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“Texas Ethies Commission P.0.80x 12070 ~ __Austin, Texas 78711-2070 (612)463-5800__ 1-800-325-8508 | PERSONAL FINANCIAL STATEMENT ForM PFS COVER SHEET Filed in accordance with chapter 572 of the Govemment Code. [arene For flings required in 2010, covering calendar year ending December 31,2009, — Use FORM PFS-INSTRUCTION GUIDE when completing tis form 59193 ' eee OFFICE USE ONLY me De Michael A- ros on a aed icing casi Suede RECEIVED Michell PR 15-2010 @ ADDRESS | Ao0ness 1pO0GK APT VBUTER CMT STATE BP CODE 491 Mitahe/! Rd . Texas Ethics Commission aT: = | Henrietta. th ie a 7 TELERONE | Baa noe TEST Sate | woweer”” | (G0) 53B9—b foF AOCESSED—APR 15.2010 TREASON FORFILING | Q canowate pcre ce STATEMENT Clevectep ofricer _ AINDICATE OFFICE) Cl arpomren oFricer wercare scene Dl execurive Hean noreare vance C7 Forwer om RETIRED JUDGE SITTING BY ASSIGNMENT Cl stare parry CHA — loner Physician Assistant Boar swcssexn | © Famiy members whose fnencial actly you are reporting (ler must repert information about the fnancialacvly ofthe Here spouse or dopendent children te fir had actual contol over that acy. ‘spouse — DEPENDENT CHILD 1 ee 2. 3 In Parts 1 through 18, you will disclose your financial activly during the preceding calendar year. In Parts 1 through 14, you are equited to disclose not only your own financial activity, but also thal of your spouse or a dependent chid if you had actual contol | over that person's financial activity 9h COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY-p. 4uagiss Texas Ethics Commission F.0.80x12070___Austin, Texas 78711-2070 (612) 463-5800 _1-800-825.8505 SOURCES OF OCCUPATIONAL INCOME ParT 1A 0 norappucaste When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. | " INFORMATION RELATES TO Vues O spouse (DEPENDENT CHILD EMPLOYMENT : we (Chock Flere Hore kanes Unie Clinies of North Teas | Yfeworensranomisn M (20 oN. Mall Bowit, TK %haso | Ci setr-ewpLoven +, NATUREQFOCCUPATION Physica. re INFORMATION RELATES TO Rirwer CO) spouse (I DerENDENT CHILD Flers Hove Adee) American, Hospiew Wichtta Falls, TX gqezro EMPLOYMENT YWfenrroven ev orien Dsarcurvoven sarune oF occieanew Tem Physinar Di srouse (Cl oerenpenr chit INFORMATION RELATESTO Sree EMPLOYMENT Ci tore ers rome Aas) Yororosymonce| Quanety Eepress Chinie | t uo Fatls, Tx NG Ci ser-euetoven 2 wast oF cocuraTon Coll: physician ‘COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY | “Texas Ethies Commission P.O. Box 12070 ‘Austin, Texas 78711-2070 (612) 463-5800_ 1-800-825-8508 RETAINERS ParT 1B | oomons This section concems fees received as a retainer by you, your spouse, or a dependent child (or by a business in which you, your spouse, or a dependent child have a "substantial interest’ for a claim on future services in case of need, rather than for Services on 2 matter specified atthe time of contracting for or receiving the fee. Report information here only ifthe value of the work actually performed during the calendar year did not equal or exceed the value ofthe retainer. For more information, ‘see FORM PFS~INSTRUCTION GUIDE, When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet. A Tae AND NORE FEE RECEIVED FROM 2 - ~ vw OF anes 7 FEE RECEIVED BY | Cruer OR FILERS BUSNESS O spouse OR SPOUSES BUSINESS D berenoenr cto __ (OR CHILD'S BUSINESS 3 FEE AMOUNT Des Han $5,000 C1 $5,000-s9,909 () $10,000-$24,90 [1] $25,000-0R MORE FEE RECEIVED FROM FEE RECEIVED BY Cruse OR FILER'S BUSINESS Di spouse (OR SPOUSE'S BUSINESS Cl DEPENDENT cHiLD. OR CHILO'S BUSINESS FEE AMOUNT Lites THaN $5,000 1 $5.000-$8.980 ) $10.000-824,009 1 26,000-0R MORE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY | ‘Texas Ethics Commission __P.0.f80x12070__Austin, Texas 78711-2070 (612)465-500 _ 1-800-926-9506 STOCK PART 2 List each business entity in which you, your spouse, or a dependent child held or acquired stock during the calendar year and indicate the category of the number of shares held or acquired. If some or al of the stock was