Texas Ethics Commission P.O.Box Austin, Texas (512) ADDRESS / PO BOX; APT/SUITE #; CITY; STATE ZIP CODE
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1 MONTHLY FILING GENERAL- COMMITTEE CAMPAIGN FINANCE REPORT F ORM MPAC COVER SHEET PG 1 The MPAC INSTRUCTION GUIDE explains how to complete this form. 3 COMMITTEE NAME Northwest Democrats of Bexar County PAC 1 ACCOUNT # (Ethics Commission filers) 2 PAGE # 1 of 7 FICE USE ONLY Received 4 COMMITTEE ADDRESS Change of Address ADDRESS / PO BOX; APT/SUITE #; CITY; STATE ZIP CODE P.O. Box SAN ANTONIO, TX Hand-delivered or Postmarked 5 CAMPAIGN TREASURER NAME MS / MRS / MR FIRST MI Roger NICKNAME LAST SUFFIX Herr Receipt # Processed Imaged Amount 6 CAMPAIGN TREASURER'S STREET ADDRESS (Residence or business) STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE 8760 Cross Mountain Trail San Antonio, TX CAMPAIGN TREASURER'S MAILING ADDRESS STREET OR PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE 8760 Cross Mountain Trail San Antonio, TX Change of Address 8 CAMPAIGN TREASURER PHONE AREA CODE PHONE NUMBER EXTENSION (210) REPORT TYPE X Monthly (Enter date below) 10th day after campaign treasurer ternination 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 X October 5 November 5 December 5 11 PERIOD COVERED Month Day Year Month Day Year THROUGH 09/26/2010 GO TO PAGE 2
2 MONTHLY FILING GPAC REPORT: F ORM MPAC COVER SHEET PG AND TOTALS 2 12 COMMITTEE NAME 13 COMMITTEE ACTIVITY (Attach lists on plain paper to complete this report if necessary.) Northwest Democrats of Bexar County PAC 1. Candidates (identify by name or, if applicable, classify by party) 2. Measures (describe by date and location of election and nature of issue) A. Supported B. Opposed A. Supported B. Opposed ACCOUNT # 14 CONTRIBUTION TOTALS TOTALS 3. Officeholders Assisted (identify by name or, if applicable, classify by party) 1. TOTAL POLITICAL CONTRIBUTIONS $10 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS), UNLESS ITEMIZED (OR $20 OR LESS IF QUALIFIED FOR HIGHER THRESHOLD) Check here if this report qualifies for the higher itemization threshold. 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS) $ 3. TOTAL POLITICAL S $10 OR LESS, UNLESS ITEMIZED $ $ , CONTRIBUTION BALANCE OUTSTANDING LOAN TOTALS 4. TOTAL POLITICAL S 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS THE LAST DAY THE REPORTING PERIOD $ 6. TOTAL PRINCIPAL AMOUNT ALL OUTSTANDING LOANS AS THE LAST DAY THE REPORTING PERIOD $ $ 11, , 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. Roger Herr Signature of Campaign Treasurer AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said, this the day 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
3 POLITICAL CONTRIBUTIONS OTHER THAN PLEDGES OR LOANS SCHEDULE A The INSTRUCTION GUIDE explains how to complete this form. 1 PAGE # Schedule: 1/2 Report: 3/7 2 FILER NAME Northwest Democrats of Bexar County PAC 3 ACCOUNT # (Ethics Commission filers) 4 5 Full name of contributor out-of-state PAC (ID# ) $20 or under, Unknown 10/18/ Unknown, TX unknown unknown 7 8 $ Acevedo, Ernesto San Antonio, TX $ County Court Judge Bexar County Diaz, Dinorah 10/18/2010 San Antonio, TX $ Attorney Self Gonzales, Norma San Antonio, TX $60.00 Attorney Self Gonzalez, Monica A. San Antonio, TX $50.00 Judge City of San Antonio
4 POLITICAL CONTRIBUTIONS OTHER THAN PLEDGES OR LOANS SCHEDULE A The INSTRUCTION GUIDE explains how to complete this form. 1 PAGE # Schedule: 2/2 Report: 4/7 2 FILER NAME Northwest Democrats of Bexar County PAC 3 ACCOUNT # (Ethics Commission filers) 4 5 Full name of contributor out-of-state PAC (ID# ) Kazen, Philip 6 San Antonio, TX Judge State of Texas 7 8 $60.00 Martinez Fischer, Trey San Antonio, TX $ Attorney Self Mireles, Margaret SAN ANTONIO, TX $ judge Torres-Stahl, Catherine San Antonio, TX $60.00 Muni Judge City of San Antonio
