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GENERAL-PURPOSE COMMITTEE
FORM GPAC
CAMPAIGN FINANCE REPORT
COVER SHEET PG 1
1 ACCOUNT #
The GPAC INSTRUCTION G UIDE explains how to complete this form.
3 COMMITTEE NAME
OFFICE USE ONLY
4 COMMITTEE
5 CAMPAIGN
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6 CAMPAIGN
7 CAMPAIGN
8 CAMPAIGN
9 REPORT TYPE
10 PERIOD
11 ELECTION
GO TO PAGE 2
F ORM GPAC
GENERAL-PURPOSE COMMITTEE REPORT:
PURPOSE AND TOTALS
COVER SHEET PG 2
12 COMMITTEE
13 COMMITTEE
14 CONTRIBUTION
TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) , UNLESS ITEMIZED TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
. . . . . . . . . . . . . . . . . . . . . . . .
TOTAL POLITICAL EXPENDITURES OF $50 OR LESS, UNLESS ITEMIZED TOTAL POLITICAL EXPENDITURES
. . . . . . . . . . . . . . . . . . . . . . . .
TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY . . . . . . . . . . . . . . . . . . . . . . . .
TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE 15 AFFIDAVIT
I swear, or affirm, under penalty of prejury, that the accompanyingreport is true and correct and includes all information required to bereported by me under Title 15, Election Code.
Sworn to and subscribed before me, by the said , to certify which, witness my hand and seal of office.
Printed name of officer administering oath POLITICAL CONTRIBUTIONS
SCHEDULE A
OTHER THAN PLEDGES OR LOANS
The INSTRUCTION GUIDE explains how to complete this form.
3 ACCOUNT #
out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) 10 Employer (See Instructions)
out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) POLITICAL CONTRIBUTIONS
SCHEDULE A
OTHER THAN PLEDGES OR LOANS
The INSTRUCTION GUIDE explains how to complete this form.
3 ACCOUNT #
out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) 10 Employer (See Instructions)
out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) POLITICAL CONTRIBUTIONS
SCHEDULE A
OTHER THAN PLEDGES OR LOANS
The INSTRUCTION GUIDE explains how to complete this form.
3 ACCOUNT #
out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) 10 Employer (See Instructions)
out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) POLITICAL CONTRIBUTIONS
SCHEDULE A
OTHER THAN PLEDGES OR LOANS
The INSTRUCTION GUIDE explains how to complete this form.
3 ACCOUNT #
out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) 10 Employer (See Instructions)
out-of-state PAC(ID#_____________________) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Principal occupation / Job title (See Instructions) POLITICAL EXPENDITURES
SCHEDULE F
The INSTRUCTION GUIDE explains how to complete this form.
3 ACCOUNT #
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6 Payee address;
Purpose of payment (See instructions regarding type of Complete if direct expenditure to benefit C/OH REIMBURSED COST TO ATTEND POLITICAL FUNDRAI -SER EVENT FOR RICK PERRY CAMPAIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Purpose of payment (See instructions regarding type of Complete if direct expenditure to benefit C/OH REIMBURSED COST TO ATTEND POLITICAL FUNDRAI -SER EVENT FOR JOE NIXON CAMPAIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Purpose of payment (See instructions regarding type of Complete if direct expenditure to benefit C/OH TICKETS FOR FUNDRAISER EVENT FOR CONGRESS -MAN JOHN CARTER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Purpose of payment (See instructions regarding type of Complete if direct expenditure to benefit C/OH TICKETS FOR FUNDRAISER EVENT FOR SENATOR T -OMMY WILLIAMS NON-POLITICAL EXPENDITURES
SCHEDULE
MADE FROM POLITICAL CONTRIBUTIONS
The INSTRUCTION GUIDE explains how to complete this form.
3 ACCOUNT #
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6 Payee address;
7 Purpose of expenditure (See instructions regarding type of information required.)
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Purpose of expenditure (See instructions regarding type of information required.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5718 WESTHEIMER SUITE 800 HOUSTON TX 77057 Purpose of expenditure (See instructions regarding type of information required.) ACCOUNTANT CONSULTATIONS RESEARCH AND ASSISTANCE WITH PR -EPARING IRS FILINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Purpose of expenditure (See instructions regarding type of information required.) BANK SETUP FEE AND MONTHLY SERVICE CHARGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Purpose of expenditure (See instructions regarding type of information required.) NON-POLITICAL EXPENDITURES
SCHEDULE
MADE FROM POLITICAL CONTRIBUTIONS
The INSTRUCTION GUIDE explains how to complete this form.
3 ACCOUNT #
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6 Payee address;
7 Purpose of expenditure (See instructions regarding type of information required.)
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Purpose of expenditure (See instructions regarding type of information required.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Purpose of expenditure (See instructions regarding type of information required.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Purpose of expenditure (See instructions regarding type of information required.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Purpose of expenditure (See instructions regarding type of information required.) NON-POLITICAL EXPENDITURES
SCHEDULE
MADE FROM POLITICAL CONTRIBUTIONS
The INSTRUCTION GUIDE explains how to complete this form.
3 ACCOUNT #
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6 Payee address;
7 Purpose of expenditure (See instructions regarding type of information required.)
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Purpose of expenditure (See instructions regarding type of information required.) TEXT ANNOTATION TEXAS RIGHT TO LIFE PAC
Information entered by filer as a memo
Schedule
total political contributions maintained = 4037.14

Source: http://bbs.ethics.state.tx.us/public/239123.pdf