sold, also indicate the | category of the amount of the net gain or loss realized from the sale. For more information, see FORM PFS~ | INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the childs listed on the Cover Sheet, T BUSINESS ENTITY we [2 STOCK HELD OR ACQUIRED BY |CIFueR _ CD spouse: Ci DEPENDENT cHitD 3 NUMBER OF SHARES TDitesstHan 100 Clio To«e — CsooToee [x00 T0408 soos C1 1000 0R ORE ee Cinerca | tess THanss.o00 (1) s6,000-s8,000 1) s10,000-824,908 1) $25,000-OR MORE Diner toss BUSINESS ENTITY ] ae ~ ‘STOCK HELD OR ACQUIRED BY | Cl Fier Cisrouse Ti oePENDENT CHILD NUMBER OF SHARES Tiss tian 100 Cl100To«0 — Clsoorose C1000 704.000 Ls.00070 9990 CL 10.000 0R MORE (F SOLD CinercaIn | (ess THawss.o00 (1) s5.000-se.09 1 s10,000-824,000 [1] $26,000-0F MORE ae Cinertoss BUSINESS ENTITY i Ta ‘STOCK HELD OR ACQUIRED BY | C] Fier Cisrouse CU dePeNDenT GHLO NUMBER OF SHARES tess tHan 100 Cltovtose — Csoooee CI 1c0oTo a0 ao Li sc0o7o 9959 C1 10000 oR MoRE SOLD Cinercan ]C] ves Than $5000 C1 ss.000-$9900 T] s10.000-824.000 ] $25000-OR MORE Ciner toss. _ | BUSINESS ENTITY aM ‘STOCK HELD OR ACQUIRED BY | L) Fuer Ciseouse CJ oepenoenrcuu NUMBER OF SHARES CltesstHaw ico — Cl tootos — C)sooTo99 —(-]1,000 10 4908 | Cscoot0 9999 £1) 10.000 0R MoRE 'F SOLD Ciner cam | C} ress raw s5000 Cl ss.000-se.02 (] s10000-$26.990 C1] s25,000-OR MORE Ciner toss BUSINESS ENTITY sane | ‘STOCK HELD OR ACQUIRED BY | Crier ~Cisrouse LI bePeNoenr cH NUMBER OF SHARES Cltess Han 100 Clwwoto«e — Cisotosea C) 00010 400 soe T0990 1) 10.0000R MoRE IF SOLD Cinercan — | Ciess rian sso00 1 ss.000-se909 C] $10.000-824.9e0 C1 s25.000-OR MORE J NET Loss ‘COPY AND ATTAGH ADDITIONAL PAGES AS NECESSARY “Texas Ethics Commission P.0. Box 12070 Austin, Texas 78711-2070 BONDS, NOTES & OTHER COMMERCIAL PAPER tourna Information, see FORM PFS-INSTRUCTION GUIDE, providing the number under which the childis isted on the Cover Sheet, (612) 463-5900 List all bonds, notes, and other commercial paper held or acquired by you, your spouse, or a dependent child during the calendar year. If sold, indicate the category of the amount of the net gain or loss realized from the sale, For more When reporting information about a dependent child's activity, indicate the child about whom you are reporting by 4-900-926-8608, PART 3 DESCRIPTION OF INSTRUMENT HELD OR ACQUIRED BY IF SOLD One can Diner toss Grier spouse, (i bepenpenr cHiLo Cues tran $5,000 C) $6,000-89.908 1] s10,000-$24.099 ] $25,000-0R MORE DESCRIPTION OF INSTRUMENT HELD OR ACQUIRED BY IF SOLD Cnet cam Ciner toss Oruer CO spouse Ci bePenvent cri. Citess tra $5,000 C1 $5.000-$9.9¢9 C] $10,000-$24.990 C] $25,000-08 MORE. DESCRIPTION OF INSTRUMENT HELD OR ACQUIRED BY Cruse CO spouse IF SOLD | Diner caw | (Cnertoss Ci bePenpenr cro tess Han $5,000) $5,000-89,988 C] $10,000-$24.909 ] $25,000-0R MORE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY ‘Texas Ethics Commission __P.0. Box 12070 ‘Austin, Texas 78711-2070 (612)469-5800 1-800-226-8506 MUTUAL FUNDS PART 4 Ci norarrucaae | List each mutual fund and the number of shares In that mutual fund that you, your spouse, or a dependent child held or Bcauied during the calendar year andindcat the category ofthe umber of hare of mlual unde el or ecqued. Semocrallof he shares oa utel und wore sol, alsoindcate he category fe amount tenet gan oles realized ffomth aa. For moreiformaten see FORM PFS-NSTRUCTIONGODE \Wen reporting infomation sbout a dependent chi’ activ, inate the child sbou! whom you are reporting by provingtne number under whe chi tntdonthve Cover Sheet 7 MUTUAL FUND wae Eduard Tones | 2 SHARES OF | 7 - SHARES OFMUTUALFUND | Yo/iven Clerowse — Coerenoenronn 3 NUMBER OF SHARES Bites than too N10 To 499] 50070 088 1.000 To 4,990 |? Setoroat con 15.000 To 9,999 J 10,000 OR MORE. sot Clues rin ssan0 Cl sso-seose e/sinpn-s24500 (($2500-08 mone Onertoss MUTUAL FUND: NAME 7 MUTUAL FUND SHARES OF MUTUAL FU Corner couse CToerenoenr cat NUMBER OF SHARES (tess ran 100} 10070" C500 10 999 1 1.000 To 4,999 SeMUTOAL