Revised No Alcohol PAC Campaign Finance Report
Content
Texas Ethics Commission
P.O. Box 12070
Austin, Texas 78711-2070
(512) 463-5800
1-800-325-8506
CORRECTION AFFIDAVIT FOR POLITICAL COMMITTEE
1. ACCOUNT # 2. Total pages filed:
FORM COR-PAC
6
3. COMMITTEE NAME
OFFICE USE ONLY
No Alcohol PAC/Neghborhood For Safety
FIRST MI LAST
4. TREASURER NAME
Date Received
Patricia
Knowles
5. ORIGINAL REPORT TYPE
Date Hand-delievered or Date Postmarked
October 25: 8th Day Before General Election 2010
Receipt # Legal Date Processed Amount Totals
6. ORIGINAL PERIOD COVERED
Month
Day
Year THROUGH
Month
Day
Year
10/18/2010
10/23/2010
Date Imaged
7. EXPLANATION OF CORRECTION
Correction of campaign finance report for poll pushers-should be a category instead of an entity Y
8. AFFIDAVIT
I swear, or affirm, under penalty of perjury, that this corrected report is true and correct. Check ONLY if applicable:
c I swear, or affirm, that I am filing this corrected report not X
later than the 14th business day after the date I learned that the report as originally filed is inaccurate or incomplete. I swear, or affirm, that any error or omission in the report as originally filed was made in good faith.
_____________________________________________________________ Signature of Campaign Treasurer AFFIX NOTARY STAMP / SEAL ABOVE
* * * Electronically Certified * * *
Patricia Knowles 16th November 10 Sworn to and subscribed before me, by __________________________________________, this the ______day of ____________, 20_____, to certify which, witness my hand and seal of office.
______________________________________________________________________________________________________________________
Signature of officer adminstering oath Printed name of officer administering oath Title of officer administering oath
Remember To Attach Any Part Of The Campaign Finance Report Form Needed To Report And Explain Corrections
Revised 08/25/2009
Texas Ethics Commission
P.O.Box 12070
Austin, Texas 78711-2070
(512) 463-5800
1-800-325-8506
SPECIFIC-PURPOSE COMMITTEE CAMPAIGN FINANCE REPORT
The SPAC Instruction Guide explains how to complete this form. 3 COMMITTEE NAME
1 ACCOUNT #
(Ethics Commission filers)
FORM SPAC
COVER SHEET PG 1
2 Total Pages Filed:
5 OFFICE USE ONLY
Date Received
No Alcohol PAC/Neghborhood For Safety
4 COMMITTEE ADDRESS cChange of Address
ADDRESS / PO BOX;
APT / SUITE #;
CITY;
STATE;
ZIP CODE
Dallas TX 75222 PO Box: 222314
Date Hand-delivered or Date Postmarked
5 CAMPAIGN TREASURER NAME
MS / MRS / MR
FIRST
MI Receipt # Amount
Patricia
NICKNAME LAST SUFFIX
Date Processed Date Imaged
Knowles
6 CAMPAIGN TREASURER'S STREET ADDRESS
(Residence or business) STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE;
ZIP CODE
4837 Swiss Ave. Dallas TX 75204
7 CAMPAIGN TREASURER'S MAILING ADDRESS c
Change of Address
STREET OR PO BOX;
APT / SUITE #;
CITY;
STATE;
ZIP CODE
Dallas TX
8 CAMPAIGN TREASURER PHONE
AREA CODE
PHONE NUMBER
EXTENSION
( )
9 REPORT TYPE
8th Day Before Main Election
10 PERIOD COVERED
10/18/2010
THROUGH
10/23/2010
11 ELECTION
ELECTION DATE
ELECTION TYPE
11/2/2010
Special
GO TO PAGE 2
Revised 09/01/2007
Texas Ethics Commission
P.O.Box 12070
Austin, Texas 78711-2070
(512) 463-5800
1-800-325-8506
SPECIFIC-PURPOSE COMMITTEE REPORT: PURPOSE AND TOTALS
12 COMMITTEE NAME
FORM SPAC
COVER SHEET PG 2
ACCOUNT #(Ethics Commission filers)
No Alcohol PAC/Neghborhood For Safety
13 COMMITTEE PURPOSE
(Attach lists on plain paper to complete this report if necessary.)
