PEARLAND ENTERTAINMENT & BEVERAGE COALITION_JULY 15 2021_FINANCE REPORT •
SPECIFIC-PURPOSE COMMITTEE FORM SPAC
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 Filer ID(Ethics Commission Filers) 2 Total pages filed:
The SPAC Instruction Guide explains how to complete this form.
3 COMMITTEE NAME
OFFICE USE ONLY
Pearland Entertainment &Beverage Coalition Date Received
4 COMMITTEE ADDRESS /PO BOX; APT/SUITE#; CITY; STATE; ZIP CODE ((II
qa o di
ADDRESS I
n Change of Address Houston, TX 77019
Date Haedjeliye1e or D Postmarked
5 CAMPAIGN MS/MRS/MR FIRST MI (( f55
TREASURER Mark Receipt# Amount$
NAME
NICKNAME LAST SUFFIX Date Procel.
Smit Date Imaged -1 I q1016a
1t
6 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT/SUITE#; CITY; STATE; ZIP CODE
TREASURER
STREET ADDRESS
(Residence or Business) Houston, TX 77019
7 CAMPAIGN STREET ADDRESS OR PO BOX; APT/SUITE#; CITY; STATE; ZIP CODE
TREASURER
MAILING ADDRESS
Houston, TX 77019
I I Change of Address
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
(
9 REPORT TYPE pi January 15 I I 30th day before election I J Exceeded Modified Reporting Limit
I I July 15 pi 8th day before election n Dissolution Report(Attached PAGFR)
I I Runoff L I 10th day after campaign treasurer termination
10 PERIOD COVERED Month Day Year Month Day Year
1 /1 /2021 THROUGH 6 / 30 / 2021
11 ELECTION ELECTION DATE ELECTION TYPE
Month Day Year Primary n Runoff n Other
/ / n General ❑ Special Description
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
SPECIFIC-PURPOSE COMMITTEE REPORT: FORM SPAC
PURPOSE AND TOTALS COVER SHEET PG 2
12 COMMITTEE NAME 13 Filer ID (Ethics Commission Filers)
Pearland Entertainment&Beverage Coalition
14 COMM TTEE CANDIDATE/OFFICEHOLDER NAME
P POSE n CANDIDATE
(Attach lists on plain paper to
complete this report if OFFICE SOUGHT(candidate)/OFFICE HELD(officeholder)
necessary.)
n OFFICEHOLDER
n SUPPORT
(Candidate or Measure) BALLOT IDENTIFICATION/# ELECTION DATE
Month Day Year
I I OPPOSE
(Candidate or Measure) pi MEASURE
/ /
n ASSIST DESCRIPTION
(Officeholder) Local Option Election
15 CONTRIBUTION 1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS,OR $
CONTRIBUTIONS MADE ELECTRONICALLY) 110
nCheck here if this report qualifies for the higher itemization threshold
2. TOTAL POLITICAL CONTRIBUTIONS $ 47450
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
EXPENDITURE 3. TOTAL UNITEMIZED POLITICAL EXPENDITURES $
TOTALS
4. TOTAL POLITICAL EXPENDITURES $ 47500
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY 62.69
BALANCE OF THE REPORTING PERIOD $
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE $
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD 0
16 SIGNATURE I swear, or affirm, under penalty of perjury, that th cco ing report is true and correct and
includes all information required to be rep e e and r T e 15 lection Code.
Signat f Campaign Treasurer(Declarant)
Please complete either option below:
(1)Affidavit
AFFIX NOTARY STAMP/SEALABOVE I.�
41k
s or to a • subscribed before me,by the said init_Ctig 5m( , this the 1
110
day`i( , ,20 al ,to cert' hich,witn y hand and seal of office.
'I _ -- r 4-I Ko sear
/nature of officer administering oath Prin name of officer administering oath Ttle officer administering oat
OR J
(2)Unsworn Declaration
My name is , and my date of birth is .
My address is .