FUND | | Cis000 70 9.29 1] 10.000 oR mcr F501 Orerewn | a Cltess Tan 5.000 [] $5.000-$9,999 [7] $10,000-824,909 [] $26,000-0R MORE | Oner toss | MUTUAL FUND — NAME, {ES OF MUTUAL FUND + NUMBER OF SHARES COLESs THAN 100 TD 10tX0 499 1 500 To 999 (1.000 To 4.899 OeMUTUAL FUND 5.000 To 9,999 D 10,000 ORyIoRE, eso Cveraaw (tess THAN $5,000 (7) $5,000-$9,999 $10,000-$24,999 '$25,000-OR MORE | Cnet toss: —_ COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY “Texas Ethics Commission P20. Box 12070 Austin, Texas 78711-2070 (612)465-5800__ 1-800-925-8506 INCOME FROM INTEREST, DIVIDENDS, ROYALTIES & RENTS part 5 Wf cornercane List each source of income you, your spouse, or a dependent child received in excess of $500 that was derived from | interest, dividends, royalties, and rents during the calendar year and indicate the category of the amount ofthe income. For more information, see FORM PFS—-INSTRUCTION GUIDE. hen reporting fomaton about a dependent cies att, nat the eid about whom you ae reporting by | providing the number under which the chi listed onthe Cover Sheet | 7 ‘SOURCE OF INCOME 2 RECEIVED BY | Orner Di spouse Cy DEPENDENT CHILO 3 ‘AMOUNT '$500-$4.990 Css.00-$5.959 1] s10.000-s2«.009 [1] $25,000-08 MORE SOURCE OF INCOME . | RECEIVED BY Orwer Ui spouse Ci nePENDENT CHILD on i ss00-s4.969 Ci s5.000-s0.999 (1 s10,000-824.999 |) $26,000-0R MORE ‘SOURCE OF INCOME RECEIVED BY Oren (Di verenpenr cuit —__ been) C1 ss00~s4,.000 CO) ss000-$9,999 C1] $10.000-$24,999 [1] $25,000-0R MORE Le COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY ‘Texas Ethics Commission P.0.80x 12070 __Austin, Texas 78711-2070 (612) 483-5800 _ 1-800-325-8606 PERSONAL NOTES AND LEASE AGREEMENTS. PART 6 forme: Identify each guarantor of a loan and each person or financial institution to whom you, your spouse, or ‘a dependent child had a total financial liability of more than $1,000 in the form of a personal note or notes or lease ‘agreement at any time during the calendar year and indicate the category of the amount of the liability. For more informa tion, see FORM PFS--INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by | providing the number under which the childs listed on the Cover Sheet ; PERSON OR INSTITUTION , HOLOING NOTE OR Cathe Mae LEASE AGREEMENT LIABILITY OF | Sener Ci spouse, Di bereNDeNT CHILD * euaRANTOR filer [Student loans | AMOUNT Cisi000-s4se0 C1 s5.000-s8 900) sto.c00-s24.999 Y$25,000-0F HORE PERSON OR INSTITUTION HOLDING NOTE OR V LEASE AGREEMENT LIABILITY OF Nffer Ci spouse, Cl vePenoent chito GUARANTOR Self AMOUNT Clstovo-sesee —¥(Ss000-88908 C1 si9on0-s24990 [] s28000-0R MORE PERSON OR INSTITUTION HOLDING NOTE OR LEASE AGREEMENT LIABILITY OF | Gruen Cisrouse Ci bependenr cup _ GUARANTOR “AMOUNT Oi s1,000-$4,999 11 $5,.000-$0,099 [7] $10,000-$24,089 1 $25,000-0R MORE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY ‘Texas Ethics Commission _P.0. Box 12070 ‘Austin, Texas 78711-2070 (612)465-5800_1-800.25-8606 INTERESTS IN REAL PROPERTY PART 7A, Describe all beneficial interests in real property held or acquired by you, your spouse, or a dependent child during the calendar year. Ifthe interest was sold, also indicate the category of the amount ofthe net gain or oss realized from the sale. For an explanation of "beneficial interest" and other specific directions for completing this section, see FORM PFS-- INSTRUCTION GUIDE, When reperting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the child is listed on the Cover Sheet, * HELD OR ACQUIRED BY Orer Ci spouse C1 bereNoeNt crit 2 STREETADDRESS ‘STREET AGDRESS, NOLUDNG EXY, COUNTY ANOSTATE CJ soravanaste Dy oveok iF FteRes Home ADoRESS 3 DESCRIPTION THalGER OF GTS OR ARES AO ME OF COUNTY WHERE LOCKED Dus | acres 4 NAMES OF PERSONS RETAINING AN INTEREST Dinorapeucasce (SEVERED MINERAL INTEREST) ° soLo Dsercan CitesstHanss.o00 1 s5.000-sa.908 [1 $10,000.