STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
6 CAMPAIGN
TREASURER'S
STREET ADDRESS
(Residence or Business) 9A01 Queenswood Drive, Austin, TX 78748
[~] July 15 |Qf 8th day before election r~] Dissolution (attach PAC-DR)
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Revised CM/21/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1-800-325-8506
.OPPOSE
(Candidate or Measure)
BALLOT IDENTIFICATION / # ELECTION DATE
Month Day Year
Proposition 1 11 2010
[~] ASSIST
DESCRIPTION
(Officeholder)
15 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the accompanying
report is true and correct and includes all information required to be
PAM EL
reported txyl9ie under Title 15, Election Code.
JSE KELLER
Notar
v Public, State of Texas
My Commission Expires
October 27,2010
^ u -u ^ u .
Sworn to and subscribed before me, by the said
u *u -. DOMINIC CHAVEZ , this the
u
day of Uctoper 20 to certify which, witness my hand and seal of office.
Revised 04/21/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1-800-325-8506
POLITICAL CONTRIBUTIONS
SCHEDULE A
OTHER THAN PLEDGES OR LOANS
4 Date 5 Full name of contributor [~J out-of-state PAC (ID#: i 7 Amount of 8 In-kind contribution
contribution (S) description (if applicable)
10/8/10 Michael R . L e v y
retired
Date Full name of contributor Q out-of-state PAC (IM- , Amount of In-kind contribution
contribution (S) description (if applicable)
- - - Michael - R . - -L-evv
Contributor address; City; "State; Zip Code
10/13/10 $1500.00 mailing list
PO Box 146, Austin, TX 78767
(if travel outside f Texas, complete Schedule T)
Principal occupation /Job title (See Instructions) Employer (See Instructions)
retired retired
Revised 04/21/2010
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1-800-325-8506
POLITICAL CONTRIBUTIONS
OTHER THAN PLEDGES OR LOANS SCHEDULE A
Date Full name of contributor Q oui-oi-siaie PAC (IDS' ) Amount of In-kind contribution
contribution (S) description (if applicable)
Dominic Chavez
Contributor address; City; State; Zip Code $250.00
10/23/10
9401 Queenswood Drive, Austin, TX / 3748
(If travel outside c f Texas, complete Schedule T)
Principal occupation /Job title (See Instructions) Employer (See Instructions)
Revised 04/21Q010