(street) (city) (state) (zip codeXcountry)
Executed in County,State of ,on the day of ,20
(month) (year)
Signature of Campaign Treasurer(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
SUBTOTALS - SPAC FORM SPAC
COVER SHEET PG 3
17 COMMITTEE NAME 18 Filer ID(Ethics Commission Filers)
19 SCHEDULE SUBTOTALS SUBTOTAL
NAME OF SCHEDULE AMOUNT
1. 0 SCHEDULE Ai: MONETARY POLITICAL CONTRIBUTIONS $ 1,950
2. ❑ SCHEDULE A2: NON-MONETARY(IN-KIND)POLITICAL CONTRIBUTIONS $ 800
3. D SCHEDULE B: PLEDGED CONTRIBUTIONS $ 0
4. n SCHEDULE C1: MONETARY CONTRIBUTIONS FROM CORPORATION OR LABOR ORGANIZATION $ 45,500
5 SCHEDULE C2: NON-MONETARY(IN-KIND)CONTRIBUTIONS FROM CORPORATION OR LABOR $ 2,400
ORGANIZATION
6. ❑ SCHEDULE D: PLEDGED CONTRIBUTIONS FROM CORPORATON OR LABOR ORGANIZATION $ 0
7. D SCHEDULE E: LOANS $ 0
8. ❑ SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ 0
9• I SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $ 0
0
10. In SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $
11. SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $ 0
12. n SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $ 0
13. n SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ 0
14. I I SCHEDULE K: INTEREST,CREDITS,GAINS,REFUNDS,AND CONTRIBUTIONS RETURNED $ 0
TO FILER
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form.
1 Total pages Schedule Al:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
Pearland Entertainment&Beverage Coalition
4 Date 5 Full name of contributor ❑out-of-state PAC(ID#: ) 7 Amount of contribution (5)
6/28/2021 Paul Grohman
$1,000
6 Contributor address; City; State; Zip Code
2116 Killdare Pearland, TX 77581
8 Principal occupation/Job title(See Instructions) 9 Employer(See Instructions)
Owner Gromax
Date Full name of contributor ❑out-of-state PAC(ID#: l Amount of contribution ($)
Randall Ferguson
5/12/2021
Contributor address; City; State; Zip Code
2607 sleepy Hollow Pearland, TX 77581 $250
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of contributor ❑out-of-state PAC(ID#: ) Amount of contribution ($)
6/5/2021 Ketul Desai
$100
Contributor address; City; State; Zip Code
3611 Spring Heights Court Pearland, TX 77584
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date ' Full name of contributor ❑out-of-state PAC(ID#: l Amount of contribution ($)
6/5/2021 Albert Johnson
$250
Contributor address; City; State; Zip Code
2225 County Road 90 Suite 111 Pearland, TX 77584
Principal occupation/Job title(See Instructions) Employer(See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC,please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule Al:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
Pearland Entertainment&Beverage Coalition
4 Date 5 Full name of contributor 0 out-of-state PAC(IDit: ) 7 Amount of contribution ($)
5/26/2021 Chandrakanth Vemula
$250
6 Contributor address; City; State; Zip Code
2227 Long Cove Court Pearland, TX 77584
8 Principal occupation/Job title(See Instructions) 9 Employer(See Instructions)
Practice Manager Internal Medicine of Houston
Date Full name of contributor ❑out-of-state PAC(ID#: ) Amount of contribution ($)
5/21/2021 John Smith
Contributor address; City; State; Zip Code
$100
13020 Imperial Shore Drive Pearland, TX 77584
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of contributor ❑out-of-state PAC(ID#: ) Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of contributor ❑out-of-state PAC(JD#: ) Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation/Job title(See Instructions) Employer(See Instructions)
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 Revised 11/13/2020
NON-MONETARY (IN-KIND) POLITICAL
CONTRIBUTIONS SCHEDULE A2
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. I Total pages Schedule A2:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
Pearland Entertainment&Beverage Coalition
4 TOTAL OF UNITEMIZED IN-KIND POLITICAL CONTRIBUTIONS $
800
5 Date 6 Full name of contributor ❑out-of-state PAC(ID#:, ) 8 Amount of 9 In-kind contribution
tllexKamkar Contribution $ description
6/27/2021
7 Contributor address; City; State; Zip Code $500 Event Cost
3409 Ashton Springs LN Pearland, TX 77584
I'Check if travel outside of Texas.Complete Schedule T.