-s2¢.988 [) $28,000-OR WORE Drerioss: HELD OR ACQUIRED BY Oruer D srouse (Dl oePenpenr chino —___ STREET ADDRESS {REET ADDRES, NELUBNG GH, SON oNOSTATE Cnoravanase C. cHECK IF FILER'S HOME ADDRESS DESCRIPTION TNaWBER OF LOTS OR ARES AED Na GOINTY WHERE LOEATED Ours Dacees NAMES OF PERSONS RETAINING AN INTEREST Ci norapeucssis (SEVERED MINERAL INTEREST) | IF sow Hiner can tess tHaN $5,000 1 $5,000-s9.992 1] $10,000-824.999 1) $25,000-08 MORE Cnerioss COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY ‘Texas Ethics Commission __P.0. 80x 12070 Austin, Texas 78711-2070 (612) 463-5800 _1-800.25-8608 INTERESTS IN BUSINESS ENTITIES PaRT 7B | roosts Describe all beneficial interests in business entities held or acquired by you, your spouse, or a dependent child during the calendar year. Ifthe interest was sold, also indicate the category of the amount ofthe net gain or loss realized from the sale. For an explanation of "beneficial interest’ and other specific directions for completing this section, see FORM PFS- INSTRUCTION GUIDE, ‘When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the childs listed on the Cover Sheet 7 HELD OR ACQUIRED BY Orwer Cl spouse (DEPENDENT CHILD 7 mie noo DESCRIPTION a oe le sation | _ 5 iF SoLD ae Dies THAN $5,000 C1 $6,000-89,088 [1] $10,000-$24.999 1 s28,000-0R MORE Cnertoss HELD OR ACQUIRED BY Orwer Csrouse (C1 DEPENDENT CHILD DESCRIPTION Contr tame sats IF SOLD Cer oan Tess rian'ss.o00 (15000-80900 1) s10.000-se4e0 C2 s26000-0R WORE | Cine Loss | HELD OR ACQUIRED BY Crier O spouse (CO DEPENDENT CHILD DESCRIPTION Ci enc Pers Home Ae) SOLD i Cnet can Less THaN $5,000 (1) $5,000-$9,999 [) $10,000-$24,999 [) $25,000~OR MORE Cnertoss COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY ‘Texas Ethics Commission P.O. Box 12070 ‘Austin, Texas 78711-2070 (612)485.5800__ 1-800-425-8606 GIFTS PART 8 identify any person or organization that has given a gift worth more than $250'o you, your spouse, or a dependent child, and describe the gif, The description ofa gift of cash or a cash equivalent, such as a negotiable instrument or gift certificate, must | include a statement ofthe value ofthe git. Do notinclude: 1) expenditures required to be reported by a person required to be registered as a lobbyist under chapter 308 of the Government Code; 2) political contributions reported as required by law; or 3) gifts given by a person related to the recipient within the second degree by consanguinity or affinity. For more information, 's0¢ FORM PFS-INSTRUCTION GUIDE, When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the childs listed on the Cover Sheet, 7 DONOR 2 |? RECIPIENT Crner O spouse C0 vePeNDeNT cH —__ 3 DESCRIPTION OF GIFT DONOR RECIPIENT Urner CD spouse ( bepeNDeNT cH —__ | DESCRIPTION OF GIFT DONOR RECIPIENT Cruse Ci spouse ( DePENDENT CHILD DESCRIPTION OF GIFT COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Texas Ethics Commission P.O. Box 12070, Austin, Texas 78711-2070 (812) 463-5800 __ 1-800-925-8608 TRUST INCOME Roorerssns providing the number under which the childs listed on the Cover Sheet. Identify each source of income received by you, your spouse, ora dependent child as beneficiary ofa trust and indicate the category of the amount of income received. Also identi each asset ofthe trust from which the beneficiary received more than $500in income, ifthe identity ofthe asset is known. For more information, see FORM PFS--INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by PART 9 ‘i Tan or mT ‘SOURCE | * BENEFICIARY Cruer OD spouse Di bePenoenr cht — 3 INCOME Cees rHaw ss.c00 [1] ss000-s9999 C1 s10000-s24999 1] $25.000-0R MORE “ ASSETS FROM WHICH ‘OVER $500 WAS RECEIVED CD unknown ‘SOURCE BENEFICIARY Orner Ci srouse Di verennent cen OMe C1tess THan $5,000 [1 s5.000-$9.989 ] $10,000-824.999 [) $25,000-0R MORE ASSETS FROM WHICH (OVER $500 WAS RECEIVED C1 unnnown SOURCE ° BENEFICIARY Orter CO srouse C1 oePeNoeNT cHiLD INCOME [tess rian ss.o00 C1 s5.000-89900 2 st0.000-s24999 C1] $25,.000-08 MORE ASSETS FROM WHICH (OVER $500 WAS RECEIVED Cunkwown ‘COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY P.0.Box 12070 ‘Austin, Texas 78711-2070 (612) 463-5800 _ 1-800-325-8606 | BLIND TRUSTS part 10A Seorwncsae Identity each blind trust that complies with section 572,023(c) of the Government Code. See FORM PFS~INSTRUCTION GUIDE When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the childs listed on the Cover Sheet 1 NAME OF TRUST 2 TRUSTEE 3 BENEFICIARY Clrucr Ci spouse Di vePeNoeNr CHILO 4 FAI ET VALUE deals: 2 Ctess THAN $5,000 [7] $5,000-$2,999 [] $10,000.