Vous êtes sur la page 1sur 12

Texas Ethics Commission P.O.

Box 12070 Austin, Texas 78711-2070 (512)463-5800 1-800-325-8506

PERSONAL FINANCIAL STATEMENT FORM PFS


COVER SHEET

OTAL NUMBER OF PAGES FILED:

Filed in accordance with chapter 572 of the Government Code. njj


For filings requ red in 2009, covering calendar year ending December 31 , 2008. - CCOUNT » gj -Q
,Use FOR vl PFS-INSTRUCTION GUIDE when completing this form. o J>
S fn c-
1
NAME TITLE" FIRST Ml OFFICE USE QNlY r< 5f;
XA 1 J
l
(W;
NICKNAME. LAST; SUFFIX
k ate Received C-O

°
<^ ^-~

o£3

SX^i <L -^
^ Q
^o^
2 ADDRESS ADDRESS • PO BOX' APT/ SUITE #; CITY; STATE; ZIP CODE
^ -^5^
WIT, L«.foM^. (*> --,)
CO
5
TO -*«

(Au^A rx wi>
A ^~^\. / S^ f 7 "^ t~\ •->
Receipt #

HD / PM Amount
l^f (CHECK IF FILER'S HOME ADDRESS)

3 AREA CODE PHONE NUMBER; EXTENSION Date Processed


TELEPHONE
NUMBER
<S>(^> M~)i- t > 9 ^ Y Date Imaged

4
REASON
FOR FILING n r.ANninATF (INDICATE OFFICE!

STATEMENT
m ElicTED nFFiHFR Aa C^NA L^ib • ° ^VxC< ' (INDICATE OFFICE)

O APPniNTFP OFF|rpR (INDICATE AGENCY!

n FVFnimvF HFAD (INDICATE AGENCY)

D FORMER OR RETIRED JUDGE SITTING BY ASSIGNMENT

Q STATE PARTY i^HAIR fINDICATF PARTY!

!~l DTHFR (INDICATE POSITION)

Family members whose financial activity you are reporting (filer must report information about the financial activity of the filer's spouse or
dependent children if the filer had actual control over that activity):

spntiSE

DEPENDENT C H|l n 1

3.

In Parts 1 through 18, you will disclose your financial activity during the preceding calendar year. In Parts 1 through 14, you are
required to disclose not only your own financial activity, but also that of your spouse ur a dependent child IT you Had actual control
over that person's financial activity.

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY


PfeViSf;'! 1 ?/01/?008
Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512)463-5800 1-800-325-8506

SOURCES OF OCCUFRATIONAL INCOME PART1A


[[] NOTAPPLICABLE

When reporting information about a dependent child's activity, indicate the child about whom you are reporting by
providing the number under which t ne child is listed on the Cover Sheet.

1
INFORMATION RELATES TO
Q'FILER CD SPOUSE d DEPENDENT CHII n

NAME AND ADDRESS OF EMPLOYER / POSITION HELD

EMPLOYMENT | [ (Check If Filer's Home Address)

IX^EMPLOYED BY ANOTHER C/-A-, o-f >TH-ki

NATURE OF OCCUPATION
D SELF-EMPLOYED

INFORMATION RELATES TO
fj FII FR O spnufiF fj nFPFNnFNTnmi n

NAME AND ADDRESS OF EMPLOYER / POSITION HELD


EMPLOYMENT | | (Check If Filer's Home Address)

D EMPLOYED BY ANOTHER

NATURE OF OCCUPATION
D SELF-EMPLOYED

INFORMATION RELATES TO
[H FILER D SPOUSE D DEPENDENT CHILD

NAME AND ADDRESS OF EMPLOYER /POSITION HELD


EMPLOYMENT | [ (Check If Filer's Home Address)

D EMPLOYED BY ANOTHER

NATURE OF OCCUPATION
D SELF-EMPLOYED

COPY A ND ATTACH ADDITIONAL PAGES AS NECESSARY


Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512)463-5800 1 -800-325-8506

RETAINERS PART 1 B

\~fl NOT APPLICABLE

This section concerns fees received as a retainer by you, your spouse, or a dependent child (or by a business in which you,
your spouse, or a dependent child have a "substantial interest") for a claim on future services in case of need, rather than for
services on a matter specified at the time of contracting for or receiving the fee. Report information here only if the value of
the work actually performed during the calendar year did not equal or exceed the value of the retainer. For more information,
see FORM PFS-INSTRUCTION GUIDE.
When reporting information about a dependent child's activity, indicate the child about whom you are reporting by
providing the number under which the child is listed on the Cover Sheet.
NAME AND ADDRESS
1
FEE RECEIVED FROM