CANDIDATE / OFFICEHOLDER NAME
c CANDIDATE
OFFICE SOUGHT (candidate) / OFFICE HELD (officeholder)
c SUPPORT
(Candidate or Measure)
c OFFICEHOLDER
c OPPOSE X
(Candidate or Measure)
BALLOT IDENTIFICATION / #
ELECTION DATE
1&2
c ASSIST
(Officeholder)
11/02/2010
c X
MEASURE DESCRIPTION
No Alcohol
18 CONTRIBUTION TOTALS
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
$
0
2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
$
30000.00
.................................. EXPENDITURE TOTALS
3. TOTAL POLITICAL EXPENDITURES OF $50 OR LESS, UNLESS ITEMIZED
$
6500.00
4. TOTAL POLITICAL EXPENDITURES
$
23148.13
.................................. CONTRIBUTION BALANCE .................................. OUTSTANDING LOAN TOTALS
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF REPORTING PERIOD
$
6851.87
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORTING PERIOD
$
0
19 AFFIDAVIT
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.
***ELECTRONICALLY CERTIFIED*** _____________________________________________________________
Signature of campaign treasurer AFFIX NOTARY STAMP / SEAL ABOVE
Patricia Knowles 16th Sworn to and subscribed before me, by the said _______________________________________________, this the ____________________ day
of ________________, 20__________, to certify which, witness my hand and seal of office. November 10
Signature of officer administering oath
Printed name of officer administering oath
Title of officer administering oath
Revised 09/01/2007
Texas Ethics Commission
P.O.Box 12070
Austin, Texas 78711-2070
(512) 463-5800
1-800-325-8506
POLITICAL CONTRIBUTIONS OTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this form
SCHEDULE A
1 Total pages Schedule A:
1 of 1
2 FILER NAME
3 ACCOUNT #
(Ethics Commission filers)
No Alcohol PAC/Neghborhood For Safety
4
Date
5 Full name of contributor c out-of-state PAC (ID#:___________________)
Vantex Enterprises, LLC 10/19/2010
............................................................................................................................
7 Amount of Contribution ($)
8 In-kind contribution description (if applicable)
15000.00
6 Contributor address;
City;
State;
Zip Code
(If travel outside of Texas, complete Schedule T)
10410 Finnell
Dallas, TX 75220
9 Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Date
Full name of contributor c out-of-state PAC (ID#:___________________)
Goody-Goody Liquor 10/19/2010
............................................................................................................................
Amount of Contribution ($)
In-kind contribution description (if applicable)
15000.00
Contributor address;
City;
State;
Zip Code
(If travel outside of Texas, complete Schedule T)
10370 Olympic Drive
Principal occupation / Job title (See Instructions)
Dallas, TX 75220-4411
Employeer (See Instructions)
Date
Full name of contributor c out-of-state PAC (ID#:___________________)
............................................................................................................................
Amount of Contribution ($)
In-kind contribution description (if applicable)
Contributor address;
City;
State;
Zip Code
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions) Amount of Contribution ($) In-kind contribution description (if applicable)
Date
Full name of contributor c out-of-state PAC (ID#:___________________)
............................................................................................................................
Contributor address;
City;
State;
Zip Code
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor c out-of-state PAC (ID#:___________________)
............................................................................................................................
Amount of Contribution ($)
In-kind contribution description (if applicable)
Contributor address;
City;
State;
Zip Code
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 08/25/2009
Texas Ethics Commission
P.O.Box 12070
Austin, Texas 78711-2070
(512) 463-5800
1-800-325-8506
POLITICAL EXPENDITURES
SCHEDULE F
The Instruction Guide explains how to complete this form
1 Total pages Schedule F:
1 of 2
2 FILER NAME 3 ACCOUNT # (Ethics Commission filers)
No Alcohol PAC/Neghborhood For Safety
4 Date 5 Payee name 7 Amount ($)
Edward & Patterson Sign 10/20/2010
..................................................................................................................... 6 Payee address; City; State; Zip Code
7848.13
4733 Don Drive
Dallas, TX 75247
8 Purpose of payment (See instructions regarding type of information required.)
9 ** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
purchase signs
(If travel outside of Texas, complete Schedule T) Date Payee name Amount ($)
Elite News 10/22/2010
..................................................................................................................... Payee address; City; State; Zip Code
1000.00
1911 East Ledbetter
Purpose of payment (See instructions regarding type of information required.)