-$24,909 [] $25,000-OR MORE | © DaTECREATED NAME OF TRUST ‘TRUSTEE | BENEFICIARY | | Corner OO srouse DO nePeNoeNT HD FAIR MARKET VALUE A a Cites thaw $5,000 Cl s8,000-s9.900 1] s10,000-s24,909 1) $25,000-08 MORE DATE CREATED NAME OF TRUST ‘TRUSTEE wnooReSS BENEFICIARY Cruse Oi spouse: Cl oePeNDeNT CHILD FAIR MARKET VALUE = Dues Han $5.00 {[] $5.000-$9.999 ) s10.000-s24,99 1] s25,000-oR MORE | DATE CREATED COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY ‘Texas Ethics Commission P.O.B0x12070___ Austin, Texas 78711-2070 (512) 403-5800 _ 1-800-325-8506 TRUSTEE STATEMENT part 10B | Severs ‘An individual who is required to identify a blind trust on Part 10A of the Personal Financial Statement must submit a statement signed by the trustee of each blind trustisted on Part 10. The portions of section 672.028 of the Government Code that relate to blind trusts are listed below. 1. NAME OF TRUST 2. TRUSTEE NAME 3 FILER ON WHOSE BEHALF STATEMENT IS BEING FILED 4 TRUSTEE STATEMENT | aff, under penalty of perjury, that! have not revealed any information tothe beneficiary ofthis trust except information that may be disclosed under section 572.023 (b)8) of the Government Code and that to the best of my knowledge, the trust complies with section 572.023 of the Government Code, Trustee Signature § 572.023. Contents of Financial Statement in General (b) The account of financial activity consists of: (6) identification of the source and the category of the amount of alincome received as beneficiary ofa trust, other than a blind trust that complies with Subsection (c), and identification of each trust asset, known to the beneficiary, from which income was received by the beneficiary in excess of $500; (14) identification of each blind trust that complies with Subsection (c), including: (A) the category of the fair market value ofthe trust; (@) the date the trust was created; (C)the name and address of the trustee; and (O)a statement signed by the trustee, under penalty of perjury, stating that: (i)the trustee has not revealed any information tothe individual, except information that may be disclosed under Subdivision (8); and (i tothe best ofthe trustee's knowledge, the trust complies with this section. (©) For purposes of Subsections (b)(8) and (14), a blind trusts a trust as to which: (1) the trustee: (A) isa disinterested party; (8) isnot the individual; (C) isnot required to register as a lobbyist under Chapter 305; (0)is nota public officer or public employee; and (€) was not appointed to public office by the individual or by a public officer or public employee the individual supervises; and | (2) the trustee has complete discretion to manage the trust, including the power to dispose of and acquire trust assets without consulting or notifying the individual. (@) fa blind rust under Subsection (c)is revoked while the individual is subject this subchapter, the individual must file an ‘amendment the individual's most recent financial statement, disclosing the date of revocation and the previously unreported value by category of each asset and the income derived from each asset. Texas Ethies Commission 1-800-525-8506 ASSETS OF BUSINESS ASSOCIATIONS ParT 11A oor | Describe all assets of each corporation, fim, partnership, limited partnership, limited liabilty partnership, professional corporation, professional association, joint venture, or other business association in which you, your spouse, or a depen- dent child held, acquired, or sold 50 percent or more ofthe outstanding ownership and indicate the category ef the amount ofthe assets. For more information, see FORM PFS~INSTRUCTION GUIDE. | When reporting information about a dependent child's activity, indicate the child about whom you are reporting by P.O. Box 12070 ‘Austin, Texas 78711-2070 __(612) 463-5800 providing the number under which the child is listed on the Cover Sheet. * BUSINESS ASSOCIATION (Hi tcreek Pers Home Actos) 2 BUSINESSTYPE 3 HELD, ACQUIRED, CO spouse OR SOLD BY ema (Coe enbent CHILO * ASSETS esoRITON T | | ! 