Texas Emlcs 0. Box 12070 Texas 73711-2070 (512) 453--5aoo (TDD 1--soo--7352a59) PERSONAL FINANCIAL STATEMENT FORM PFS COVER SHEET PAGE 1 Filed in accordance with chaprer 572 oflhe r3rwemrnerrI Code. ForfilingsIequIrsI)1'In 1013 covering calendar year endmg December 51, 2012. wow Use FORM PFS--INSTRUCTION GUIDE when compIeling Ihis Iorm. NAME OFFICE USE ONLY MELVIN rm R-wmd I.Asr APR 0 9 2013 ADDRESS IPO sax suYE,1IP>sro~ REASON FOR FILING CANDIDATE STATEMENT ELECTED OFFICER urmrcars CI APPOINTED OFFICER axscunva HEAD roman on RETIRED moss sIrnNG av sure PARTY CHAIR rwurur: Pmw) OTHER rrunrurz vnsmum Farmly memhevs whose yw are rapamrrg (see SPOUSE mu: 1 2. 3' In Parts 1 through yvu will disclose your financIaI during the preceding calendar year. In Pans 1 through 14. you are reqmred Ia aracme not enIy your awn financial but mm mm aryaur spouse or a dependent child (see inslrucuensj COPY AND ATTACH ADDITIONAL PAGES A5 NECESSARY 075 V. wwvI.e|hlcs.IaIa|e.Ix.us Rzvised Texas Ethics Commission _.q?Box 12070 Austin, Texas 38711-2070 (512) 463-5800 (TDD 1-800-735-2989) PERSONAL FINANCIAL STATEMENT COVER SHEET PAGE 2 On this page, indicate which parts of Form PFS are not applicable to you. If you place a check in the box next to a Part below. then no pages for that Part should be included in the report. If you do not place a check in the box, then pages for that Part must be included in the report. 5 PARTS NOT APPLICABLE TO FILER Part 1A - Sources of Occupational Income Part 1B- Retainers Part 2 - Stock Part 3 - Bonds. Notes Other Commercial Paper Part 4 - Mutual Funds Part 5 - Income from Interest, Dividends, Royalties Rents Part 6 - Personal Notes and Leasefitgreements Part 7A- Interests in Real Property El Part TB - Interests in Business Entities NIA Part 8 -- Gifts Part 9 -Trust Income NIA Part 10A- Blind Trusts Part 103 --Trustee Statement Part 11A-Assets of BusinessAssociations Part 11 - Liabilities of Business Associations Part 12 - Boards and Executive Positions Part 13 - ExpensesAccepted Under Honorarium Exception Part 14 - Interest in Business in Commom with Lobbyist Part 15 - Fees Received for Services Rendered to a Lobbyist or Lobbyist's Employer Part 16 - Representation by Legislator Before State Agency Part 17 - Benefits Derived from Functions Honoring Public Servant NIA Part 18 - Legislative Continuances Revised 02l21I2013 Texas Ethics Commission P.O. Box 12070 Austin,Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) SOURCES OF OCCUPATIONAL INCOME PART 1A If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. 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 INFORMATION RELATES TO FILER SPOUSE DEPENDENT CHILD NAME AND ADDRESS OF EMPLOYER POSITION HELD 2 EMPLOYMENT (Check if Fi|er's Home Address) EMPLOYED BYANOTHER SELREMPLOYED NATURE OF OCCUPATION MEDIATION - ARBITRATION INFORMATION RELATES TO FILER spouse DEPENDENT CHILD NAME AND ADDRESS OF EMPLOYER I POSITION HELD EMPLOYMENT El (Check If FiIer's Home Address) EMPLOYED BY ANOTHER NATURE OF OCCUPATION . INFORMATION RELATES T0 FILER SPOUSE DEPENDENT CHILD NAME AND ADDRESS OF EMPLOYER I POSITION HELD EMPLOYMENT (Check if Fi|er's Home Address) EMPLOYED BY ANOTHER INATUREOFIOCCIJPATIONI I I COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02/211201 3 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-500-735-2989) RETAINERS PART 1B If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. 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 FEE RECEIVED FROM NAME OF BUSINESS FEE RECEIVED BY FILER OR BUSINESS SPOUSE OR BUSINESS DEPENDENT CHILD OR BUSINESS FEE AMOUNT LESS THAN $5,000 MORE NAME AND ADDRESS FEE RECEIVED FROM NAME OF BUSINESS FEE RECEIVED BY FILER OR BUSINESS SPOUSE OR BUSINESS DEPENDENT CHILD OR BUSINESS FEE AMOUNT LESS THAN $5,000 MORE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 0212112013 Texas Ethics Commission STOCK Box 12070 If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. Austin Texas 78711-2070 (512) 463-5800 (TDD PART 2 INSTRUCTION GUIDE. 