Dallas, TX 75216
** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
Advertising
(If travel outside of Texas, complete Schedule T) Date Payee name Amount ($)
KBFB Radio 10/20/2010
..................................................................................................................... Payee address; City; State; Zip Code
2000.00
13331 Preston Rd
Purpose of payment (See instructions regarding type of information required.)
Dallas, TX 75240
** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
Advertising
(If travel outside of Texas, complete Schedule T) Date Payee name Amount ($)
Fred Walker 10/20/2010
..................................................................................................................... Payee address; City; State; Zip Code
2000.00
1305 Arizona Ave
Purpose of payment (See instructions regarding type of information required.)
Dallas, TX 75203
** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
Sign distribution
(If travel outside of Texas, complete Schedule T)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED
Revised 08/25/2009
Texas Ethics Commission
P.O.Box 12070
Austin, Texas 78711-2070
(512) 463-5800
1-800-325-8506
POLITICAL EXPENDITURES
SCHEDULE F
The Instruction Guide explains how to complete this form
1 Total pages Schedule F:
2 of 2
2 FILER NAME 3 ACCOUNT # (Ethics Commission filers)
No Alcohol PAC/Neghborhood For Safety
4 Date 5 Payee name 7 Amount ($)
Ferrell Woodhouse and DFW Pros. Think 10/20/2010
..................................................................................................................... 6 Payee address; City; State; Zip Code
800.00
2701 Fondsen Suite 141 Dallas, TX 75206
8 Purpose of payment (See instructions regarding type of information required.) 9 ** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
T-shirts
(If travel outside of Texas, complete Schedule T) Date Payee name Amount ($)
KHVN Radio 10/20/2010
..................................................................................................................... Payee address; City; State; Zip Code
3000.00
57887 South Hampton Suite 285 Dallas, TX 75232
Purpose of payment (See instructions regarding type of information required.) ** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
Advertising
(If travel outside of Texas, complete Schedule T) Date Payee name Amount ($)
..................................................................................................................... Payee address; City; State; Zip Code
Purpose of payment (See instructions regarding type of information required.)
** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
(If travel outside of Texas, complete Schedule T) Date Payee name ..................................................................................................................... Payee address; City; State; Zip Code Amount ($)
Purpose of payment (See instructions regarding type of information required.)
** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
(If travel outside of Texas, complete Schedule T)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED
Revised 08/25/2009
P.O. Box 12070
Austin, Texas 78711-2070
(512) 463-5800
1-800-325-8506
CORRECTION AFFIDAVIT FOR POLITICAL COMMITTEE
1. ACCOUNT # 2. Total pages filed:
FORM COR-PAC
6
3. COMMITTEE NAME
OFFICE USE ONLY
No Alcohol PAC/Neghborhood For Safety
FIRST MI LAST
4. TREASURER NAME
Date Received
Patricia
Knowles
5. ORIGINAL REPORT TYPE
Date Hand-delievered or Date Postmarked
October 25: 8th Day Before General Election 2010
Receipt # Legal Date Processed Amount Totals
6. ORIGINAL PERIOD COVERED
Month
Day
Year THROUGH
Month
Day
Year
10/18/2010
10/23/2010
Date Imaged
7. EXPLANATION OF CORRECTION
Correction of campaign finance report for poll pushers-should be a category instead of an entity Y
8. AFFIDAVIT
I swear, or affirm, under penalty of perjury, that this corrected report is true and correct. Check ONLY if applicable:
c I swear, or affirm, that I am filing this corrected report not X
later than the 14th business day after the date I learned that the report as originally filed is inaccurate or incomplete. I swear, or affirm, that any error or omission in the report as originally filed was made in good faith.
_____________________________________________________________ Signature of Campaign Treasurer AFFIX NOTARY STAMP / SEAL ABOVE
* * * Electronically Certified * * *
Patricia Knowles 16th November 10 Sworn to and subscribed before me, by __________________________________________, this the ______day of ____________, 20_____, to certify which, witness my hand and seal of office.
