Texas Ethics CommissionP.O. Box 12070Austin, Texas 78711-2070(512)463-58001-800-325-8506
SPECIFIC-PURPOSE COMMITTEE REPORT:PURPOSE & TOTALS
FORM
SPACC
OVER
S
HEETPG
2
12
COMMITTEENAMEACCOUNT #
(Ethics Commission filers)
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COMMITTEEPURPOSE
(Attach lists on plainpaper to complete thisreport if necessary.)SUPPORT
(Candidate or Measure)
OPPOSE
(Candidate or Measure)
ASSIST
(Officeholder only)
CANDIDATEOFFICEHOLDERMEASURE
CANDIDATE / OFFICEHOLDER NAMEOFFICE SOUGHT (candidate) / OFFICE HELD (officeholder)BALLOT IDENTIFICATION / #ELECTION DATEMonth Day YearDESCRIPTION
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CONTRIBUTION
1.TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THANPLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
$
TOTALS
2.TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
$
. . . . . . . . . . . . . . .
EXPENDITURETOTALS
3.TOTAL POLITICAL EXPENDITURES OF $50 OR LESS, UNLESS ITEMIZED
$
4.TOTAL POLITICAL EXPENDITURES
. . . . . . . . . . . . . . .
CONTRIBUTIONBALANCE
. . . . . . . . . . . . . . .
OUTSTANDINGLOAN TOTALS
$
5.TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAYOF THE REPORTING PERIOD
$
6.TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THELAST DAY OF THE REPORTING PERIOD
$
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AFFIDAVIT
I 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.Signature of Campaign TreasurerAFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said, this thedayof, 20, to certify which, witness my hand and seal of office.
Signature of officer administering oathPrint name of officer administering oathTitle of officer administering oath
Electronically filed using Software Version 3.3.7
0.004,231,086.492,422.701,318,765.479,355,100.350.00Texans for Rick Perry00015741
Governor Rick PerryXX
Governor
Dr. Richard Box
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