10 Principal occupation/Job title(FOR NON-JUDICIAL)(See Instructions) 11 Employer(FOR NON-JUDICIAL)(See Instructions)
Self Employed
12 Contributor's principal occupation(FOR JUDICIAL) 13 Contributor's job title(FOR JUDICIAL)(See Instructions)
14 Contributor's employer/law firm(FOR JUDICIAL) 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 El out-of-statePAC(ID#: ) Amount of I In-kind contribution
Luke Orlando Contribution $ I description
6/2/2021
$400 Office Supplies
Contributor address; City; State; Zip Code I
$300 I
11200 Broadway Pearland TX 77584 n Check if travel outside of Texas.Complete Schedule T.
Principal occupation/Job title(FOR NON-JUDICIAL)(See Instructions) Employer(FOR NON-JUDICIAL)(See Instructions)
Councilmen
Contributor's principal occupation(FOR JUDICIAL) Contributor's job title(FOR JUDICIAL)(See Instructions)
Contributor's employer/law firm(FOR JUDICIAL) Law firm of contributor's spouse(if any)(FOR JUDICIAL)
If contributor is a child,law firm of parent(s)(if any)(FOR JUDICIAL)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
MONETARY CONTRIBUTIONS FROM
CORPORATION OR LABOR ORGANIZATION SCHEDULE Cl
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule Cl:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
Pearland Entertainment&Beverage Coalition
4 Date 5 Corporation/ Labor Organization name 7 Amount of contribution ($)
5/14/2021 Media Riders
$3,000
6 Corporation/ Labor Organization address; City; State; Zip Code
2010 E.Broadway St. Pearland,TX 77581
Date Corporation/ Labor Organization name Amount of contribution ($)
5/14/2021 Stadia Sports Grill $500
Corporation/ Labor Organization address; City; State; Zip Code
1853 Pearland Parkway 153 Pearland TX 77581
Date Corporation/ Labor Organization name Amount of contribution ($)
5/13/2021 RCI Holdings
$25,000
Corporation/ Labor Organization address; City; State; Zip Code
10737 Cutten Road Houston,TX 77066
Date Corporation/ Labor Organization name Amount of contribution ($)
6/2/2021 AA Cleaning Services
$1,500
Corporation/ Labor Organization address; City; State; Zip Code
2810 Wagon Trail Road, Pearland,TX 77584
Date Corporation/ Labor Organization name Amount of contribution ($)
6/1/2021 Wrap&Roll $2,000
Corporation/ Labor Organization address; City; State; Zip Code
8209 Broadway St.,Suite 102 Pearland,TX 77581
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
MONETARY CONTRIBUTIONS FROM
CORPORATION OR LABOR ORGANIZATION SCHEDULE Cl
If the requested information is not applicable, DO NOT include this page in the report
The Instruction Guide explains how to complete this form. 1 Total pages Schedule C1:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
Pearland Entertainment&Beverage Coalition
4 Date 5 Corporation/ Labor Organization name 7 Amount of contribution ($)
6/7 2021 STOA International Architects $1'O00
6 Corporation/ Labor Organization address; City; State; Zip Code
6001 Savoy,Suite 100 Houston,TX 77036
Date Corporation/ Labor Organization name Amount of contribution ($)
Clay Development
6/16/2021 $2,500
Corporation/ Labor Organization address; City; State; Zip Code
1244 N.Post Oak Lane Houston,TX 77055
Date Corporation/ Labor Organization name Amount of contribution ($)
6/25/2021 Newquest Equity,LC $5,000
Corporation/ Labor Organization address; City; State; Zip Code
8827 W.Sam Houston,PKWY N Houston,TX 77040
Date Corporation/ Labor Organization name Amount of contribution ($)
6/28/2021 Massey Oaks Development LP
$2,500
Corporation/ Labor Organization address; City; State; Zip Code
275 Hill Street,Suite 300 Reno, NV 89501
Date Corporation/ Labor Organization name Amount of contribution ($)
6/7/2021 Geoscience Engineering
$2,500
Corporation/ Labor Organization address; City; State; Zip Code
405 E.20th Street Houston,TX 77008
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
NON-MONETARY (IN-KIND) CONTRIBUTIONS FROM
CORPORATION OR LABOR ORGANIZATION SCHEDULE C2
If the requested information is not applicable, DO NOT include this page in the report.
1
The Instruction Guide explains how to complete this form. Total pages Schedule C2:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
Pearland Entertainment&Beverage Coalition
4 Date 5 Corporation/ Labor Organization name 7 Amount of 18 In-kind contribution
Contribution $ I description
6/27/2021 Vallenson's Brewing Company
$400
Beer
6 Corporation/ Labor Organization address; City; State; Zip Code
4081 Rice Drier Road Pearland,TX 77581
nCheck if travel outside of Texas.Complete Schedule T.