2 NAME OF BUSINESS

FEE RECEIVED BY
D FILER
OR FILER'S BUSINESS

D SPOUSE
OR SPOUSE'S BUSINESS

D DEPENDENT CHILD
OR CHILD'S BUSINESS

3
FEE AMOUNT D LESS THAN $5,000 D $5,000-$9,999 D S10,000--$24,999 Q $25,000~OR MORE

NAME AND ADDRESS


FEE RECEIVED FROM

NAME OF BUSINESS
FEE RECEIVED BY
D FILER
OR FILER'S BUSINESS

D SPOUSE
OR SPOUSE'S BUSINESS

D DEPENDENT CHILD
OR CHILD'S BUSINESS

FEE AMOUNT L"H LESS THAN $5,000 EH S5,000-$9,999 CH $10,000-S24,999 fj $25,000-OR MORE
j _ __

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY


Texas bthics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1 -800-325-8506

STOCK PART 2

0NOT APPLICABLE

List each business entity in which you, your spouse, or a dependent child held or acquired stock during the calendar year
and indicate the category of the number of shares held or acquired. If some or all of the stock was sold, also indicate the
category of the amount of the net gain or loss realized from the sale. For more information, see FORM PFS-
INSTRUCTION GUIDE.
When reporting information about a dependent child's activity, indicate the child about whom you are reporting by
providing the number under which the child is listed on the Cover Sheet.
1 NAME
BUSINESS ENTITY

2
STOCK HELD OR ACQUIRED BY D FILER Q SPOUSE D DEPENDENT CHILD
3 D 100 TO 499 D 500 TO 999 D1 ,000 TO 4,999
NUMBER OF SHARES D LESS THAN 100
D 5,000 TO 9.999 D 10,000 OR MORE
4 IF SOLD D NET GAIN D LESS THAN $5,000 D $5,000-$9,999 D S10.000-$24,999 G 325,000-OR MORE
D NET LOSS

BUSINESS ENTITY MAME

STOCK HELD OR ACQUIRED BY D FILER D SPOUSE D DEPENDENT CHILD

NUMBER OF SHARES D LESS THAN 100 D 100 TO 499 D 500 TO 999 1G


,000 TO 4,999

D 5,000 TO 9,999 D 10,000 OR MORE


IF SOLD D NET GAIN D LESS THAN $5,000 D $5,000-$9,999 D S10,000--$24,999 D 325,000-OR MORE
D NET LOSS

BUSINESS ENTITY NAME

STOCK HELD OR ACQUIRED BY D FILER G SPOUSE G DEPENDENT CHILD _

NUMBER OF SHARES D LESS THAN 100 D 100 TO 499 Q 500 TO 999 Q TO 4,999
1,000

D 5,000 TO 9,999 G 10,000 OR MORE


IF SOLD D NET GAIN D LESS THAN $5,000 G $5,000-$9,999 Q 310,000-324,999 G $25,000-OR MORE
D NET LOSS

BUSINESS ENTITY NAME

STOCK HELD OR ACQUIRED BY D FILER Q SPOUSE G DEPENDENT CHILD

NUMBER OF SHARES D LESS THAN 100 G 100 TO 499 G 500 TO 999 1Q,000 TO 4,999

D 5,000 TO 9,999 G 10,000 OR MORE


IF SOLD D NET GAIN D LESS THAN $5,000 Q $5,000-$9,999 Q 31 0,000-324,999 G $25,000-OR MORE
Q NET LOSS

BUSINESS ENTITY NAME

STOCK HELD OR ACQUIRED BY D FILER G SPOUSE G DEPENDENT CHILD

NUMBER OF SHARES D LESS THAN 100 G 100 TO 499 G 500 TO 999 Q TO 4.999
1,000

G 5,000 TO 9,999 D 10,000 OR MORE


IF SOLD G NET GAIN D LESS THAN $5.000 O S5,000-$9,999 Q S10.000-S24.999 Q $25.000-OR MORE

D NET LOSS
COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1 -800-325-8506

BONDS, NOTES & OTHER COMMERCIAL PAPER PARTS

NOT APPLICABLE

List all bonds, notes, and other commercial paper held or acquired by you, your spouse, or a dependent child during the
calendar year. If sold, indicate the category of the amount of the net gain or loss realized from the sale. For more
information, see FORM PFS-INSTRUCTiON GUIDE.
When reporting information about a dependent child's activity, indicate the child about whom you are reporting by
providing the number under which the child is listed on the Cover Sheet.