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-- 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 BUSINESS ENTITY NAME 2 STOCK HELD OR ACQUIRED BY 3 NUMBER OF SHARES FILER SPOUSE DEPENDENT CHILD 100 TO 499 500 TO 999 1,000 TO 4,999 10.000 OR MORE LESS THAN 100 5,000 To 9.999 4 IF SOI-D NET GAIN LESS THAN $5,000 MORE NET LOSS BUSINESS ENTITY NAME STOCK HELD OR ACQUIRED BY FILER SPOUSE DEPENDENT CHILD NUMBER OF SHARES LESS THAN 100 100 TO 499 500 TO 999 1,000 TO 4,999 CI 5.000 TO 9.999 10.000 OR MORE IF NET GAIN LESS THAN $5.000 MORE NET LOSS BUSINESS ENTITY NAME STOCK HELD OR ACQUIRED BY FILER SPOUSE DEPENDENT CHILD NUMBER OF SHARES LESS THAN 100 100 TO 499 500 TO 999 1,000 TO 4,999 5,000 To 9,999 10.000 OR MORE IF SOLD NET GAIN LESS THAN $5.000 MORE NET LOSS BUSINESS ENTITY NAME STOCK HELD OR ACQUIRED BY FILER SPOUSE DEPENDENT CHILD NUMBER OF SHARES LESS THAN 100 100 TO 499 500 TO 999 1,000 TO 4,999 5.000 TO 9.999 10.000 OR MORE IF SOI-I3 NET GAIN LESS THAN $5,000 MORE NET LOSS BUSINESS ENTITY NAME STOCK HELD OR ACQUIRED BY FILER SPOUSE DEPENDENT CHILD NUMBER OF SHARES LESS THAN 100 100 TO 499 500 TO 999 1,000 TO 4,999 5,000 TO 9,999 CI 10.000 OR MORE IF SOI-I3 NET GAIN LESS THAN $5,000 MORE NET LOSS COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 (T DD 1-800-735-2989) BONDS, NOTES OTHER COMMERCIALPAPER If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. PART 3 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 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 DESCRIPTION OF INSTRUMENT 2 3 HELD OR ACQUIRED BY I:l FILER E]sI=ousE DEPENDENT CHILD IF SOLD NET GAIN El LESS THAN $5.000 MORE NET LOSS DESCRIPTION OF INSTRUMENT HELD OR ACQUIRED BY FILER El DEPENDENT CHILD IF SOLD El NET GAIN El LESS THAN $5,000 El MORE NET LOSS DESCRIPTION OF INSTRUMENT HELD OR ACQUIRED BY El FILER El SPOUSE DEPENDENT CHILD IF SOLD NET GAIN LESS THAN $5.000 El 910,000-924,999 NET LOSS COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02I'21l2013 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) MUTUAL FUNDS If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. PART 4 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. 1 MUTUAL FUND NAM 2 SHARES OF MUTUAL FUND HELD OR ACQUIRED BY FILER SPOUSE DEPENDENT CHILD 3 NUMBER OF SHARES LESS THAN 100 4.999 OF MUTUAL FUND El 5,000 TO 9.999 oR MORE 4 SOLD NET Gm" LESS THAN 05,000 95.000.99.999 MORE I: NET LOSS MUTUAL FUND NAME SHARES OF MUTUAL FUND HELD OR ACQUIRED BY El El SPOUSE El DEPENDENT CHILD NUMBER OF SHARES LESS THAN 100 100 To 499 500 TO 999 TO 4,999 OF MUTUAL FUND 5.000 TO 9999 El 10,000 oR MORE IF SOLD NET GAIN LESS THAN 95,000 El MORE El NET LOSS MUTUAL FUND NAME SHARES OF MUTUAL FUND HELD OR ACQUIRED BY FILER spousg DEPENDENT CHILD NUMBER 0.: SHARES LESS THAN 100 |:|100 TO 499 500 TO 999 1.000 TO 4.999 OF MUTUAL FUND 5.000 TO 9,999 OR MORE El NET Gm" LESS THAN 95,000 El 95.000.99.999 910.000--024.999 MORE NET Loss COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) INCOME FROM DIVIDENDS, ROYALTIES RENTS 5 If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. 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 AND ADDRESS 1 SOURCE OF INCOME CHESAPEAKE OPERATING CO. OKLAHOMA CITY, OK 2 RECEIVED BY FILER SPOUSE DEPENDENT CHILD 3 AMOUNT MORE I. NAME AND ADDRESS SOURCE OF INCOME RECEIVED BY FILER El SPOUSE El DEPENDENT CHILD AMOUNT . MORE NAME AND ADDRESS SOURCE OF INCOME RECEIVED BY FILER SPOUSE DEPENDENT CHILD AMOUNT MORE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02l21l2013 Iexas Ethics Commission P.O. Box 12070 Austin,Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2959) PERSONAL NOTES AND LEASE AGREEMENTS PART 6 If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. 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. 