38 gambling 66 purchasing 10 arts & humanities 39 handicapped persons 67 redistricting 11 business & commerce 40 health & health care 68 religion 12 cemeteries 41 highways & roads 69 retirement systems 13 charitable & nonprofit organizations 42 historic preservation & museums 70 safety 14 city government 43 hospitals 71 special districts & authorities 15 civil remedies & liabilities 44 housing 72 state agencies, boards & commissions 16 coastal affairs & beaches 45 human services 73 state employees, officers & symbols 17 common carriers 46 insurance 74 state finances 18 communications & press 47 labor 75 taxation 19 consumer protection 48 law enforcement 76 tort reform 20 corporations & associations 49 lawyers 77 tourism 21 corrections 50 libraries 78 transportation 22 county government 51 malpractice-health care providers 79 utilities 23 courts 52 mental health & mental retardation 80 vehicles & traffic 24 crime 53 military & veterans 81 water 25 criminal procedures 54 mines & mineral resources 82 weapons 26 day care 55 minors 83 women’s issues 27 disaster preparedness & relief 56 nursing homes 28 economic & industrial development 57 occupational regulation 84 OTHER _________________________ 29 education 5 DOCKET NOS. OR OTHER DESIGNATION not applicable DESIGNATION AGENCY DESIGNATION AGENCY DESIGNATION AGENCY additional pages GO TO SCHEDULE B Revised 09/16/2008 American LegalNet, Inc. www.FormsWorkflow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (800) 325-8506 DETAILED EXPENDITURES FORM TRANSPORTATION & LODGING LA SCHEDULE B 1 PAGE # Use the FORM LA INSTRUCTION GUIDE for assistance in filling out this form. Attach additional copies of this form as needed. 3 ACCOUNT # 2 REGISTRANT NAME 4 RECIPIENT NAME FIRST; MI; LAST; SUFFIX 5 TRANSPORTATION TYPE OF TRANSPORTATION INFORMATION TRAVEL DATES DEPARTURE CITY Month Day / ARRIVAL Year / Month ARRIVAL CITY 6 LODGING Day / DEPARTURE Year / NAME OF LODGING ESTABLISHMENT INFORMATION LODGING DATES ADDRESS; CITY; STATE; ZIP CODE Month Day Month PREVIOUS REPORTING PERIOD / Day Year / CHECK OUT 7 Year / CHECK IN / Credit card expenditure occurred during the previous reporting period: 8 TRANSPORTATION / LODGING PURPOSE 4 RECIPIENT NAME FIRST; MI; LAST; SUFFIX 5 TRANSPORTATION TYPE OF TRANSPORTATION INFORMATION TRAVEL DATES DEPARTURE CITY Month ARRIVAL CITY Year / Month Day / ARRIVAL 6 LODGING Day / DEPARTURE Year / NAME OF LODGING ESTABLISHMENT INFORMATION LODGING DATES ADDRESS; CITY; STATE; ZIP CODE Month Day / CHECK IN Month CHECK OUT 7 PREVIOUS REPORTING PERIOD Year / Day / Year / Credit card expenditure occurred during the previous reporting period: 8 TRANSPORTATION / LODGING PURPOSE GO TO SCHEDULE C Revised 09/16/2008 American LegalNet, Inc. www.FormsWorkflow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (800) 325-8506 DETAILED EXPENDITURES FORM FOOD & BEVERAGES LA SCHEDULE C 1 PAGE # Use the FORM LA INSTRUCTION GUIDE for assistance in filling out this form. Attach additional copies of this form as needed. 3 ACCOUNT # 2 REGISTRANT NAME 4 RECIPIENT NAME FIRST; MI; LAST; SUFFIX 5 PLACE OF EXPENDITURE NAME OF RESTAURANT OR OTHER PLACE 6 EXPENDITURE DATE Month Day / 7 EXPENDITURE AMOUNT CITY; STATE; ZIP CODE Year / Check if credit card expenditure occurred outside reporting period. Check one or enter exact amount. Less than $100 $200 but less than $250 $350 but less than $400 $100 but less than $150 $250 but less than $300 $400 but less than $450 $150 but less than $200 $300 but less than $350 $450 but less than $500 4 RECIPIENT NAME PLACE OF EXPENDITURE Exact amount $ ________________________ FIRST; MI; LAST; SUFFIX 5 - OR - NAME OF RESTAURANT OR OTHER PLACE 6 EXPENDITURE DATE Month Day / 7 EXPENDITURE AMOUNT CITY; STATE; ZIP CODE Year / Check if credit card expenditure occurred outside reporting period. Check one or enter exact amount. 