Date Corporation/ Labor Organization name Amount of In-kind contribution
Contribution $ description
6/27/2021 Baldish Brewing Company
$400 Beer
Corporation/ Labor Organization address; City; State; Zip Code
1231 Broadway Pearland,TX 77581 f�I
I 1 Check if travel outside of Texas.Complete Schedule T.
Date Corporation/ Labor Organization name Amount of In-kind contribution
Contribution $ I description
6/27/2021 Duo Winery&Cider
$400 I Beer
Corporation/ Labor Organization address; City; State; Zip Code
2150 Dickinson Ave. Dickinson,TX 77539 f�7
I 1 Check if travel outside of Texas.Complete Schedule T.
Date Corporation/ Labor Organization name Amount of I In-kind contribution
Contribution $ I description
6/27/2021 No Label Brewing
$400
I Beer
Corporation/ Labor Organization address; City; State; Zip Code
5351 1st Street Katy, TX 77493 I�I
I 1 Check if travel outside of Texas.Complete Schedule T.
Date Corporation/ Labor Organization name Amount of I In-kind contribution
Contribution $ description
Texas Leaguer Brewing Company
6/27/2021
$400 Beer
Corporation/ Labor Organization address; City; State; Zip Code
13503 Pike Road Missouri City TX 77489
I'Check if travel outside of Texas.Complete Schedule T.
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
NON—MONETARY (IN—KIND) CONTRIBUTIONS FROM
CORPORATION OR LABOR ORGANIZATION SCHEDULE C2
If the requested information is not applicable, DO NOT include this page in the report
The Instruction Guide explains how to complete this form. 1 Total pages Schedule C2:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
Pearland Entertainment&Beverage Coalition
4 Date 5 Corporation/ Labor Organization name 7 Amount of 18 In-kind contribution
Contribution $ I description
Spindletap Brewery
6272021
$400 Beer
6 Corporation/ Labor Organization address; City; State; Zip Code
10622 Hirsch Houston, TX 77016 I l� I
I Check if travel outside of Texas.Complete Schedule T.
Date Corporation/ Labor Organization name Amount of I In-kind contribution
Contribution $ I description
Corporation/ Labor Organization address; City; State; Zip Code I
nCheck if travel outside of Texas.Complete Schedule T.
Date Corporation/ Labor Organization name Amount of I In-kind contribution
Contribution $ I description
Corporation/ Labor Organization address; City; State; Zip Code
nCheck if travel outside of Texas.Complete Schedule T.
Date Corporation/ Labor Organization name Amount of I In-kind contribution
Contribution $ I description
Corporation/ Labor Organization address; City; State; Zip Code
l 1 Check if travel outside of Texas.Complete Schedule T.
Date Corporation/ Labor Organization name Amount of I In-kind contribution
Contribution $ I description
Corporation/ Labor Organization address; City; State; Zip Code
Check if travel outside of Texas.Complete Schedule T.
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
POLITICAL EXPENDITURES MADE FROM POLITICAL
CONTRIBUTIONS SCHEDULE Fl
If the requested information is not applicable,DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising
Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/ContractLabor Other(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
Pearland Entertainment&Beverage Coalition
4 Date 5 Payee name
6/15/2020 Allied Data Service
6 Amount ($) 7 Payee address; City; State; Zip Code
1000
a (a) Category(See Categories listed at the top of this schedule) (b)Description
PURPOSE
OF Consulting Expense
EXPENDITURE •
(c) 0 Check if travel outside of Texas.Complete ScheduleT. n Check if Austin.TX,officeholder living expense
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
5/21/2021 Accelevate 2020 LLC
Amount ($) Payee address; City; State; Zip Code
3800 Creek Road Dripping Springs TX 78620
$29,000
Category(See Categories listed at the top of this schedule) Description
PURPOSE Contract Labor
OF Petition Efforts
EXPENDITURE
❑ Check if travel outside of Texas.Complete Schedule T. 0 Check if Austin,TX,officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
6/30/2021 Accelevate 2020 LL C
Amount ($) Payee address; City; State; Zip Code
10,000 3800 Creek Road Dripping Springs TX 78620
Category(See Categories listed at the top of this schedule) Description
PURPOSE
OF Contract Labor Petition Efforts
EXPENDITURE
nCheckif travel outside of Texas.Complete ScheduleT. n Check if Austin,TX.officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
POLITICAL EXPENDITURES MADE FROM POLITICAL
CONTRIBUTIONS SCHEDULE Fl
If the requested information is not applicable,DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising
Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage EExpense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/ConhactLabor Other(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule Fl: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
Pearland Entertainment&Beverage Coalition
4 Date 5 Payee name
6/10/202I Accelevate 2020,LLC
6 Amount ($) 7 Payee address; City; State; Zip Code
$7,500 3800 Creek Road Dripping Springs TX 78620
8 (a)Category(See Categories listed at the top of this schedule) (b)Description
PURPOSE Contract Labor
OF Petition Efforts
EXPENDITURE
(c) El Check iif travel outside of Texas.Complete Schedule T. n C• heck if Austin,TX,officeholder living expense
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Category(See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
ElCheck if travel outside of Texas.Complete ScheduleT. C• heck if Austin,TX,officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Category(See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
nCheck if travel outside of Texas.Complete ScheduleT. n C• heck if Austin,TX,officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
POLITICAL COMMITTEE
STATEMENT OF DISSOLUTION FORM PAC - DR
The Instruction Guide explains how to complete this form.