DESCRIPTION
OF INSTRUMENT

HELD OR ACQUIRED BY
FILER D SPOUSE D DEPENDENT CHILD

IF SOLD
D LESS THAN 85,000 D $5,000--$9,999 D $10,000--$24,999 D $25,000--OR MORE
D NET GAIN

D NET LOSS

DESCRIPTION
OF INSTRUMENT

HELD OR ACQUIRED BY
D FILER D SPOUSE D DEPENDENT CHILD

IF SOLD
D LESS THAN $5,000 D $5,000-$9,999 D S10,000-$24,999 D S25.000--OR MORE
D NET GAIN

D NET LOSS

DESCRIPTION
OF INSTRUMENT

HELD OR ACQUIRED BY
D FILER D SPOUSE D DEPENDENT CHILD

IF SOLD
D LESS THAN $5,000 D S5!000-$9,999 D $10,000-324,999 Q 325,000-OR MORE
D NET GAIN

LJ NET LOSS

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY


Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (51 2) 463-5800 1 -800-325-8506

MUTUAL FUNDS PART 4

rj NOTAPPLICABLE

List each mutual fund and the number of shares in that mutual fund that you, your spouse, or a dependent child held or
acquired during the calendar year and indicate the category of the number of shares of mutual funds held or acquired. If
some or all of the shares of a mutual fund were sold, also indicate the category of the amount of the net gain or loss realized
from the sale. For more information, see FORM PFS--INSTRUCTION GUIDE.
When reporting information about a dependent child's activity, indicate the child about whom you are reporting by
providing the number under which the child is listed on the Cover Sheet.
NAME
1 MUTUAL FUND

2
SHARES OF MUTUAL FUND
PQ/FILER G SPOUSE G DEPENDENT CHILD
HELD OR ACQUIRED BY

3 NUMBER OF SHARES G LESS THAN 100 Q 100 TO 499 Q 500 TO 999 1,000 TO 4,999
G
OF MUTUAL FUND
6"^000 TO 9,999 D 10,000 OR MORE

4 IF SOLD G NET GAIN


G LESS THAN $5,000 G $5,000-S9,999 G $10,000-$24,999 G S25.000-OR MORE
Q NET LOSS

MUTUAL FUND NAME

/ 1 ^><< r-V (_ 6. S\ (_ t£.-KvTX/r/^'n

SHARES OF MUTUAL FUND


Q'FILER G SPOUSE G DEPENDENT CHILD
HELD OR ACQUIRED BY

NUMBER OF SHARES G LESS THAN 100 Q^OO TO 499 G 500 TO 999 G1 ,000 TO 4,999
OF MUTUAL FUND
Q 5,000 TO 9,999 G 10,000 OR MORE

IF SOLD G NET GAIN


G LESS THAN $5,000 G $5,000-$9,999 G $10,000-$24,999 G S25.000-OR MORE
Q NET LOSS

MUTUAL FUND NAME

/ f ! IA.LO
SHARES OF MUTUAL FUND
EJ FILER G SPOUSE Q DEPENDENT CHILD
HELD OR ACQUIRED BY

NUMBER OF SHARES G LESS THAN 100 Q l 00 TO 499 Q^OO TO 999 1 ,000 TO 4,999
G
OF MUTUAL FUND
G 5.000 TO 9,999 G 1 0,000 OR MORE

IF SOLD D NET GAIN


G LESS THAN $5,000 Q $5,000-39,999 G SlO;000-$24,999 G 825,000-OR MORE
G NET LOSS

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY


Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512)463-5800 1-800-325-8506

INCOME FROM INTEREST, DIVIDENDS, ROYALTIES & RENTS PART 5


| | NOTAPPLICABLE

List each source of income you, your spouse, or a dependent child received in excess of $500 that was derived from
interest, dividends, royalties, and rents during the calendar year and indicate the category of the amount of the income. For
more information, see FORM PFS-INSTRUCTION GUIDE.
When reporting information about a dependent child's activity, indicate the child about whom you are reporting by
providing the number under which the child is listed on the Cover Sheet.

