fraser.ethics.report
TRANSCRIPT
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Texas Ethics Commission P.O.Box 12070 Austin, Texas 78711-2070 (512)463-5800 TDD 1-800-735-2989
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SPECIFIC-PURPOSE COMMITTEE
F
ORM
SPAC CAMPAIGN FINANCE REPORTC
OVER
S
HEET PG
1
The SPAC I
NSTRUCTION
1ACCOUNT #
2 PAGE # (Ethics Commission filers)
3 COMMITTEE NAME
4 COMMITTEE ADDRESS
Change of Address
G
UIDE
explains how to complete this form.
00016469 1 of 83
PO Austin, Box TX 13243
78711
OFFICE USE
ONLY Fraser for Texas Senate
Date Received
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
Date Hand-delivered or Date Postmarked
5 CAMPAIGN
TREASURER
Ms. Dian MS / MRS / MR FIRST MI
Receipt # Amount
NAME
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Date Processed
NICKNAME LAST SUFFIX
Stai
Date Imaged
6 CAMPAIGN
TREASURER'S STREET ADDRESS
103 Lighthouse Blvd. (Residence or business)
PO Horseshoe Box 8830
Bay, TX 78657
PO Austin, Box TX 13243
78711
(830) 598-6226
X
07/01/2010 12/31/2010 STREET ADDRESS (NO PO BOX PLEASE); APT/SUITE #; CITY; STATE;
ZIP CODE
7 CAMPAIGN
TREASURER'S MAILING ADDRESS
Change of Address
STREET OR PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
8 CAMPAIGN
TREASURER PHONE
AREA CODE PHONE NUMBER EXTENSION
9 REPORT TYPE
January 15
July 15
30th day before election
8th day before election
Runoff
Exceeded $500 limitDissolution (attach PAC-DR)
10th day after campaign treasurer termination
10 PERIOD COVERED
Month Day Year
Month Day Year
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THROUGH
11 ELECTION
ELECTION DATE ELECTION TYPE Month Day Year
Primary Runoff General Special
GO TO PAGE 2
Electronically filed using Software Version 3.4.1
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Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512)463-5800 1-800-325-8506
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SPECIFIC-PURPOSE COMMITTEE REPORT:
FORM
SPAC PURPOSE & TOTALS
COVER
S
HEET PG
2
12 COMMITTEE
NAME
Fraser for Texas Senate
00016469
Troy Fraser
X
X
ACCOUNT #
(Ethics Commission filers)
13 COMMITTEE
PURPOSE
(Attach lists on plain paper to complete this report if necessary.)
SUPPORT (Candidate or Measure)
OPPOSE (Candidate or Measure)
ASSIST (Officeholder only)
CANDIDATE
CANDIDATE / OFFICEHOLDER NAME
OFFICE SOUGHT (candidate) / OFFICE HELD (officeholder) OFFICEHOLDER
Senate District 24
BALLOT IDENTIFICATION / # ELECTION DATE
Month Day Year
DESCRIPTION MEASURE
14 CONTRIBUTION
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN TOTALS
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PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
$
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
Dian Stai
2,965.00
$
396,821.75
. . . . . . . . . . . . . . . EXPENDITURE TOTALS
3. TOTAL POLITICAL EXPENDITURES OF $50 OR LESS, UNLESS ITEMIZED
$
1,906.10
4. TOTAL POLITICAL EXPENDITURES
$
161,185.84
. . . . . . . . . . . . . . .
CONTRIBUTION BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
OF THE REPORTING PERIOD
$1,489,576.20 . . . . . . . . . . . . . . . OUTSTANDING LOAN TOTALS
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LAST DAY OF THE REPORTING PERIOD
$
0.00
15AFFIDAVIT
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 NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said
, this the
day
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of , 20 , to certify which, witness my hand and seal of office.