1 1 1 1 1 1 | ! I | | | | | | 1 1 1 1 | | | | | | | 1 1 1 L Ditess tian $5,000 i s10.000.s24.900 Citess than $5,000 Di s10,000-s24,90 ites TaN 5,000, 1 s10.000-s24,900 Guess tran $6,000 Tis10,000-s24,000 Cites THAN $5,000 1 s10,000-324,900 Cites THAN $5,000, 1 s10,000-s24,¢00 Ciess THAN $5,000 Cis10,000--524,909 Cites Thaw $6,000 Ci s10,000-s24.900 Ci s5000-s9.080 Ci s28,000-0R MORE C1 s5000-$9.990 1 $25,000-oR MORE Gi 85,000-s9,900 Gi s26,000--08 moRE 1 s5,000-s9.908 1D s25,000-08 MORE 1 s5.000-$9.900 $25,000-OF WORE Ci s5.000-s0,900 i s2s.000-08 MORE 1 s5,000-s9,908 1 s25,000-08 MORE s5:000-s0.989 1 s25,000-0F woRE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY. ‘Texas Ethics Commission | LIABILITIES OF BUSINESS ASSOCIATIONS x NoTAPPLCABLE P.0.80x 12070 ‘Austin, Texas 78711-2070 (612) 485-5800 4-200-225-8608, ParT 11B Describe ail liabilities of each corporation, firm, partnership, limited partnership, limited liability partnership, professional corporation, professional association, join venture, or other business association in which you, your spouse, ora depen- dent child held, acquired, or sold 60 percent or more of the outstanding owmership and indicate the category ofthe amount ofthe assets, For more information, see FORM PFS-INSTRUCTION GUIDE. When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the childs listed on the Cover Sheet * BUSINESS ASSOCIATION 2 BUSINESS TYPE Tener hone) 3 HELD, ACQUIRED, FILER ‘OR SOLD BY oe Ci srouse Di verencenr crit * UaBILITIES DESCRIPTION | T | | | | | | | | | | | | | | | | | ! | | ! | | | ! | ! | 1 1 | | | Cites THaN $5,000 i s10.000-s24.989 Cites tHan 35,000 i s10.000-s24,000 Cites tran $5,000 1 s10,000-s24,000, (Ci ess THAN $5,000 Ci s10.000-s24,900 Ci Less THAN $5,000 0) s10,000-s24.900 Ci Less THAN $5,000 Ui s10.000-524.998 Ci) Less THAN $5,000 i s10.000-s24.990 Di tess tHaN $5,000 1 s10,000-24.900 C1 s5,00-s9.009 Cl s25.000-0F WORE i s8000-s0,980 0) s25.000-0F MORE 1 s5000-s0.900 s25.000-0R moRE C1) s5,000-s9,999 0 s25.000-0R MORE Gi s5,000-s9.989 (1 s25,000-08 MORE Ci s50000-s9.989 Ui s25.000-0F WoRE Di s5.000-s9.980 i s25.000-0F wore s5,000-s9.000 i s25.000-0F woRE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Texas Ethics Commission P.0. Box 12070 ‘Austin, Texas 78711-2070 (612) 463-5800 _ 1-800-325-8608 BOARDS AND EXECUTIVE POSITIONS PART 12 Divorce List ll boards of directors of which you. your spouse, or a dependent child are a member and all executive positions you, your spouse, ora dependent child nol in corporations, fms, partnerships, imited partnerships, limited abit partner- Ships, professional corporations, professional associations, joint ventures, other business associations, or proprietorships, stating the name ofthe organization and the positon held. For more information, see FORM PFS-INSTRUCTION GUIDE When reporting information about a dependent child's activity, indicate the child about whom you are reporting by providing the number under which the childs listed on the Cover Sheet, * ORGANIZATION ? posITION HELD 5 posITION HELD BY Crner CO seouse Ci oePeNDENT CHILD ORGANIZATION POSITION HELD POSITION HELD BY Oruer Cisrouse CO DPENDENT CHILD ~ ORGANIZATION ] POSITION HELD POSITION HELD BY Crner Ci spouse (Dy verenvenr cn | ORGANIZATION POSITION HELD POSITION HELD BY Cruer CO spouse Ci verenoenr cio —__ ORGANIZATION POSITION HELD POSITION HELD BY Oruer i srouse (i vePeNDENT cHLD COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY “Texas Ethies Commission P.O. Box 12070 Austin, Texas 78711-2070 (612)402-5800__ 1-800-325-8508 EXPENSES ACCEPTED UNDER HONORARIUM