Texas Ethics Commission P.O.Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1-800-325-8506 CANDIDATE / OFFICEHOLDER CANDIDATE / OFFICEHOLDER CANDIDATE / OFFICEHOLDER CANDIDATE / OFFICEHOLDER FORM FORM FORM FORM C/OH C/OH C/OH C/OH CAMPAIGN FINANCE REPORT CAMPAIGN FINANCE REPORT CAMPAIGN FINANCE REPORT CAMPAIGN FINANCE REPORT Cover Sheet pg 1 Cover Sheet pg 1 Cover Sheet pg 1 Cover Sheet pg 1 The C/OH Instruction Guide explains how to complete The C/OH Instruction Guide explains how to complete The C/OH Instruction Guide explains how to complete The C/OH Instruction Guide explains how to complete this form. this form. this form. this form. 1. ACCOUNT # (Ethics Commission filers) 2. Total Pages Filed: OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY OFFICE USE ONLY Date Received Date Hand-delievered or Date Postmarked Receipt # Amount Date Processed Date Imaged 3. CANDIDATE / OFFICEHOLDER NAME MS / MRS / MR FIRST MI NICKNAME LAST SUFFIX 4. CANDIDATE / OFFICEHOLDER MAILING ADDRESS c Change of Address Address/PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE 5. CANDIDATE / OFFICEHOLDER PHONE AREA CODE PHONE NUMBER EXTENSION 6. CAMPAIGN TREASURER NAME MS / MRS / MR FIRST MI NICKNAME LAST SUFFIX 7. CAMPAIGN TREASURER ADDRESS (Residence or business) STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE 8. CAMPAIGN TREASURER PHONE AREA CODE PHONE NUMBER EXTENSION 9. REPORT TYPE 10. PERIOD COVERED THROUGH 11. ELECTION ELECTION DATE ELECTION TYPE 12. OFFICE OFFICE HELD (if any) 13. OFFICE SOUGHT (if known) 14. NOTICE OF DIRECT CAMPAIGN EXPENDITURE BY OTHER INDIVIDUALS c additional pages ** Direct campaign expenditures are campaign expenditures made by others without the candidate's prior consent or approval Candidates are required to disclose this information only if they receive notification of the direct campaign expenditure. ** NAME ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE GO TO PAGE 2 GO TO PAGE 2 GO TO PAGE 2 GO TO PAGE 2 Revised 04/21/2010 153 Mrs Jennifer S Gates 4914 Keyhole Lane Dallas TX 75229 (214) 692 5595 Mr Bennett Glazer 5314 Lobello Drive Dallas TX 75229 (972) 392 8216 30th Day Before Main Election 1/1/2013 3/31/2013 5/11/2013 General None Council District 13
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The C/OH Instruction Guide explains how to completeThe C/OH Instruction Guide explains how to completeThe C/OH Instruction Guide explains how to completeThe C/OH Instruction Guide explains how to completethis form.this form.this form.this form.
1. ACCOUNT # (Ethics Commission filers)
2. Total Pages Filed:
OFFICE USE ONLYOFFICE USE ONLYOFFICE USE ONLYOFFICE USE ONLYDate Received
Date Hand-delievered or Date Postmarked
Receipt # Amount
Date Processed
Date Imaged
3. CANDIDATE / OFFICEHOLDER NAME
MS / MRS / MR FIRST MI
NICKNAME LAST SUFFIX
4. CANDIDATE / OFFICEHOLDER MAILING ADDRESSc Change of Address
Address/PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
5. CANDIDATE / OFFICEHOLDER PHONE
AREA CODE PHONE NUMBER EXTENSION
6. CAMPAIGN TREASURER NAME
MS / MRS / MR FIRST MI
NICKNAME LAST SUFFIX
7. CAMPAIGN TREASURER ADDRESS
(Residence or business)
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
15 C/OH NAME 16 ACCOUNT #(Ethics Commission filers)
17 NOTICEFROMPOLITICALCOMMITTEE(S)
c additional pages
** This box is for notice of political contributions accepted or political expenditures made by political committees to supportthe candidate/officeholder. These expenditures may have been made without the candidate's or officeholder's knowledge orconsent. Candidates and officeholders are required to report this information only if they receive notice of suchexpenditures.**
COMMITTEE TYPE
c GENERAL
c SPECIFIC
COMMITTEE TYPE COMMITTEE NAME
COMMITTEE ADDRESS
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
19 AFFIDAVITI swear, or affirm, under penalty of perjury, that the accompanying reportis true and correct and includes all information required to be reported byme under Title 15, Election code.
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THANPLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS2. TOTAL POLITICAL CONTRIBUTIONS2. TOTAL POLITICAL CONTRIBUTIONS2. TOTAL POLITICAL CONTRIBUTIONS(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
3. TOTAL POLITICAL EXPENDITURES OF $50 OR LESS, UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES4. TOTAL POLITICAL EXPENDITURES4. TOTAL POLITICAL EXPENDITURES4. TOTAL POLITICAL EXPENDITURES
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAYOF REPORTING PERIOD
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THELAST DAY OF THE REPORTING PERIOD
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)
POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS POLITICAL CONTRIBUTIONS SCHEDULE ASCHEDULE ASCHEDULE ASCHEDULE A
OTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANSOTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this formThe Instruction Guide explains how to complete this form
3 ACCOUNT # (Ethics Commission filers)
1 Total pages Schedule A:
2 FILER NAME
4 Date
Date
Date
Date
Date
9 Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Employeer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 04/21/2010
5 Full name of contributor c out-of-state PAC (ID#:___________________)