5 PLACE OF EXPENDITURE 6 EXPENDITURE DATE $350 but less than $400 $250 but less than $300 $400 but less than $450 $150 but less than $200 RECIPIENT NAME $200 but less than $250 $100 but less than $150 4 Less than $100 $300 but less than $350 $450 but less than $500 EXPENDITURE AMOUNT Exact amount $ ________________________ FIRST; MI; LAST; SUFFIX NAME OF RESTAURANT OR OTHER PLACE Month Day / 7 - OR - CITY; STATE; ZIP CODE Year / Check if credit card expenditure occurred outside reporting period. Check one or enter exact amount. Less than $100 $200 but less than $250 $350 but less than $400 $100 but less than $150 $250 but less than $300 $400 but less than $450 $150 but less than $200 $300 but less than $350 $450 but less than $500 GO TO SCHEDULE D - OR - Exact amount $ ________________________ Revised 09/16/2008 American LegalNet, Inc. www.FormsWorkflow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (800) 325-8506 DETAILED EXPENDITURES FORM ENTERTAINMENT LA SCHEDULE D 1 PAGE # Use the FORM LA INSTRUCTION GUIDE for assistance in filling out this form. Attach additional copies of this form as needed. 3 ACCOUNT # 2 REGISTRANT NAME 4 RECIPIENT NAME FIRST; MI; LAST; SUFFIX 5 PLACE OF EXPENDITURE PLACE OF ENTERTAINMENT 6 EXPENDITURE DATE Month Day / 7 EXPENDITURE AMOUNT CITY; STATE; ZIP CODE Year / Check if credit card expenditure occurred outside reporting period. Check one or enter exact amount. Less than $100 $200 but less than $250 $350 but less than $400 $100 but less than $150 $250 but less than $300 $400 but less than $450 $150 but less than $200 $300 but less than $350 $450 but less than $500 4 RECIPIENT NAME PLACE OF EXPENDITURE EXPENDITURE DATE $ ________________________ PLACE OF ENTERTAINMENT 6 Exact amount FIRST; MI; LAST; SUFFIX 5 - OR - Month Day / 7 EXPENDITURE AMOUNT CITY; STATE; ZIP CODE Year Check if credit card expenditure occurred outside reporting period. / Check one or enter exact amount. Less than $100 $200 but less than $250 $350 but less than $400 $100 but less than $150 $250 but less than $300 $400 but less than $450 $150 but less than $200 $300 but less than $350 $450 but less than $500 4 RECIPIENT NAME PLACE OF EXPENDITURE EXPENDITURE DATE $ ________________________ PLACE OF ENTERTAINMENT 6 Exact amount FIRST; MI; LAST; SUFFIX 5 - OR - Month Day / 7 EXPENDITURE AMOUNT CITY; STATE; ZIP CODE Year / Check if credit card expenditure occurred outside reporting period. Check one or enter exact amount. Less than $100 $200 but less than $250 $350 but less than $400 $100 but less than $150 $250 but less than $300 $400 but less than $450 $150 but less than $200 $300 but less than $350 $450 but less than $500 - OR - Exact amount $ ________________________ Revised 09/16/2008 GO TO SCHEDULE E American LegalNet, Inc. www.FormsWorkflow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (800) 325-8506 DETAILED EXPENDITURES FORM GIFTS SCHEDULE REGISTRANT NAME 4 RECIPIENT NAME E 1 PAGE # Use the FORM LA INSTRUCTION GUIDE for assistance in filling out this form. Attach additional copies of this form as needed. 2 LA 3 ACCOUNT # FIRST; MI; LAST; SUFFIX 5 GIFT DESCRIPTION 6 7 PREVIOUS REPORTING PERIOD EXPENDITURE AMOUNT Credit card expenditure occurred during the previous reporting period: Check one or enter exact amount. $200 but less than $250 $350 but less than $400 $100 but less than $150 $250 but less than $300 $400 but less than $450 $150 but less than $200 4 RECIPIENT NAME Less than $100 $300 but less than $350 $450 but less than $500 - OR - Exact amount $ ________________________ FIRST; MI; LAST; SUFFIX 5 GIFT DESCRIPTION 6 PREVIOUS REPORTING PERIOD 7 EXPENDITURE AMOUNT Credit card expenditure occurred during the previous reporting period: Check one or enter exact amount. $200 but less than $250 $350 but less than $400 $100 but less than $150 $250 but less than $300 $400 but less than $450 $150 but less than $200 4 RECIPIENT NAME Less