EXCEPTION ParT 13 (Cy NoraPpucaste Identify any person who provided you with necessary transportation, meals, or lodging, as permitted under section 36.07(0) of the Penal Code, in connection with a conference or similar event in which you rendered services, such as addressing an audience or participating in a seminar, that were more than perfunctory. Also provide the amount of the expenditures on transportation, meals, or lodging, You are not required to include items you have already reported as political contributions. ‘ona campaign finance report, or expenditures required to be reported by a lobbyist under the lobby law (chapter 305 of the Government Code). For more information, see FORM PFS—INSTRUCTION GUIDE. eas Pk Board! 7 PROVIDER ? amount Travel, Lodging ve meals | PROVIDER ‘AMOUNT PROVIDER - AMOUNT PROVIDER AMOUNT COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY ‘Texas Ethics Commission 20. Box 12070 ‘Austin, Texas 78711-2070 (612) 483-5800 _ 1-800-525-8608 INTEREST IN BUSINESS IN COMMON WITH LOBBYIST PART 14 J(norarrucase Identify each corporation, firm, partnership, limited partnership, limited liability partnership, professional corporation, profes- sional association, joint venture, or other business association, other than a publicly-held corporation, in which you, your ‘spouse, or a dependent child, and a person registered as a lobbyist under chapter 306 of the Government Code that both have aninterest, For more information, see FORM PFS-INSTRUCTION GUIDE, * BUSINESS ENTITY ae ano ADDRESS ? INTERESTHELD BY Oruer Ci srouse (1 bePeNoenr cHito —__ BUSINESS ENTITY faeeoneeess INTEREST HELD BY Orter Disrouse 1 bePenoent cHito | BUSINESS ENTITY ees INTEREST HELD BY Cruer Ciseouse CJ oePenoenr cH BUSINESS ENTITY ae Axo anon INTEREST HELD BY Orner Cisrouse —C] be PeNoen CHILD BUSINESS ENTITY awe aro Aooness INTEREST HELD BY Oruer Cisrouse CJ ne PENDENT CHILD COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Texas Ethics Commission __P20. Box 12070 ‘Austin, Texas 78711-2070 (612)463-5800 _ 1-800-925-8508, | FEES RECEIVED FOR SERVICES RENDERED part 15 TOALOBBYIST OR LOBBYIST'S EMPLOYER NoTAPPLCABLE Report any fee you received for providing services to or on behalf of a person required to be registered as lobbyist under chapter 305 ofthe Government Code, or for providing services to or on behalf ofa person you actully now directly compen Sates or reimburses a person required to be registered as a lobbyist. Report the name of each person or entity for which the services were provided, and indicate the category of the amount of each fee. For more information, see FORM PFS-- INSTRUCTION GUIDE. * PERSON OR ENTITY FOR WHOM SERVICES WERE PROVIDED FEE CATEGORY Ces THaN 5.000 0) $5.000-89.960 C] st0,000-s24.000 1) $25,000-0R MORE PERSON OR ENTITY FOR WHOM SERVICES WERE PROVIDED. FEE CATEGORY tess Tian $5000 C1 ss.000-s099 1 s10.000-s24509 1] $25,000-08 MORE PERSON OR ENTITY | FOR WHOM SERVICES WERE PROVIDED FEE CATEGORY Cues ran s5000 C1 ss1000-s0,c00 11 s10.000-s24.900 1] $25.000-0R MORE PERSON OR ENTITY FOR WHOM SERVICES WERE PROVIDED. pec eeosY Cites THan $6,000 1 $5.000-s9.999 C1 $10,000-824,909 C1 $28,000-OF NORE PERSON OR ENTITY FOR WHOM SERVICES | WERE PROVIDED. FEE CATEGORY Cess rian $5000 (2 $8.000-s8.99@ C s10.000-s24,060 [1 $25,000-oR MORE PERSON OR ENTITY | FOR WHOM SERVICES WERE PROVIDED FEE CATEGORY tess THAN ss.000 1 $5,000-s0,009 1) $10.000-24.090 C1 $28,000-OR MORE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY “Texas Ethies Commission P.0.80x 12070 __Austin, Texas 78711-2070 (612)483-5600_ 1-800-325-8606 REPRESENTATION BY LEGISLATOR BEFORE PART 16 STATE AGENCY NOTAPPLICABLE, This section applies only to members ofthe Texas Legislature. Amember ofthe Texas Legislature who represents a person for compensation before a state agency in the executive branch must provide the name of the agency, the name of the person represented, and the category of the amount of the fee received for the representation. For more information, see FORM