Complete only if"Report Type"on page 1 is marked"Dissolution" ••
1 COMMITTEE NAME 2 Filer ID (Ethics Commission Filers)
3 Statement of Dissolution
I, the undersigned campaign treasurer, do not expect the occurrence of any further reportable activity by
this political committee for this or any other campaign or election for which reporting under the Election
Code is required. I declare that all of the information required to be reported by me has been reported. I
understand that designating a report as a dissolution report terminates the appointment of campaign
treasurer. I further understand that a political committee may not make or authorize political expenditures
or accept political contributions without having an appointment of campaign treasurer on file.
Signature of Campaign Treasurer
DO NOT SIGN UNLESS POLITICAL
COMMITTEE IS TO BE DISSOLVED
Please complete either option below:
(1)Affidavit
AFFIX NOTARY STAMP/SEALABOVE
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
OR
(2)Unsworn Declaration
My name is , and my date of birth is
My address is ,
(street) (dty) (state) (zip codeXcountry)
Executed in County,State of ,on the day of ,20
(month) (year)
Signature of Campaign Treasurer(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
MONETARY CONTRIBUTIONS FROM
CORPORATION OR LABOR ORGANIZATION SCHEDULE Cl
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule Cl:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Corporation/ Labor Organization name 7 Amount of contribution ($)
6 Corporation/ Labor Organization address; City; State; Zip Code
Date Corporation/ Labor Organization-name Amount of contribution ($)
Corporation/ Labor Organization address; City; State; Zip Code
Date Corporation/ Labor Organization name Amount of contribution ($)
Corporation/ Labor Organization address; City; State; Zip Code
Date Corporation/ Labor Organization name Amount of contribution ($)
Corporation/ Labor Organization address; City; State; Zip Code
Date Corporation/ Labor Organization name Amount of contribution ($)
Corporation/ Labor Organization address; City; State; Zip Code
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
MONETARY CONTRIBUTIONS FROM
CORPORATION OR LABOR ORGANIZATION SCHEDULE Cl
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule Cl
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Corporation/ Labor Organization name 7 Amount of contribution ($)
6 Corporation/ Labor Organization address; City; State; Zip Code
Date Corporation/ Labor Organization name Amount of contribution ($)
Corporation/ Labor Organization address; City; State; Zip Code
Date Corporation/ Labor Organization name Amount of contribution ($)
Corporation/ Labor Organization address; City; State; Zip Code
Date Corporation/ Labor Organization name Amount of contribution ($)
Corporation/ Labor Organization address; City; State; Zip Code
Date Corporation/ Labor Organization name Amount of contribution ($)
Corporation/ Labor Organization address; City; State; Zip Code
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020
MONETARY CONTRIBUTIONS FROM
CORPORATION OR LABOR ORGANIZATION SCHEDULE Cl
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule Cl:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Corporation/ Labor Organization name 7 Amount of contribution ($)
6 Corporation/ Labor Organization address; City; State; Zip Code
Date Corporation/ Labor Organization name Amount of contribution ($)
Corporation/ Labor Organization address; City; State; Zip Code
Date Corporation/ Labor Organization name Amount of contribution ($)
Corporation/ Labor Organization address; City; State; Zip Code
Date Corporation/ Labor Organization name Amount of contribution ($)
Corporation/ Labor Organization address; City; State; Zip Code
Date Corporation/ Labor Organization name Amount of contribution ($)
Corporation/ Labor Organization address; City; State; Zip Code
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/13/2020