than $100 $300 but less than $350 $450 but less than $500 - OR - Exact amount $ ________________________ FIRST; MI; LAST; SUFFIX 5 GIFT DESCRIPTION 6 PREVIOUS REPORTING PERIOD 7 EXPENDITURE AMOUNT Credit card expenditure occurred during the previous reporting period: Check one or enter exact amount. Less than $100 $200 but less than $250 $350 but less than $400 $100 but less than $150 $250 but less than $300 $400 but less than $450 - OR - Exact amount $150 but less than $200 $300 but less than $350 $450 but less than $500 $ ________________________ GO TO SCHEDULE F Revised 09/16/2008 American LegalNet, Inc. www.FormsWorkflow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (800) 325-8506 DETAILED EXPENDITURES FORM AWARDS & MEMENTOS SCHEDULE Use the FORM LA INSTRUCTION GUIDE for assistance in filling out this form. Attach additional copies of this form as needed. RECIPIENT NAME 5 PREVIOUS REPORTING PERIOD 1 PAGE # AWARD / MEMENTO DESCRIPTION 6 F 3 ACCOUNT # 2 REGISTRANT NAME 4 LA 7 EXPENDITURE AMOUNT FIRST; MI; LAST; SUFFIX Credit card expenditure occurred during the previous reporting period: Check one or enter exact amount. Less than $100 5 PREVIOUS REPORTING PERIOD $400 but less than $450 - OR - Exact amount $300 but less than $350 $450 but less than $500 $ ________________________ AWARD / MEMENTO DESCRIPTION 6 $250 but less than $300 $150 but less than $200 RECIPIENT NAME $350 but less than $400 $100 but less than $150 4 $200 but less than $250 7 EXPENDITURE AMOUNT FIRST; MI; LAST; SUFFIX Credit card expenditure occurred during the previous reporting period: Check one or enter exact amount. Less than $100 5 PREVIOUS REPORTING PERIOD $400 but less than $450 - OR - Exact amount $300 but less than $350 $450 but less than $500 $ ________________________ AWARD / MEMENTO DESCRIPTION 6 $250 but less than $300 $150 but less than $200 RECIPIENT NAME $350 but less than $400 $100 but less than $150 4 $200 but less than $250 7 EXPENDITURE AMOUNT FIRST; MI; LAST; SUFFIX Credit card expenditure occurred during the previous reporting period: Check one or enter exact amount. Less than $100 $200 but less than $250 $350 but less than $400 $100 but less than $150 $250 but less than $300 $400 but less than $450 - OR - Exact amount $150 but less than $200 $300 but less than $350 $450 but less than $500 $ ________________________ GO TO SCHEDULE G Revised 09/16/2008 American LegalNet, Inc. www.FormsWorkflow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (800) 325-8506 DETAILED EXPENDITURES FORM POLITICAL FUNDRAISERS & CHARITY EVENTS LA SCHEDULE Use the form LA Instruction Guide for assistance in filling out this form. Attach additional copies of this form as needed. 1 PAGE # 2 REGISTRANT NAME 3 ACCOUNT # 4 RECIPIENT NAME FIRST; MI; LAST; SUFFIX 5 BENEFICIARY G CHARITY / EVENT NAME CHARITY POLITICAL FUNDRAISER 6 NAME OF CANDIDATE(S) / OFFICEHOLDER(S) BENEFITTED EVENT DATE Month Day / Year / 4 RECIPIENT NAME FIRST; MI; LAST; SUFFIX 5 BENEFICIARY Check if credit card expenditure occurred outside reporting period. CHARITY / EVENT NAME CHARITY POLITICAL FUNDRAISER 6 NAME OF CANDIDATE(S) / OFFICEHOLDER(S) BENEFITTED EVENT DATE Month Day / Year / 4 RECIPIENT NAME FIRST; MI; LAST; SUFFIX 5 BENEFICIARY Check if credit card expenditure occurred outside reporting period. CHARITY / EVENT NAME CHARITY POLITICAL FUNDRAISER 6 NAME OF CANDIDATE(S) / OFFICEHOLDER(S) BENEFITTED EVENT DATE Month Day / Year / 4 RECIPIENT NAME FIRST; MI; LAST; SUFFIX 5 BENEFICIARY Check if credit card expenditure occurred outside reporting period. CHARITY / EVENT NAME CHARITY POLITICAL FUNDRAISER 6 EVENT DATE NAME OF CANDIDATE(S) / OFFICEHOLDER(S) BENEFITTED Month Day / Year / Check if credit card expenditure occurred outside reporting period. SCHEDULE G IS THE LAST SCHEDULE FOR REPORTING DETAILED ACTIVITY Revised 09/16/2008 American LegalNet, Inc. www.FormsWorkflow.com