Signature of officer administering oath Print name of officer administering oath Title of officer administering oath
Electronically filed using Software Version 3.4.1
III
III
III
III El
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Texas Ethics Commission P.O.Box 12070 Austin, Texas 78711-2070 (512)463-5800 TDD 1-800-735-2989
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POLITICAL CONTRIBUTIONS
A OTHER THAN PLEDGES OR LOANS
The I
NSTRUCTION
SCHEDULE
G
UIDE
explains how to complete this form.
1 PAGE #
2 FILER NAME 3ACCOUNT # (Ethics Commission filers)
4 5
6
Schedule: 1/45 Report: 3/83
Fraser for Texas Senate
00016469
Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
7Amount of
8
In-kind contributionA&M PAC
contribution ($)
description (if applicable)
12/11/2010
$1,000.00
Austin, TX 78768-4609
(If travel outside of Texas,
complete Schedule T) 9 Principal occupation / Job title (See Instructions) 10
Employer (See Instructions)
Date Full name of contributor X out-of-state PAC (ID#______________)
C00181826
Amount of
In-kind contribution
Aetna PAC
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contribution ($)
description (if applicable)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10/26/2010
Contributor address; City; State; Zip Code
$1,000.00
Hartford, CT 06156
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor X out-of-state PAC (ID#______________)
C00127258
Amount of contribution ($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Trexlertown, PA 18087
Electronically filed using Software Version 3.4.1
In-kind contribution Air
Products Political Alliance
description (if applicable)
12/10/2010
$1,000.00
(If travel outside of Texas,complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Amount of contribution ($)
In-kind contribution
Allen Boone Humphries Robinson LLP
description (if applicable)
12/10/2010
$1,000.00
Houston, TX 77027
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Amount of contribution ($)
In-kind contribution
American Collectors Association of Texas PACdescription (if applicable)
12/11/2010
$250.00
Lindale, TX 75771
(If travel outside of Texas,
complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions)
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Texas Ethics Commission P.O.Box 12070 Austin, Texas 78711-2070 (512)463-5800 TDD 1-800-735-2989
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POLITICAL CONTRIBUTIONS
A OTHER THAN PLEDGES OR LOANS
The I
NSTRUCTION
SCHEDULE
G
UIDE
explains how to complete this form.
1 PAGE #
2 FILER NAME 3ACCOUNT # (Ethics Commission filers)
4 5
6
Schedule: 2/45 Report: 4/83
Fraser for Texas Senate
00016469
Date Full name of contributor X out-of-state PAC (ID#______________)
C00375782
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Boise, ID 83706
7Amount of
8
In-kind contribution
American Ecology Corporation PAC
contribution ($)
description (if applicable)
10/25/2010
$500.00
(If travel outside of Texas,complete Schedule T) 9 Principal occupation / Job title (See Instructions) 10
Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
Amount of
In-kind contribution
American Electric Power Company - TX Comm for Responsible
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contribution ($)
description (if
applicable) . Govt
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10/26/2010
Contributor address; City; State; Zip Code
$5,000.00
Austin, TX 78701
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Electronically filed using Software Version 3.4.1 Amount of contribution ($)In-kind contribution
American National Insurance Employee PAC
description (if applicable)
10/18/2010
$1,500.00
Galveston, TX 77550
(If travel outside of Texas,
complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Amount of contribution ($)
In-kind contribution
American Pharmacy PAC
description (if applicable)
10/26/2010
$1,000.00
Corpus Christi, TX 78401
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Contributor address; City; State; Zip Code
Amount of contribution ($)
In-kind contribution
Anawaty, Henry III (Mr.)
