Use the INSTRUCTION GUIDE for assistance in filling out this form. LOBBY ACTIVITIES REPORT 1 Number of Pages of Schedules Filed: Schedule A Filed: Yes No B C D E F G COVER SHEET PAGE # OFFICE USE ONLY 4 REPORT TYPE REGULAR (Monthly) EXCEEDED $1000 MODIFIED (Annual) FINAL (Attach Form TN) 5 REPORT DEADLINE February 10 March 10 April 10 May 10 6 COVERED BEGINNING June 10 July 10 August 10 September 10 October 10 November 10 December 10 January 10 ENDING HD / PM Receipt # Legal Date Processed Amount $ Totals / / THROUGH / / Date Imaged 7 TOTALS BY TYPE Transportation & Lodging Gifts (other than awards & mementos) $0.00 Food & Beverages Awards & Mementos Entertainment Political Fundraisers/Charity Events Mass Media Communications 8 TOTALS BY PERSONS BENEFITTED State Senators State Representatives Executive Agency Employees Immediate Family of Legislative/ Executive Branch Member $0.00 Other Elected/Appointed State Officers Events to Which All Legislators Are Invited Legislative Branch Employees Guests 9 INDIVIDUAL S FOR ENTITY additional pages YES NO NAME OF ENTITY ADDRESS OF ENTITY PHONE NO. OF ENTITY OF S REPORTED FOR ENTITY 10 SIGNATURE To the best of my knowledge the accompanying document is true and correct and includes all information to be reported by me under Chapter 05, Government Code. I further affirm that, to the best of my knowledge, I have complied with Section 05.08, Government Code (Prohibited Conflicts of Interest). AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said, this the day of, 0, 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
LOBBY ACTIVITIES REPORT SUBJECT MATTER SCHEDULE A Use the INSTRUCTION GUIDE for assistance in filling out this form. 4 SUBJECT MATTER CATEGORIES If your lobby communications pertained to subject matters not marked on your original lobby registration or on a previous amendment, check the appropriate boxes. 1 abortion aeronautics aging 4 agriculture 5 alcoholic beverage regulation 6 alcoholism & drug abuse 7 aliens 8 amusements, games, sports 9 animals 10 arts & humanities 11 business & commerce 1 cemeteries 1 charitable & nonprofit organizations 14 city government 15 civil remedies & liabilities 16 coastal affairs & beaches 17 common carriers 18 communications & press 19 consumer protection 0 corporations & associations 1 corrections county government courts 4 crime 5 criminal procedures 6 day care 7 disaster preparedness & relief 8 economic & industrial development 9 education 0 elections 1 energy environment ethics 4 family issues 5 fees & other non-tax revenue 6 financial institutions 7 fire fighters & police 8 gambling 9 handicapped persons 40 health & health care 41 highways & roads 4 historic preservation & museums 4 hospitals 44 housing 45 human services 46 insurance 47 labor 48 law enforcement 49 lawyers 50 libraries 51 malpractice-health care providers 5 mental health & cognition 5 military & veterans 54 mines & mineral resources 55 minors 56 nursing homes 57 occupational regulation 58 oil & gas 59 open records & open meetings 60 parks & wildlife 61 political subdivisions 6 probate 6 product liability 64 property interests 65 public lands 66 purchasing 67 redistricting 68 religion 69 retirement systems 70 safety 71 special districts & authorities 7 state agencies, boards & commissions 7 state employees, officers & symbols 74 state finances 75 taxation 76 tort reform 77 tourism 78 transportation 79 utilities 80 vehicles & traffic 81 water 8 weapons 8 women s issues 84 OTHER 5 DOCKET NOS. OR OTHER DESIGNATION DESIGNATION AGENCY not applicable additional pages DESIGNATION AGENCY DESIGNATION AGENCY GO TO SCHEDULE B
DETAILED S TRANSPORTATION & LODGING SCHEDULE B Use the INSTRUCTION GUIDE for assistance in filling out this form. 4 5 TRANSPORTATION INFORMATION TYPE OF TRANSPORTATION DEPARTURE CITY TRAVEL DATES DEPARTURE / / ARRIVAL CITY ARRIVAL / / 6 LODGING INFORMATION NAME OF LODGING ESTABLISHMENT LODGING DATES CHECK IN / / CHECK OUT / / 7 8 TRANSPORTATION / LODGING PURPOSE TRANSPORTATION INFORMATION TYPE OF TRANSPORTATION DEPARTURE CITY ARRIVAL CITY TRAVEL DATES DEPARTURE / / ARRIVAL / / LODGING INFORMATION NAME OF LODGING ESTABLISHMENT LODGING DATES CHECK IN / / CHECK OUT / / TRANSPORTATION / LODGING PURPOSE GO TO SCHEDULE C
DETAILED S FOOD & BEVERAGES SCHEDULE C Use the INSTRUCTION GUIDE for assistance in filling out this form. 4 5 PLACE OF NAME OF RESTAURANT OR OTHER PLACE 6 DATE 7 PLACE OF NAME OF RESTAURANT OR OTHER PLACE DATE GO TO SCHEDULE D
DETAILED S ENTERTAINMENT SCHEDULE D Use the INSTRUCTION GUIDE for assistance in filling out this form. 4 5 PLACE OF PLACE OF ENTERTAINMENT 6 DATE 7 PLACE OF PLACE OF ENTERTAINMENT DATE GO TO SCHEDULE E
DETAILED S GIFTS SCHEDULE E Use the INSTRUCTION GUIDE for assistance in filling out this form. 4 5 GIFT DESCRIPTION 6 7 GIFT DESCRIPTION GIFT DESCRIPTION GO TO SCHEDULE F
DETAILED S AWARDS & MEMENTOS SCHEDULE F Use the INSTRUCTION GUIDE for assistance in filling out this form. 4 5 AWARD / MEMENTO DESCRIPTION 6 7 AWARD / MEMENTO DESCRIPTION AWARD / MEMENTO DESCRIPTION GO TO SCHEDULE G
DETAILED S POLITICAL FUNDRAISERS & CHARITY EVENTS SCHEDULE G Use the form LA Instruction Guide for assistance in filling out this form. 4 5 BENEFICIARY CHARITY / EVENT NAME CHARITY POLITICAL FUNDRAISER NAME OF CANDIDATE(S) / OFFICEHOLDER(S) BENEFITTED 6 EVENT DATE / / Check if credit card expenditure occurred outside reporting period. BENEFICIARY CHARITY / EVENT NAME CHARITY POLITICAL FUNDRAISER NAME OF CANDIDATE(S) / OFFICEHOLDER(S) BENEFITTED BENEFICIARY CHARITY / EVENT NAME CHARITY POLITICAL FUNDRAISER NAME OF CANDIDATE(S) / OFFICEHOLDER(S) BENEFITTED BENEFICIARY CHARITY / EVENT NAME CHARITY POLITICAL FUNDRAISER NAME OF CANDIDATE(S) / OFFICEHOLDER(S) BENEFITTED SCHEDULE G IS THE LAST SCHEDULE FOR DETAILED ACTIVITY