NAME AN; ADDRESS

SOURCE OF INCOME

3 A-

RECEIVED BY
FILER SPOUSE D DEPENDENT CHILD

AMOUNT 500-$4,999 D $5,000-$9,999 D $10,000-324,999 Q $25,000-OR MORE

NAME AND ADDRESS


SOURCE OF INCOME

RECEIVED BY
D FILER D SPOUSE D DEPENDENT CHILD

AMOUNT D $500-34,999 D $5,000-59,999 Q $10,000-$24,999 Q $25,000-OR MORE

NAME AND ADDRESS


SOURCE OF INCOME

RECEIVED BY
D FILER D SPOUSE D DEPENDENT CHILD

AMOUNT D 5SUU"54,999 D 55,000-59,999 D $10,000-524,999 Q S25.000-OR MORE

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY

Revised 1P/01.2008
Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 1 -800-325-8506

PERSONAL NOTES AND LEASE AGREEMENTS PART 6


^NOTAPPLICABLE

Identify each guarantor of a loan and each person or financial institution to whom you, your spouse, or
a dependent child had a total financial liability of more than $1,000 in the form of a personal note or notes or lease
agreement at any time during the calendar year and indicate the category of the amount of the liability. For more informa-
tion, see FORM PFS--INSTRUCTION GUIDE.
When reporting information about a dependent child's activity, indicate the child about whom you are reporting by
providing the number under which the child is listed on the Cover Sheet.

PERSON OR INSTITUTION
HOLDING NOTE OR
LEASE AGREEMENT

2
LIABILITY OF
fj Fll FR Q SPDUSF D DFPFNnFNTr.HII n

GUARANTOR

4
AMOUNT D $1,000-54,999 D $5,000»$9,999 D $10,000-324,999 D S25.000-OR MORE

PERSON OR INSTITUTION
HOLDING NOTE OR
LEASE AGREEMENT

LIABILITY OF
Q Fll FR n SPOUSE [H HFRFNinPNTCHII n

GUARANTOR

AMOUNT D $1,000-34,999 D 35,000-39,999 D $10,000-324,999 D 325,000-OR MORE

PERSON OR INSTITUTION
HOLDING NOTE OR
LEASE AGREEMENT

LIABILITY OF
L~] FILER D RPniJSF G nFRFNOFNTCHII n

GUARANTOR

AMOUNT D $1,000-54.999 L] 35,000-59,999 D $10,000-S24,999 D 525,000-OR MORE

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY

Revised 12.-0*.'?OOS
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1 -800-325-8506

INTERESTS IN REAL PROPERTY PART 7 A

NOTAPPLICABLE

Describe all beneficial interests in real property held or acquired by you, your spouse, or a dependent child during the
calendar year. If the interest was sold, also indicate the category of the amount of the net gain or loss realized from the sale.
For an explanation of "beneficial interest" and other specific directions for completing this section, see FORM PFS--
INSTRUCTION GUIDE.
When reporting information about a dependent child's activity, indicate the child about whom you are reporting by
providing the number under which the child is listed on the Cover Sheet.

HELD OR ACQUIRED BY FILER D SPOUSE J DEPENDENT CHILD

2 STREET ADDRESS INCLUDING CITY. COUNTY, AND STAT


STREETADDRESS
NpW/AILABLE
CHECK IF FILER'S HOME ADDRESS

NUMBER OF LOTS OR ACRES AND NAME OF COUNTY WHERE LOCATED


3
DESCRIPTION
[j LOTS

~1 ACRES

NAMES OF PERSONS
RETAILING AN INTEREST
L^NOT APPLICABLE
(SEVERED MINERAL INTEREST)

IF SOLD
Q NET GAIN D LESS THAN 35,000 D $5,000-$9,999 D 310,000-324,999 D S25.000--OR MORE

n NET LOSS

HELD OR ACQUIRED BY D FILER D SPOUSE D DEPENDENT CHILD

STREET ADDRESS. INCLUDING CITY, COUNTY, AND STATE


STREETADDRESS
[~| NOTAVAILABLE
fj CHECK IF FILER'S HOME ADDRESS

NUMBER OF LOTS OR ACRES AND NAME OF COUNTY WHERE LOCATED


DESCRIPTION
D LOTS

L~] ACRES

NAMES OF PERSONS
RETAINING AN INTEREST
D NOTAPPLICABLE
(SEVERED MINERAL INTEREST)

IF SOLD
Q NET GAIN D LESS THAN S5.000 D S5,000-S9,999 D S10,000--S24.999 D S25.000-OR MORE

j I NCTLO66

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY

flevised 15,01/5008
Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 1 -800-325-8506

INTERESTS IN BUSINESS ENTITIES PART 7B

OTAPPLICABLE

Describe all beneficial interests in business entities held or acquired by you, your spouse, or a dependent child during the
calendar year. If the interest was sold, also indicate the category of the amount of the net gain or loss realized from the sale.
For an explanation of "beneficial interest" and other specific directions for completing this section, see FORM PFS--
INSTRUCTION GUIDE.
When reporting information about a dependent child's activity, indicate the child about whom you are reporting by
providing the number under which the child is listed on the Cover Sheet.