description (if applicable)
12/10/2010
$1,000.00
Austin, TX 78730
(If travel outside of Texas,
complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions) Commercial
Landlord Self
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Texas Ethics Commission P.O.Box 12070 Austin, Texas 78711-2070 (512)463-5800 TDD 1-800-735-2989
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contribution ($)
description (if applicable)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12/10/2010
Contributor address; City; State; Zip Code
$1,000.00
Burlingame, CA 94010
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
Amount of contribution ($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Electronically filed using Software Version 3.4.1
In-kind contribution
Aransas-Corpus Christi Pilots
description (if applicable)
12/11/2010
$250.00
Corpus Christi, TX 78403-1659
(If travel outside of Texas,
complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Amount of contribution ($)
In-kind contribution
AT&T PAC
description (if applicable)
10/15/2010
$871.11
Austin, TX 78701
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Raffle tournament
prizes for golf
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Texas Ethics Commission P.O.Box 12070 Austin, Texas 78711-2070 (512)463-5800 TDD 1-800-735-2989
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POLITICAL CONTRIBUTIONS
A OTHER THAN PLEDGES OR LOANS
The I
NSTRUCTION
SCHEDULE
G
UIDE
explains how to complete this form.
1 PAGE #
2 FILER NAME 3ACCOUNT # (Ethics Commission filers)
4 5
6
Schedule: 4/45 Report: 6/83
Fraser for Texas Senate
00016469
Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
7Amount of
8
In-kind contributionAvery, Chris (Mr.)
contribution ($)
description (if applicable)
09/03/2010
$3,000.00
Fredericksburg, TX 78624
(If travel outside of Texas,
complete Schedule T) 9 Principal CEO occupation / Job title (See Instructions)10
Employer James Avery
(See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
Amount of
In-kind contribution
Aycox, Rod (Mr.)
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Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Amount of contribution ($)
In-kind contributionBeef PAC
description (if applicable)
12/11/2010
$2,500.00
Amarillo, TX 79106
(If travel outside of Texas,
complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions)
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Texas Ethics Commission P.O.Box 12070 Austin, Texas 78711-2070 (512)463-5800 TDD 1-800-735-2989
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POLITICAL CONTRIBUTIONS
A OTHER THAN PLEDGES OR LOANS
The I
NSTRUCTION
SCHEDULE
G
UIDE
explains how to complete this form.
1 PAGE #
2 FILER NAME 3ACCOUNT # (Ethics Commission filers)
4 5
6
Schedule: 5/45 Report: 7/83
Fraser for Texas Senate
00016469
Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
7Amount of
8
In-kind contributionBeer Alliance of Texas PAC
contribution ($)
description (if applicable)
09/27/2010
$2,500.00
Austin, TX 78701
(If travel outside of Texas,
complete Schedule T) 9 Principal occupation / Job title (See Instructions) 10
Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
Amount of
In-kind contribution
Boating Trades Association of Metropolitan Houston PAC
contribution ($)
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description (if applicable)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12/09/2010
Contributor address; City; State; Zip Code
$500.00
Houston, TX 77098
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
Amount of contribution ($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Electronically filed using Software Version 3.4.1
In-kind contributionBoating Trades Association of Texas PAC
description (if applicable)
12/09/2010
$500.00
Austin, TX 78701
(If travel outside of Texas,
complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Amount of contribution ($)
In-kind contribution
Bonham, Jeff (Mr.)
description (if applicable)
10/26/2010
$350.00
Austin, TX 78701
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Golf prizes
Tournament Raffle
Vice President CenterPoint Energy
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Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Amount of contribution ($)
In-kind contributionBooth Ahrens & Werkenthin
description (if applicable)
11/05/2010
$1,000.00
Austin, TX 78701
(If travel outside of Texas,
complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions)
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Texas Ethics Commission P.O.Box 12070 Austin, Texas 78711-2070 (512)463-5800 TDD 1-800-735-2989
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description (if applicable)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12/02/2010
Contributor address; City; State; Zip Code
$2,500.00
Austin, TX 78701
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor X out-of-state PAC (ID#______________)
C00384818
Amount of
In-kind contribution
Caremark RX Employees PAC
contribution ($)description (if applicable)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10/26/2010
Contributor address; City; State; Zip Code
$2,500.00
Washington, DC 20005
(If travel outside of Texas,
complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Electronically filed using Software Version 3.4.1 Amount of contribution ($)
In-kind contribution
Cash America International Inc. Multi-Candidate PAC
description (if applicable)
10/26/2010
$1,500.00
Fort Worth, TX 76102
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor X out-of-state PAC (ID#______________)
C00148031
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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POLITICAL CONTRIBUTIONS
A OTHER THAN PLEDGES OR LOANS
The I
NSTRUCTION
SCHEDULE
G
UIDE
explains how to complete this form.
