Texas > Statewide > Ethics Commission
Legislavtive Caucus LEG - Texas
| Legislavtive Caucus Form. This is a Texas form and can be used in Ethics Commission Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) LEGISLATIVE CAUCUS REPORT OF CONTRIBUTIONS & EXPENDITURES 1 ACCOUNT # The Form LEG Instruction Guide explains how to complete this form. 3 CAUCUS NAME FORM LEG COVER PAGE 2 Total pages filed: OFFICE USE ONLY Date Received 4 CAUCUS CHAIR First Name Middle Initial Last Name 5 CAUCUS MAILING ADDRESS change of address Street Address or P.O. Box; Apt./Suite # Date Hand-delivered or Postmarked City; State; Zip Code Receipt # Amount Date Processed 6 REPORT TYPE PERIOD COVERED NO REPORTABLE ACTIVITY 1. Date Imaged January 15 July 15 7 Month Day Year Month Day Year Through 8 Check here if the caucus has no reportable activity during this report period. (Sign below and submit this page only.) 9 CONTRIBUTION TOTALS TOTAL CONTRIBUTIONS OF $50 OR LESS FROM NON-CAUCUS MEMBERS (Do Not Include Loan Information or Amounts Itemized on Schedule A(L)) $ $ $ $ $ 2. TOTAL CONTRIBUTIONS (Include Contributions from Caucus Members; Do Not Include Loan Information) EXPENDITURE TOTALS 3. TOTAL EXPENDITURES OF $50 OR LESS (Do Not Include Amounts Itemized on Schedule F(L)) 4. OUTSTANDING LOAN TOTALS 10 AFFIDAVIT TOTAL EXPENDITURES TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORT PERIOD 5. I swear, or affirm, under penalty of perjury, that the accompanying report is true and correct and includes all information required to be reported by me under Title 15, Election Code. Signature of Caucus Chair AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said ___________________________________________________, this the ______________ day of __________________, 20 _______ , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath www.ethics.state.tx.us Revised 07/18/2005 American LegalNet, Inc. www.FormsWorkFlow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) NON-CAUCUS MEMBER CONTRIBUTIONS ITEMIZED CONTRIBUTIONS OTHER THAN LOANS 1 SCHEDULE A(L) (FOR FORM LEG) The Instruction Guide explains how to complete this form. 2 CAUCUS NAME Total pages Schedule A(L): 3 Date 4 Full name of contributor 6 Amount of contribution ($) 7 In-kind contribution description (if applicable) 5 Contributor address; City; State; Zip Code Date Full name of contributor Contributor address; City; State; Zip Code Date Full name of contributor Contributor address; City; State; Zip Code Date Full name of contributor Contributor address; City; State; Zip Code Date Full name of contributor Contributor address; City; State; Zip Code Date Full name of contributor Contributor address; City; State; Zip Code ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED www.ethics.state.tx.us Revised 07/18/2005 American LegalNet, Inc. www.FormsWorkFlow.com Amount of contribution ($) In-kind contribution description (if applicable) Amount of contribution ($) In-kind contribution description (if applicable) Amount of contribution ($) In-kind contribution description (if applicable) Amount of contribution ($) In-kind contribution description (if applicable) Amount of contribution ($) In-kind contribution description (if applicable) Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) LOANS TO LEGISLATIVE CAUCUS ITEMIZED LOAN AND GUARANTOR INFORMATION SCHEDULE E(L) (FOR FORM LEG) 1 Total pages Schedule E(L): The Instruction Guide explains how to complete this form. 2 CAUCUS NAME 3 TOTAL OF UNITEMIZED LOANS: 4 Date of loan $ 8 Loan Amount ($) 6 Name of lender 5 Is lender a financial Institution? 7 Lender address; City; State; Zip Code Y N 11 Description of Collateral none 12 GUARANTOR INFORMATION 13 Name of guarantor 14 Guarantor address; not applicable City; State; Zip Code 16 Principal Occupation 17 Employer Date of loan Name of lender Is lender a financial Institution? Lender address; City; State; Zip Code Y N Description of Collateral none GUARANTOR INFORMATION Name of guarantor Guarantor address; not applicable City; State; Zip Code Principal Occupation Employer ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED www.ethics.state.tx.us 9 Interest rate 10 Maturity date 15 Amount Guaranteed ($) Loan Amount ($) Interest rate Maturity date Amount Guaranteed ($) Revised 07/18/2005 American LegalNet, Inc. www.FormsWorkFlow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) LEGISLATIVE CAUCUS EXPENDITURES ITEMIZED EXPENDITURES 1 SCHEDULE F(L) (FOR FORM LEG) The Instruction Guide explains how to complete this form. 2 CAUCUS NAME Total pages Schedule F(L): 3 Date 4 Payee name 6 Amount ($) 5 Payee address; City; State; Zip Code 7 Purpose of expenditure (See instructions regarding type of information required.) Date Payee name Payee address; City; State; Zip Code Purpose of expenditure (See instructions regarding type of information required.) Date Payee name Payee address; City; State; Zip Code Purpose of expenditure (See instructions regarding type of information required.) Date Payee name Payee address; City; State; Zip Code Purpose of expenditure (See instructions regarding type of information required.) ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED www.ethics.state.tx.us Revised 07/18/2005 American LegalNet, Inc. www.FormsWorkFlow.com Amount ($) Amount ($) Amount ($)
|
|||||||