5 POLITICAL S SCHEDULE F Accounting/Banking Fees CATEGORIES Gifts/Awards/Memorial Expense Salaries/Wages/Contract Labor Legal Services Solicitation/Fundraising Expense Food/Beverage Expense Travel In District Polling Expense Travel Out Of District Printing Expense The INSTRUCTION GUIDE explains how to complete this form. Loan Repayment/Reimbursement Transportation Equipment & Related Expense Contributions/Donations Made By Candidate/Officeholder/Political Committee OTHER (enter a category not listed above) 1 PAGE # 2 FILER NAME 3 ACCOUNT # (TEC filers) Schedule: 1/3 Report: 5/7 Northwest Democrats of Bexar County PAC /15/2010 Blackburn Advisory Group 6 Amount ($) 7 Payee address City; State; Zip Code $5, Westover Hills Blvd Ste. 103 Expenditure from San Antonio, TX (a) Category (See Categories listed at the top of this schedule) (b) Description Radio Ads 9 10/24/2010 Dorrycott, Anna & David $ Westlyn Dr. Expenditure from SAN ANTONIO, TX Category (See Categories listed at the top of this schedule) Description Data Recovery Dorrycott, Joyce $ Village Park Expenditure from San Antonio, TX Category (See Categories listed at the top of this schedule) Description Copier 10/18/2010 Luby's Cafateria $ Igram Mall Expenditure from San Antonio, TX Category (See Categories listed at the top of this schedule) Description Monthly Breakfast meeting
6 POLITICAL S SCHEDULE F Accounting/Banking Fees CATEGORIES Gifts/Awards/Memorial Expense Salaries/Wages/Contract Labor Legal Services Solicitation/Fundraising Expense Food/Beverage Expense Travel In District Polling Expense Travel Out Of District Printing Expense The INSTRUCTION GUIDE explains how to complete this form. Loan Repayment/Reimbursement Transportation Equipment & Related Expense Contributions/Donations Made By Candidate/Officeholder/Political Committee OTHER (enter a category not listed above) 1 PAGE # 2 FILER NAME 3 ACCOUNT # (TEC filers) Schedule: 2/3 Report: 6/7 Northwest Democrats of Bexar County PAC /24/2010 Middleton, Jacob 6 Amount ($) 7 Payee address City; State; Zip Code $ Bluestone Expenditure from San Antonio, TX (a) Category (See Categories listed at the top of this schedule) (b) Description Computer - re-emburseemt 9 10/19/2010 Office Depot $ Bandera #113 Expenditure from San Antonio, TX Category (See Categories listed at the top of this schedule) Description Toner 10/15/2010 Partners for Youth $3, Farm Road Expenditure from San Antonio, TX Category (See Categories listed at the top of this schedule) Description Gift/Awards/Memorials Expense Andy Mireles Memorial 10/15/2010 Studio M $ West Ave Expenditure from SAN ANTONIO, TX Category (See Categories listed at the top of this schedule) Description Production for Radio Ad
7 POLITICAL S SCHEDULE F Accounting/Banking Fees CATEGORIES Gifts/Awards/Memorial Expense Salaries/Wages/Contract Labor Legal Services Solicitation/Fundraising Expense Food/Beverage Expense Travel In District Polling Expense Travel Out Of District Printing Expense The INSTRUCTION GUIDE explains how to complete this form. Loan Repayment/Reimbursement Transportation Equipment & Related Expense Contributions/Donations Made By Candidate/Officeholder/Political Committee OTHER (enter a category not listed above) 1 PAGE # 2 FILER NAME 3 ACCOUNT # (TEC filers) Schedule: 3/3 Report: 7/7 Northwest Democrats of Bexar County PAC /15/2010 Time Warner Cable 6 Amount ($) 7 Payee address City; State; Zip Code $ P.O Expenditure from SAN ANTONIO, TX (a) Category (See Categories listed at the top of this schedule) (b) Description TV 9 US Post Office $1, Huebner Road Expenditure from San Antonio, TX Category (See Categories listed at the top of this schedule) Description Postage
Texas Ethics Commission P.O.Box 12070 Austin, Texas 78711-2070 (512)463-5800 TDD 1-800-735-2989 ADDRESS / PO BOX; APT/SUITE #; CITY; STATE ZIP CODE
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