1 PERSON OR INSTITUTION HOLDING NOTE OR LEASE AGREEMENT 2 LIABILITY or FILER SPOUSE DEPENDENT CHILD 3 GUARANTOR 4 AMOUNT MORE PERSON OR INSTITUTION HOLDING NOTE OR LEASE AGREEMENT LIABILITY OF FILER SPOUSE DEPENDENT CHILD GUARANTOR AMOUNT $1 MORE PERSON OR INSTITUTION HOLDING NOTE OR LEASE AGREEMENT LIABILITY OF FILER SPOUSE DEPENDENT CHILD GUARANTOR AMOUNT MORE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02/21/2013 Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 (TDD INTERESTS IN REAL PROPERTY PART 7A If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. 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. 1 HELD OR ACQUIRED BY FILER sPousE DEPENDENT CHILD 2 STREETADDRESS NOT AVAILABLE CHECK HOME ADDRESS NUMBER OF LOTS OR ACRES AND NAME OF COUNTY WHERE LOCATED 3 DESCRIPTION LOTS 1- DENTON COUNTY, TX ACRES NAMES OF RETAINING AN INTEREST (SEVERED MINERAL INTEREST) 5 lF SOLD NET GAIN Less THAN $5,000 MORE NET LOSS HELD OR ACQUIRED BY FILER SPOUSE Ij DEPENDENT CHILD STREET ADDRESS, INCLUDING CITY, COUNTY. AND STATE VARIOUS MINERAL INTERESTS TN TX -WHEELER, HEMPHILL AND LIPSCOMB NOTAVAILABLE AND UNDIVIDED INTEREST IN PROPERTIES TIME SHARES CHECK lF HOME ADDRESS NUMBER OF LOTS OR ACRES AND NAME OF COUNTY WHERE DESCRIPTION LOTS VARIOUS ACREs NAMES OF PERSONS RETAINING AN INTEREST NOT APPLICABLE (SEVERED MINERAL INTEREST) IF SOLD NET GAIN LESS THAN $5,000 MORE NET Loss COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2939) INTERESTS IN BUSINESS ENTITIES PART 7B If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. 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. 1 HELD OR ACQUIRED BY FILER SPOUSE El DEPENDENT CHILD 2 NAME AND ADDRESS (Check If Filer's Home Address) SIMS ADR SERVICES 3 IF SOLD NET GAIN El LESS THAN $5.000 MORE NET LOSS HELD OR ACQUIRED BY FILER El SPOUSE El DEPENDENT CHILD NAME AND ADDRESS (Check If Filer's Home Address) IF SOLD NET GAIN El LESS THAN $5,000 El MORE NET LOSS HELD OR ACQUIRED BY FILER SPOUSE DEPENDENT CHILD NAME AND ADDRESS DESCRIPTION (Check If Fi|er's Home Address) IF SOLD NET GAIN LEss THAN $5,000 MORE NET LOSS COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02/21/2013 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735>>-2939) GIFTS PART 8 If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. 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 informaticn, 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 1DONOR 2 RECIPIENT FILER spouse DEPENDENT CHILD 3 DESCRIPTION OF GIFT NAME AND ADDRESS DONOR RECIPIENT FILER SPOUSE DEPENDENT CHILD DESCRIPTION OF GIFT NAME AND ADDRESS DONOR RECIPIENT FILER El SPOUSE CI DEPENDENT CHILD DESCRIPTION OF GIFT COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02/21/2013 Texas Ethics Commission P.O. Box 12070 Austin,Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989} TRUST INCOME If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. PART 9 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. 1 SOURCE NAME OF TRUST 2 BENEFICIARY 3 INCOME FILER LESS THAN $5.000 El El MORE SPOUSE DEPENDENT CHILD 4 ASSETS FROM WHICH OVER $500 WAS RECEIVED El UNKNOWN SOURCE NAME OF TRUST BENEFICIARY INCOME LESS THAN $5.000 MORE SPOUSE DEPENDENT CHILD ASSETS FROM WHICH OVER $500 WAS RECEIVED El UNKNOWN SOURCE 4-- NAME OF TRUST BENEFICIARY FILER lj SPOUSE DEPENDENT CHILD INCOME THAN $5,000 MORE ASSETS FROM WHICH OVER $500 WAS RECEIVED UNKNOWN COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02/21/2013 Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2939} BLIND TRUSTS PART 10A If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. Identify each blind trust that complies with section 572.023(c) of the Government Code. 