Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512)463-5800 1-800-325-8506 GENERAL-PURPOSE COMMITTEE CAMPAIGN FINANCE REPORT GPAC FORM COVER SHEET PG 1 The GPAC INSTRUCTION GUIDE explains how to complete this form. 1 ACCOUNT # (Ethics Commission filers) 2 PAGE # 1/5 3 COMMITTEE NAME OFFICE USE ONLY Texas Speech Language Hearing Association PAC Received 4 COMMITTEE ADDRESS Change of Address ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE Hand-delivered or Postmarked 5 CAMPAIGN TREASURER NAME MS / MRS / MR FIRST MI Mr. Don R................... NICKNAME LAST SUFFIX McCullough Receipt # Processed Imaged Amount 6 CAMPAIGN TREASURER'S STREET ADDRESS (Residence or business) 7 CAMPAIGN TREASURER'S MAILING ADDRESS Change of Address STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE STREET OR PO BOX; APT/SUITE#; CITY; STATE; ZIP CODE 8 CAMPAIGN TREASURER PHONE AREA CODE PHONE NUMBER EXTENSION ( 512 ) 454-8626 9 REPORT TYPE January 15 30th day before election Dissolution (attach PAC-DR) 10 PERIOD COVERED X 8th day before election July 15 Runoff 10th day after campaign treasurer termination THROUGH 01/01/2005 06/30/2005 11 ELECTION ELECTION DATE ELECTION TYPE Primary Runoff General Special GO TO PAGE 2
GENERAL-PURPOSE COMMITTEE REPORT: F ORM GPAC COVER SHEET PG PURPOSE AND TOTALS 2 12 COMMITTEE NAME 13 COMMITTEE ACTIVITY (Attach lists on plain paper to complete this report if necessary.) Texas Speech Language Hearing Association 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) 3. Officeholders Assisted (identify by name or, if applicable, classify by party) A. Supported B. Opposed A. Supported B. Opposed ACCOUNT # 14 CONTRIBUTION TOTALS 1. TOTAL OF $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $ 4187.00 EXPENDITURE TOTALS 2. TOTAL (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) $ 3. TOTAL POLITICAL EXPENDITURES OF $50 OR LESS, UNLESS ITEMIZED $ 5807.00 CONTRIBUTION BALANCE OUTSTANDING LOAN TOTALS 4. TOTAL POLITICAL EXPENDITURES 5. TOTAL MAINTAINED AS OF THE LAST DAY OF THE REPORTING PERIOD $ 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORTING PERIOD $ $ 22292.95 15 AFFIDAVIT I swear, or affirm, under penalty of prejury, that the accompanying report is true and correct and includes all information required to be reported by me under Title 15, Election Code. DON R. MCCULLOUGH 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 Revised 09/01/2003
3/5 4 5 PANHANDLE REGIONAL SPEECH & HEARING ASSOCIATION 6 7 8 15 9 AMARILLO TX 79159 LOCAL ASSOCIATION 10 HOUSTON ASSOCIATION FOR COMMUNICATON DISORDERS 25 HOUSTON TX 77027 Mrs. TERI TRAVIS 7 SPRING TX 77389 Ms. RAHCELL HARRIS 75.00 SULPHUR SPRINGS TX 75482 SPEECH THREAPY Mrs. RONDA WEST 125.00 HOUSTON TX 77079
4/5 4 5 Ms. KRISTEN POSEY 6 7 8 225.00 9 ROUND ROCK TX 78681 10 Ms. DENEEIS WATSON 105.00 POLLOCK TX 75969 Ms. DEBORAH KOELLIKER 65.00 MT VERNON TX 75457 Ms. JENNY CLARK 10 AMARILLO TX 79102 Mrs. APRIL SMITH-KOEBEL 105.00 SAN ANTONIO TX 78230
5/5 4 5 Mr. MERIDITH MOORE 6 7 35 8 9 Principal occupation PLANO / Job TX title (See 75093 Instructions) 10