1 PAGE #
2 FILER NAME 3ACCOUNT # (Ethics Commission filers)
4 5
6
Schedule: 7/45 Report: 9/83
Fraser for Texas Senate
00016469
Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
7Amount of
8
In-kind contributionCenterpoint Energy PAC
contribution ($)
description (if applicable)
11/23/2010
$3,000.00
Houston, TX 77210
(If travel outside of Texas,
complete Schedule T) 9 Principal occupation / Job title (See Instructions) 10
Employer (See Instructions)
Date Full name of contributor X out-of-state PAC (ID#______________)
C00419911
Amount of
In-kind contribution
Centurylink Employees PAC
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contribution ($)
description (if applicable)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .09/03/2010
Contributor address; City; State; Zip Code
$2,000.00
Raleigh, NC 27601
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
Amount of contribution ($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Electronically filed using Software Version 3.4.1
In-kind contribution
CH2M Hill Texas PAC
description (if applicable)
10/26/2010
$500.00
Dallas, TX 75251
(If travel outside of Texas,
complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Amount of contribution ($)
In-kind contribution
Chesapeake Energy for Texans PAC
description (if applicable)
10/21/2010
$3,000.00
Austin, TX 78701
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor X out-of-state PAC (ID#______________)
C00035006
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Texas Ethics Commission P.O.Box 12070 Austin, Texas 78711-2070 (512)463-5800 TDD 1-800-735-2989
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POLITICAL CONTRIBUTIONS
A OTHER THAN PLEDGES OR LOANS
The I
NSTRUCTION
SCHEDULE
G
UIDE
explains how to complete this form.
1 PAGE #
2 FILER NAME 3ACCOUNT # (Ethics Commission filers)
4 5
6
Schedule: 8/45 Report: 10/83
Fraser for Texas Senate
00016469
Date Full name of contributor X out-of-state PAC (ID#______________)
C90007923
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
ADA, OK 74820
7Amount of
8
In-kind contribution
Chickasaw Nation
contribution ($)
description (if applicable)
12/10/2010
$5,000.00
(If travel outside of Texas,complete Schedule T) 9 Principal occupation / Job title (See Instructions) 10
Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
Amount of
In-kind contribution
Coats Rose Yale Ryman & Lee PAC
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8/3/2019 Fraser.ethics.report
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contribution ($)
description (if applicable)
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Contributor address; City; State; Zip Code
$1,000.00
Houston, TX 77046
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor X out-of-state PAC (ID#______________)
C00248716
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Contributor address; City; State; Zip Code
Philadelphia, PA 19103
Electronically filed using Software Version 3.4.1 Amount of contribution ($)
In-kind contribution
Comcast Corporation PAC
description (if applicable)
10/26/2010
$1,500.00
(If travel outside of Texas,
complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#______________)
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Contributor address; City; State; Zip Code
Amount of contribution ($)
In-kind contribution
Committee For Responsible Government of Temple Inland Inc.
description (if applicable)
10/25/2010
$1,250.00
Austin, TX 78701
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor X out-of-state PAC (ID#______________)
C00112896
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8/3/2019 Fraser.ethics.report
41/41
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Contributor address; City; State; Zip Code
Bartlesville, OK 74004
Amount of contribution ($)
In-kind contributionConocoPhilllips Spirit PAC
description (if applicable)
12/10/2010
$1,000.00
(If travel outside of Texas,
complete Schedule T) Principal occupation / Job title (See Instructions) Employer (See Instructions)