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 2 NAME AND ADDRESS TRUSTEE 3 BE ICIAR FILER SPOUSE El DEPENDENT CHILD 4 FAIR MARKET VALUE LESS THAN $5,000 MORE 5 DATE CREATED NAME OF TRUST NAME AND ADDRESS TRUSTEE ENEFICIARY FILER SPOUSE DEPENDENT CHILD FAIR MARKET VALUE LESS THAN $5.000 MORE DATE CREATED NAME OF TRUST NAME AND ADDRESS TRUSTEE BENEFICIARY |:Il FILER SPOUSE DEPENDENT CHILD FAIR MARKET VALUE LESS THAN $5.000 MORE DATE CREATED COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY ReViSed 02/21/2013 Texas Ethics Commission P.0. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) TRUSTEE PART10B If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. An individual who is required to identify a blind trust on Part 10A of the Personal Financial Statement must submit a statement signed by the trustee of each blind trust listed on Part 10A. The portions of section 572.023 of the Government Code that relate to blind trusts are listed below. 1 NAME OF TRUST 2 TRUSTEE NAME 3 FILER ON WHOSE BEHALF STATEMENT IS BEING FILED 4 TRUSTEE STATEMENT Trustee Signature 572.023. Contents of Financial Statement In General The account of financial activity consists of: (8) identification of the source and the category of the amount of all income received as beneficiary of a trust, other than a blind trust that complies with Subsection and identification of each trust asset, if known to the beneficiary, from which income was received by the beneficiary in excess of $500; (14) identification of each blind trust that complies with Subsection including: (A) the category of the fair market value of the trust; (B) the date the trust was created; (C) the name and address of the trustee; and (D) a statement signed by the trustee, under penalty of perjury stating that: the trustee has not revealed any information to the individual, except information that may be disclosed under Subdivision and (ii) to the best of the trustee's knowledge, the trust complies with this section. For purposes of Subsections and (14), a blind trust is a trust as to which: (1) the trustee: (A) is a disinterested party; (B) is not the individual; (C) is not required to register as a lobbyist under Chapter 305; (D) is not a public officer or public employee; and (E) was not appointed to public office by the individual or by a public officer or public employee the individual supervises; and (2) the trustee has complete discretion to manage the trust, including the power to dispose of and acquire trust assets without consulting or notifying the individual. If a blind trust under Subsection is revoked while the individual is subject to this subchapter, the individual must file an amendment to the individual's most recent financial statement, disclosing the date of revocation and the previously unreported value by category of each asset and the income derived from each asset. ReViSed 02'-2112013 Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) ASSETS OF BUSINESSASSOCIATIONS PART 11A If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. Describe all assets of each corporation. firm. partnership. limited partnership, limited liability partnership, professional corporation. professional association, joint venture. or other business association in which you, your spouse. or a depen- dent child held, acquired. or sold 50 percent or more of the outstanding ownership and indicate the category of the amount of the assets. 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 BUSINESS ASSOCIATION 2 BUSINESS TYPE 3 FILER OR SOLD BY SPOUSE CHILD CATEGORY LESS THAN $5.000 4 ASSETS DESCRIPTION MORE LESS THAN $5.000 MORE LESS THAN $5.000 El MORE LESS THAN $5.000 |:|LEss THAN $5.000 MORE LESS THAN $5,000 El MORE LESS THAN $5.000 MORE |:lLEss THAN $5.000 MORE --T-- COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02/21/2013 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 LIABILITIES OF BUSINESSASSOCIATIONS If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. (512) 463-5800 (TDD 1-800-735-2989) PART 11B Describe all liabilities of each corporation, firm, partnership, limited partnership, limited liability partnership, professional corporation, professional association, joint venture, or other business association in which you, your spouse, or a depen- dent child held, acquired, or sold 50 percent or more of the outstanding ownership and indicate the category of the amount of the assets. 