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Monthly Filing General-Purpose Committee Campaign Finance Report MPAC - Texas
| Monthly Filing General-Purpose Committee Campaign Finance Report Form. This is a Texas form and can be used in Ethics Commission Statewide . |
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Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) MONTHLY FILING GENERAL-PURPOSE COMMITTEE CAMPAIGN FINANCE REPORT 1 ACCOUNT # The MPAC Instruction Guide explains how to complete this form. 3 COMMITTEE NAME (Ethics Commission Filers) FORM MPAC COVER SHEET PG 1 2 Total pages filed: OFFICE USE ONLY Date Received 4 COMMITTEE ADDRESS ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE Change of Address HD / PM Receipt # Amount 5 CAMPAIGN TREASURER NAME MS / MRS / MR FIRST MI Date Processed NICKNAME LAST SUFFIX 6 CAMPAIGN TREASURER'S STREET ADDRESS (residence or business) STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; 7 CAMPAIGN TREASURER'S MAILING ADDRESS Change of Address STREET OR PO BOX; APT / SUITE #; CITY; STATE; 8 CAMPAIGN TREASURER PHONE AREA CODE PHONE NUMBER EXTENSION ( ) 9 REPORT TYPE Monthly (Enter date below) 10th day after campaign treasurer termination Dissolution (attach PAC-DR) 10 MONTHLY REPORT FILING DEADLINE January 5 February 5 March 5 April 5 May 5 June 5 July 5 August 5 September 5 11 PERIOD COVERED Month Day Year THROUGH GO TO PAGE 2 www.ethics.state.tx.us Revised 09/28/2011 American LegalNet, Inc. www.FormsWorkFlow.com Date Imaged ZIP CODE ZIP CODE October 5 November 5 December 5 Month Day Year Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) MONTHLY FILING GPAC REPORT: PURPOSE AND TOTALS 12 COMMITTEE NAME FORM MPAC COVER SHEET PG 2 ACCOUNT # (Ethics Commission Filers) 13 COMMITTEE ACTIVITY (attach lists on plain paper to complete this report if necessary.) 1. Candidates (identify by name or, if applicable, classify by party) A. Supported B. Opposed 2. Measures A. Supported (describe by date and location of election and nature of issue) B. Opposed 3. Officeholders Assisted (identify by name or, if applicable, classify by party) 14 CONTRIBUTION TOTALS 1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED check here if this report qualifies for the higher itemization threshold $ $ $ $ $ $ 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) EXPENDITURE TOTALS 3. TOTAL POLITICAL EXPENDITURES OF $10 OR LESS, UNLESS ITEMIZED 4. CONTRIBUTION BALANCE OUTSTANDING LOAN TOTALS 15 AFFIDAVIT TOTAL POLITICAL EXPENDITURES TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF THE REPORTING PERIOD TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORTING PERIOD 5. 6. I swear, or affirm, under penalty of perjury, that the accompanying report is true and correct and includes all information required to be reported by me under Title 15, Election Code. Signature of Campaign Treasurer AFFIX NOTA RY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said ______________________________________, ___________ day this the of _____________, 20 _______, to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath www.ethics.state.tx.us Revised 09/28/2011 American LegalNet, Inc. www.FormsWorkFlow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) POLITICAL CONTRIBUTIONS OTHER THAN PLEDGES OR LOANS The Instruction Guide explains how to complete this form. 2 FILER NAME SCHEDULE A 1 3 Total pages Schedule A: ACCOUNT # (Ethics Commission Filers) 4 Date 5 Full name of contributor out-of-state PAC (ID#:_________________________) 7 Amount of contribution ($) 8 In-kind contribution description (if applicable) 6 Contributor address; City; State; Zip Code 9 Principal occupation / Job title (See Instructions) 10 Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#:_________________________) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) (If travel outside of Texas, complete Schedule T) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#:_________________________) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#:_________________________) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#:_________________________) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements. www.ethics.state.tx.us (If travel outside of Texas, complete Schedule T) Amount of contribution ($) In-kind contribution description (if applicable) Amount of contribution ($) In-kind contribution description (if applicable) (If travel outside of Texas, complete Schedule T) Amount of contribution ($) In-kind contribution description (if applicable) (If travel outside of Texas, complete Schedule T) Amount of contribution ($) In-kind contribution description (if applicable) (If travel outside of Texas, complete Schedule T) Revised 09/28/2011 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) PLEDGED CONTRIBUTIONS The Instruction Guide explains how to complete this form. 2 FILER NAME SCHEDULE B 1 3 Total pages Schedule B: ACCOUNT # (Ethics Commission Filers) 4 5 Date TOTAL OF UNITEMIZED PLEDGES: 6 8 Amount of $ 9 In-kind description (if applicable) Full name of pledgor out-of-state PAC (ID#:___________________________) pledge ($) 7 Pledgor address; City; State; Zip Code 10 Principal occupation / Job title (See Instructions) 11 Employer (See Instructions) Date Full name of pledgor out-of-state PAC (ID#:___________________________) Pledgor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of pledgor out-of-state PAC (ID#:___________________________) Pledgor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of pledgor out-of-state PAC (ID#:___________________________) Pledgor address; City; State; Zip Code Principal
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