Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) POLITICAL COMMITTEE SPECIAL PRE-ELECTION REPORT OF CONTRIBUTIONS 1 3 ACCOUNT # FORM PAC-C 2 Total pages filed: OFFICE USE ONLY Date Received COMMITTEE NAME 4 NICKNAME LAST SUFFIX 5 CAMPAIGN TREASURER MAILING ADDRESS ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES) 6 Date 7 Contributor name 9 Amount of contribution ($) 8 Contributor address; City; State; Zip Code (If travel outside of Texas, complete Schedule T) Date Contributor name Amount of contribution ($) Contributor address; City; State; Zip Code (If travel outside of Texas, complete Schedule T) Date Contributor name Amount of contribution ($) Contributor address; City; State; Zip Code (If travel outside of Texas, complete Schedule T) PLEDGED CONTRIBUTIONS Date Pledgor name Amount of pledge ($) City; State; Zip Code Pledgor address; (If travel outside of Texas, complete Schedule T) ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED www.ethics.state.tx.us Revised 09/01/2007 American LegalNet, Inc. www.FormsWorkFlow.com CAMPAIGN TREASURER NAME MS / MRS / MR FIRST MI HD / PM Receipt # Amount Date Processed Date Imaged 10 In-kind contribution description (if applicable) In-kind contribution description (if applicable) In-kind contribution description (if applicable) In-kind description (if applicable) Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) Special pre-election reports (formerly known as telegram reports) cover the period beginning the ninth day before an election and ending at 12 noon on the day before the election. A special pre-election report must be filed with the Ethics Commission electronically, unless otherwise exempted from electronic filing. A special pre-election report filed electronically must be received by the commission no later than midnight of the first business day after the date the contribution is accepted or the direct campaign expenditure is made. A special pre-election report that is exempt from the electronic filing requirement is not required to be on a form prescribed by the commission; it may be on regular stationery. A special pre-election report that is filed on paper must be received by the commission no later than 5 p.m. of the first business day after the contribution is accepted or the direct campaign expenditure is made. Contributions and expenditures disclosed on a special pre-election report must be disclosed again on the next required report. Political Contributions: A general-purpose committee is required to file a special pre-election report if the committee accepts political contributions from a person that in the aggregate exceed $5,000 during the period covered by a special pre-election report. A specific-purpose political committee that supports or opposes a candidate for statewide office; district office filled by voters of more than one county; judicial district office filled by voters of only one county; State Board of Education; state senator; or state representative, is required to file a special pre-election report if the committee receives one or more contributions from a single source that total more than $1,000 during the period covered by a special pre-election report. The committee is required to report the amounts of the contributions, the full name and address of the contributor, and the dates of the contributions. Reporting Travel Outside of Texas: The law requires detailed information regarding in-kind contributions and political expenditures for travel outside of Texas. This information should be reported on Schedule T and attached to this form. Schedule T can be found on the Ethics Commission's website at www.ethics.state.tx.us/whatsnew/ travel_outside_Texas.html. Direct Expenditures: A general-purpose committee that makes direct campaign expenditures supporting or opposing either a single candidate that in the aggregate exceed $1,000 or a group of candidates that in the aggregate exceed $15,000 during the period covered by a special pre-election report must use Form PAC-E (Special Pre-Election Report of Direct Expenditures) to report the expenditures. Form PAC-E can be found on the Ethics Commission website at www.ethics.state.tx.us/filinginfo/g&mpacfrm.htm. www.ethics.state.tx.us Revised 09/01/2007 American LegalNet, Inc. www.FormsWorkFlow.com