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 BUSINESS ASSOCIATION 2 BUSINESS TYPE NAME AND ADDRESS (Check If Filer's Home Address) 3 HELD, ACQUIRED, OR SOLD BY FILER spouse El DEPENDENT CHILD 4 LIABILITIES DESCRIPTION CATEGORY Less THAN $5,000 LESS THAN $5,000 El El Less THAN $5,000 El Less THAN $5,000 El LESS THAN $5.000 El LESS THAN $5.000 El Less THAN $5.000 LESS THAN $5.000 $25,000--on MORE MORE MORE MORE CI $25,000--on MORE MORE MORE MORE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02/21/2013 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) BOARDS AND EXECUTIVE POSITIONS PART 12 If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. List all boards of directors of which you, your spouse, or a dependent child are a member and all executive positions you, your spouse, or a dependent child hold in corporations, firms, partnerships, limited partnerships, limited liability partner- ships, professional corporations, professional associations, joint ventures, other business associations, or proprietorships, stating the name of the organization and the position held. For more information, see FORM 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 ORGANIZATION 2 POSITION HELD 3 POSITION HELD BY SPOUSE DEPENDENT CHILD II ORGANIZATION POSITION HELD POSITION HELD BY FILER El SPOUSE DEPENDENT CHILD ORGANIZATION POSITION HELD POSITION HELD BY FILER SPOUSE DEPENDENT CHILD ORGANIZATION POSITION HELD POSITION HELD BY FILER El SPOUSE El DEPENDENT CHILD I -- 1' ORGANIZATION POSITION HELD POSITION HELD BY FILER SPOUSE DEPENDENT CHILD COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02l21I2013 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2939) EXPENSES ACCEPTED UNDER HONORARIUM EXCEPTION PART 13 If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. Identify any person who provided you with necessary transportation, meals, or lodging, as permitted under section 36.07(b) of the Penal Code, in connection with a conference or similar event in which you rendered services, such as addressing an audience or participating in a seminar, that were more than perfunctory Also provide the amount of the expenditures on transportation, meals, or lodging. You are not required to include items you have already reported as political contributions on a campaign finance report, or expenditures required to be reported by a lobbyist under the lobby law (chapter 305 of the Government Code). For more information, see FORM PFS--INSTRUCTION GUIDE. NAME AND ADDRESS 1 PROVIDER 2 AMOUNT NAME AND ADDRESS PROVIDER AMOUNT NAME AND ADDRESS PROVIDER AMOUNT NAME AND ADDRESS PROVIDER AMOUNT COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02l21l20'|3 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (T DD 1-800-735-2989) INTEREST IN BUSINESS IN COMMON WITH LOBBYIST PART 14 If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. Identify each corporation, firm, partnership, limited partnership, limited liability partnership, professional corporation, profes- sional association, joint venture, or other business association, other than a publicly-held corporation, in which you, your spouse, or a dependent child, and a person registered as a lobbyist under chapter 305 of the Government Code that both have an interest. For more information, see FORM PFS--INSTRUCTION GUIDE. 