PFS-INSTRUCTION GUIDE. Note: Beginning September 1, 2003, legislators may not, for compensation, represent another person before a state agency in the executive branch. The prohibition does not apply if (1) the representation is pursuant to an attomey/client relationship in a criminal law matter, 2) the representation involves the filing of documents that involve only ministerial acts fon the part of the agency; or (3) the representation is in regard to a matter for which the legislator was hired before ‘September 1, 2003, 7 STATE AGENCY 2 PERSON REPRESENTED a pee aec ony tess tran $5,000 1] $5,000-80.900 (7) $10.000-s24,000 ] $25,000-0F MORE | STATE AGENCY | PERSON REPRESENTED Pee cae coe [ess THAN $5,000] $5,000-$9,909 [1] $10,000-$24,900 1) $25,000-0R MORE STATE AGENCY PERSON REPRESENTED Po calecoy tess tran $5,000] $5,000-$9.968 [1] $10,000-824,009 [1 $26,000-08 MORE STATE AGENCY PERSON REPRESENTED eee Cites Han $5,000) $5,000-s0.909 [1] s10,000-$24.909 1 $25,000-0R MORE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY ‘Texas Ethics Commission P.0.80x 12070 __Austin, Texas 78711-2070 (612) 483-5800 _ 1-800-325-8606 BENEFITS DERIVED FROM FUNCTIONS HONORING PaRT 17 PUBLIC SERVANT NOTAPPLICABLE ‘Section 36.10 of the Penal Code provides that the gift prohibitions set out in section 36.08 of the Penal Code do not apply toa benefit derived from a function in honor or appreciation of a public servant required to file a statement under chapter 572 of the Government Code or ile 15 of the Election Cade ifthe benefit and the source of any benefit over $60 in value are: 1) reported in the statement and 2) the benefits used solely to defray expenses that accrue in the performance of duties or activities in connection with the office which are nonreimbursable by the state or a paltical subdivision. If such a benefits received and is notreported by the public servant under ttle 15 ofthe Election Code, the benefitis reportable here. For more information, see FORM PFS~INSTRUCTION GUIDE. 7 TE RO NSORESS ‘SOURCE OF BENEFIT 2 BENEFIT SOURCE OF BENEFIT BENEFIT ‘SOURCE OF BENEFIT ' BENEFIT ‘SOURCE OF BENEFIT BENEFIT E ‘COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY ‘Texas Ethics Commission P.O. Box 12070 ‘Austin, Texas 78711-2070 (512) 483-5800, LEGISLATIVE CONTINUANCES xGoroncme Identify any legislative continuance that you have applied for or obtained under section 30,003 ofthe Civil Practice and Remedies Code, or under another law or rule that requires or permits a court to grant continuances on the grounds that an attorney for a party is a member or member-elect ofthe legislature. 1-800-925-8606 part 18 NAME OF PARTY | REPRESENTED DATE RETAINED, STYLE, CAUSE NUMBER, (COURT & JURISDICTION DATE OF CONTINUANCE APPLICATION WAS CONTINUANCE GRANTED? Dives NAME OF PARTY REPRESENTED DATE RETAINED STYLE, CAUSE NUMBER, | COURT, & JURISDICTION DATE OF CONTINUANCE, APPLICATION ‘WAS CONTINUANCE GRANTED? Dives Ono COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY “Texas Ethies Commission P.O. Box 12070 Austin, Texas 78711-2070 __ (612) 463-5800_1-800-325.8506 | PERSONAL FINANCIAL STATEMENT AFFIDAVIT ‘The law requires the personal financial statement to be verified. The verification page must have the signature of the individual required to fle the personal financial statement, as well as the signature and stamp or seal of office of a notary public or other person authorized by law to administer oaths and affirmations. Without proper verification, the statement Is not considered filed. | swear, or affirm, under penalty of perjury, that this financial statement covers calendar year ending December 31, 2009, andis true and correct and includes all information required to be reported by me under chapter 572 of the Government Code. Sanature afer Phatig M Blin) wort and subscribes betoe me oythe saa HA. de bell (M6 wis me DY cy 1p L 20 40 to certify which, witness my hand and seal of office. Signature ofa sanstaring oath Pant name officer samiserng oath “ie of ecer acrneing oath