______________________________________________________________________________________________________________________
Signature of officer adminstering oath Printed name of officer administering oath Title of officer administering oath
Remember To Attach Any Part Of The Campaign Finance Report Form Needed To Report And Explain Corrections
Revised 08/25/2009
Texas Ethics Commission
P.O.Box 12070
Austin, Texas 78711-2070
(512) 463-5800
1-800-325-8506
SPECIFIC-PURPOSE COMMITTEE CAMPAIGN FINANCE REPORT
The SPAC Instruction Guide explains how to complete this form. 3 COMMITTEE NAME
1 ACCOUNT #
(Ethics Commission filers)
FORM SPAC
COVER SHEET PG 1
2 Total Pages Filed:
5 OFFICE USE ONLY
Date Received
No Alcohol PAC/Neghborhood For Safety
4 COMMITTEE ADDRESS cChange of Address
ADDRESS / PO BOX;
APT / SUITE #;
CITY;
STATE;
ZIP CODE
Dallas TX 75222 PO Box: 222314
Date Hand-delivered or Date Postmarked
5 CAMPAIGN TREASURER NAME
MS / MRS / MR
FIRST
MI Receipt # Amount
Patricia
NICKNAME LAST SUFFIX
Date Processed Date Imaged
Knowles
6 CAMPAIGN TREASURER'S STREET ADDRESS
(Residence or business) STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE;
ZIP CODE
4837 Swiss Ave. Dallas TX 75204
7 CAMPAIGN TREASURER'S MAILING ADDRESS c
Change of Address
STREET OR PO BOX;
APT / SUITE #;
CITY;
STATE;
ZIP CODE
Dallas TX
8 CAMPAIGN TREASURER PHONE
AREA CODE
PHONE NUMBER
EXTENSION
( )
9 REPORT TYPE
8th Day Before Main Election
10 PERIOD COVERED
10/18/2010
THROUGH
10/23/2010
11 ELECTION
ELECTION DATE
ELECTION TYPE
11/2/2010
Special
GO TO PAGE 2
Revised 09/01/2007
Texas Ethics Commission
P.O.Box 12070
Austin, Texas 78711-2070
(512) 463-5800
1-800-325-8506
SPECIFIC-PURPOSE COMMITTEE REPORT: PURPOSE AND TOTALS
12 COMMITTEE NAME
FORM SPAC
COVER SHEET PG 2
ACCOUNT #(Ethics Commission filers)
No Alcohol PAC/Neghborhood For Safety
13 COMMITTEE PURPOSE
(Attach lists on plain paper to complete this report if necessary.)
CANDIDATE / OFFICEHOLDER NAME
c CANDIDATE
OFFICE SOUGHT (candidate) / OFFICE HELD (officeholder)
c SUPPORT
(Candidate or Measure)
c OFFICEHOLDER
c OPPOSE X
(Candidate or Measure)
BALLOT IDENTIFICATION / #
ELECTION DATE
1&2
c ASSIST
(Officeholder)
11/02/2010
c X
MEASURE DESCRIPTION
No Alcohol
18 CONTRIBUTION TOTALS
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
$
0
2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
$
30000.00
.................................. EXPENDITURE TOTALS
3. TOTAL POLITICAL EXPENDITURES OF $50 OR LESS, UNLESS ITEMIZED
$
6500.00
4. TOTAL POLITICAL EXPENDITURES
$
23148.13
.................................. CONTRIBUTION BALANCE .................................. OUTSTANDING LOAN TOTALS
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF REPORTING PERIOD
$
6851.87
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORTING PERIOD
$
0
19 AFFIDAVIT
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.
***ELECTRONICALLY CERTIFIED*** _____________________________________________________________
Signature of campaign treasurer AFFIX NOTARY STAMP / SEAL ABOVE
Patricia Knowles 16th Sworn to and subscribed before me, by the said _______________________________________________, this the ____________________ day
of ________________, 20__________, to certify which, witness my hand and seal of office. November 10
Signature of officer administering oath
Printed name of officer administering oath
Title of officer administering oath
Revised 09/01/2007
Texas Ethics Commission
P.O.Box 12070
Austin, Texas 78711-2070
(512) 463-5800
1-800-325-8506
POLITICAL CONTRIBUTIONS OTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this form
SCHEDULE A
1 Total pages Schedule A:
1 of 1
2 FILER NAME
3 ACCOUNT #
(Ethics Commission filers)
No Alcohol PAC/Neghborhood For Safety
4
Date
5 Full name of contributor c out-of-state PAC (ID#:___________________)
Vantex Enterprises, LLC 10/19/2010
............................................................................................................................
7 Amount of Contribution ($)
8 In-kind contribution description (if applicable)
15000.00
6 Contributor address;
City;
State;
Zip Code
(If travel outside of Texas, complete Schedule T)
10410 Finnell
Dallas, TX 75220
9 Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Date
Full name of contributor c out-of-state PAC (ID#:___________________)
Goody-Goody Liquor 10/19/2010
............................................................................................................................