HELD OR ACQUIRED BY D FILER D SPOUSE D DEPENDENT CHILD

NAME AND ADDRESS


DESCRIPTION | | (Check if Filer's Home Address)

IF SOLD
D LESS THAN S5,OQO D $5,000-$9,999 Q $10,000--$24,999 Q $25,000--OR MORE
D NET GAIN

D NET LOSS

HELD OR ACQUIRED BY D FILER D SPOUSE D DEPENDENT CHILD

NAME AND ADDRESS


DESCRIPTION [~~] (Check If Filer's Home Address)

IF SOLD
D LESS THAN $5,000 D $5,000-$9,999 D $10,000-$24,999 Q $25,000-OR MORE
D NET GAIN
D NET LOSS

HELD OR ACQUIRED BY D FILER D SPOUSE D DEPENDENT CHILD

NAME AND ADDRESS


DESCRIPTION fj (Check If Filer's Home Address)

IF SOLD
D LESS THAN $5,000 D $5,000-39,999 Q $10,000-$24,999 D 525,000-OR MORE
D NET GAIN

D NET LOSS

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY


Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (51 2) 463-5800 1 -800-325-8506

GIFTS PART 8

NOT APPLICABLE

Identify any person or organization that has given a gift worth more than $250 to you, your spouse, or a dependent child, and
describe the gift. The description of a gift of cash or a cash equivalent, such as a negotiable instrument or gift certificate, must
include a statement of the value of the gift. Do not include: 1) expenditures required to be reported by a person required to be
registered as a lobbyist under chapter 305 of the Government Code; 2) political contributions reported as required by law; or
3) gifts given by a person related to the recipient within the second degree by consanguinity or affinity. For more information,
see FORM PFS-INSTRUCTION GUIDE.
When reporting information about a dependent child's activity, indicate the child about whom you are reporting by
providing the number under which the child is listed on the Cover Sheet.
NAME AND ADDRESS

DONOR

RECIPIENT ILER D SPOUSE D DEPENDENT CHILD

DESCRIPTION OF GIFT
(' ( v o o o
NAME AND ADDRESS
DONOR

RECIPIENT D FILER D SPOUSE D DEPENDENT CHILD

DESCRIPTION OF GIFT

NAME AND ADDRESS


DONOR

RECIPIENT D FILER D SPOUSE D DEPENDENT CHILD

DESCRIPTION OF GIFT

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY


Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1 -800-325-8506

TRUSTJNCOME PART 9

n'NOT APPLICABLE

Identify each source of income received by you, your spouse, or a dependent child as beneficiary of a trust and indicate the
category of the amount of income received. Also identify each asset of the trust from which the beneficiary received more
than $500 in income, if the identity of the asset is known. For more information, see FORM PFS--INSTRUCTION GUIDE.
When reporting information about a dependent child's activity, indicate the child about whom you are reporting by
providing the number under which the child is listed on the Cover Sheet.

NAME OF TRUST
SOURCE

2
BENEFICIARY D FILER D SPOUSE l~l nFPFNDFNTCHII D

3
INCOME D LESS THAN $5,000 D $5,000-39,999 D $10,000-$24,999 D S25.000-OR MORE

4
ASSETS FROM WHICH
OVER $500 WAS RECEIVED

D UNKNOWN

NAME OF TRUST
SOURCE

BENEFICIARY D FILER D SPOUSE f] nFPFNDFNTCHII D

INCOME D LESS THAN $5,000 D $5,000-$9,999 D $10,000-S24,999 D $25,000-OR MORE

ASSETS FROM WHICH


OVER $500 WAS RECEIVED

D UNKNOWN

NAME OF TRUST
SOURCE

BENEFICIARY D FILER D SPOUSE D DEPENDENT CHILD

INCOME [j LESS THAN $5,000 D $5,000-$9,999 D 310,000-524,999 D S25.000-OR MORE

ASSETS FROM WHICH


OVER $500 WAS RECEIVED

D UNKNOWN

COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY

Vous aimerez peut-être aussi