Amount of Contribution ($)
In-kind contribution description (if applicable)
15000.00
Contributor address;
City;
State;
Zip Code
(If travel outside of Texas, complete Schedule T)
10370 Olympic Drive
Principal occupation / Job title (See Instructions)
Dallas, TX 75220-4411
Employeer (See Instructions)
Date
Full name of contributor c out-of-state PAC (ID#:___________________)
............................................................................................................................
Amount of Contribution ($)
In-kind contribution description (if applicable)
Contributor address;
City;
State;
Zip Code
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions) Amount of Contribution ($) In-kind contribution description (if applicable)
Date
Full name of contributor c out-of-state PAC (ID#:___________________)
............................................................................................................................
Contributor address;
City;
State;
Zip Code
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor c out-of-state PAC (ID#:___________________)
............................................................................................................................
Amount of Contribution ($)
In-kind contribution description (if applicable)
Contributor address;
City;
State;
Zip Code
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
Revised 08/25/2009
Texas Ethics Commission
P.O.Box 12070
Austin, Texas 78711-2070
(512) 463-5800
1-800-325-8506
POLITICAL EXPENDITURES
SCHEDULE F
The Instruction Guide explains how to complete this form
1 Total pages Schedule F:
1 of 2
2 FILER NAME 3 ACCOUNT # (Ethics Commission filers)
No Alcohol PAC/Neghborhood For Safety
4 Date 5 Payee name 7 Amount ($)
Edward & Patterson Sign 10/20/2010
..................................................................................................................... 6 Payee address; City; State; Zip Code
7848.13
4733 Don Drive
Dallas, TX 75247
8 Purpose of payment (See instructions regarding type of information required.)
9 ** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
purchase signs
(If travel outside of Texas, complete Schedule T) Date Payee name Amount ($)
Elite News 10/22/2010
..................................................................................................................... Payee address; City; State; Zip Code
1000.00
1911 East Ledbetter
Purpose of payment (See instructions regarding type of information required.)
Dallas, TX 75216
** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
Advertising
(If travel outside of Texas, complete Schedule T) Date Payee name Amount ($)
KBFB Radio 10/20/2010
..................................................................................................................... Payee address; City; State; Zip Code
2000.00
13331 Preston Rd
Purpose of payment (See instructions regarding type of information required.)
Dallas, TX 75240
** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
Advertising
(If travel outside of Texas, complete Schedule T) Date Payee name Amount ($)
Fred Walker 10/20/2010
..................................................................................................................... Payee address; City; State; Zip Code
2000.00
1305 Arizona Ave
Purpose of payment (See instructions regarding type of information required.)
Dallas, TX 75203
** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
Sign distribution
(If travel outside of Texas, complete Schedule T)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED
Revised 08/25/2009
Texas Ethics Commission
P.O.Box 12070
Austin, Texas 78711-2070
(512) 463-5800
1-800-325-8506
POLITICAL EXPENDITURES
SCHEDULE F
The Instruction Guide explains how to complete this form
1 Total pages Schedule F:
2 of 2
2 FILER NAME 3 ACCOUNT # (Ethics Commission filers)
No Alcohol PAC/Neghborhood For Safety
4 Date 5 Payee name 7 Amount ($)
Ferrell Woodhouse and DFW Pros. Think 10/20/2010
..................................................................................................................... 6 Payee address; City; State; Zip Code
800.00
2701 Fondsen Suite 141 Dallas, TX 75206
8 Purpose of payment (See instructions regarding type of information required.) 9 ** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
T-shirts
(If travel outside of Texas, complete Schedule T) Date Payee name Amount ($)
KHVN Radio 10/20/2010
..................................................................................................................... Payee address; City; State; Zip Code
3000.00
57887 South Hampton Suite 285 Dallas, TX 75232
Purpose of payment (See instructions regarding type of information required.) ** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
Advertising
(If travel outside of Texas, complete Schedule T) Date Payee name Amount ($)
..................................................................................................................... Payee address; City; State; Zip Code
Purpose of payment (See instructions regarding type of information required.)
** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
(If travel outside of Texas, complete Schedule T) Date Payee name ..................................................................................................................... Payee address; City; State; Zip Code Amount ($)
Purpose of payment (See instructions regarding type of information required.)
** Complete if direct expenditure to benefit C/OH ** Candidate / Officeholder name Office sought Office held
(If travel outside of Texas, complete Schedule T)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED
Revised 08/25/2009