1 NAME AND ADDRESS BUSINESS ENTITY 2 INTEREST HELD BY FILER SPOUSE DEPENDENT CHILD NAME AND ADDRESS BUSINESS ENTITY INTEREST HELD BY FILER SPOUSE DEPENDENT CHILD -- -7 NAME AND ADDRESS BUSINESS ENTITY INTEREST HELD BY FILER SPOUSE CI DEPENDENT CHILD NAME AND ADDRESS INTEREST HELD BY FILER El SPOUSE DEPENDENT CHILD NAME AND ADDRESS INTEREST HELD BY FILER El SPOUSE DEPENDENT CHILD COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 0212112013 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 DD 1-800-735-2989) FEES RECEIVED FOR SERVICES RENDERED PART15 TO A LOBBYIST OR EMPLOYER If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. Report any fee you received for providing services to or on behalf of a person required to be registered as a lobbyist under chapter 305 of the Government Code, or for providing services to or on behalf of a person you actually know directly compen- sates or reimburses a person required to be registered as a lobbyist. Report the name of each person or entity for which the services were provided, and indicate the category of the amount of each fee. For more information, see FORM PFS-- INSTRUCTION GUIDE. 1 PERSON OR ENTITY FOR WHOM SERVICES WERE PROVIDED 2 FEE CATEGORY |j LESS THAN $5,000 MORE mm PERSON OR ENTITY FOR WHOM SERVICES WERE PROVIDED FEE CATEGORY LESS THAN $5,000 MORE :2 mm' PERSON OR ENTITY FOR WHOM SERVICES WERE PROVIDED FEE CATEGORY |j LESS THAN $5.000 MORE PERSON OR ENTITY FOR WHOM SERVICES WERE PROVIDED FEE CATEGORY LESS THAN $5,000 MORE PERSON OR ENTITY FOR WHOM SERVICES WERE PROVIDED FEE CATEGORY El LESS THAN $5,000 El MORE PERSON OR ENTITY FOR WHOM SERVICES WERE PROVIDED FEE CATEGORY LESS THAN $5.000 MORE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (T DD 1-800-735-2989) REPRESENTATION BY LEGISLATOR BEFORE PART 15 STATE AGENCY If the requested information is not applicable, indicate that On Page 2 of the Cover Sheet. This section applies only to members of the Texas Legislature. Amember Of theTexas Legislature who represents a person for compensation before a state agency in the executive branch must provide the name Of the agency. the name of the person represented, and the category of the amount of the fee received for the representation. For more information. see FORM PFS--INSTRUCTION GUIDE. Note: Beginning September 1. 2003. legislators may not. for compensation. represent another person before a state agency in the executive branch. The prohibition does not apply if: (1) the representation is pursuant to an attorney/client relationship in a criminal law matter; (2) the representation involves the filing Of documents that involve only ministerial acts On the part of the agency; or (3) the representation is in regard to a matter for which the legislator was hired before September 1. 2003. STATE AGENCY PERSON REPRESENTED FEE CATEGORY LESS THAN $5.000 El MORE STATE AGENCY PERSON REPRESENTED FEE CATEGORY LESS THAN $5.000 |j MORE STATE AGENCY PERSON REPRESENTED FEE CATEGORY LESS THAN $5.000 MORE STATE AGENCY PERSON REPRESENTED FEE CATEGORY LESS THAN $5,000 El MORE COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) BENEFITS DERIVED FROM FUNCTIONS HONORING PART 17 PUBLIC SERVANT If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. Section 36.10 of the Penal Code provides that the gift prohibitions set out in section 36.08 of the Penal Code do not apply to a benefit derived from a function in honor or appreciation of a public servant required to file a statement under chapter 257 of the Government Code or title 15 of the Election Code if the benefit and the source of any benefit over $50 in value are: 1) reported in the statement and 2) the benefit is used solely to defray expenses that accrue in the performance of duties or activities in connection with the office which are nonreimbursable by the state or a political subdivision. If such a benefit is received and is not reported by the public servant under title 15 of the Election Code, the benefit is reportable here. For more information, see FORM PFS--INSTRUCTION GUIDE. NAME AND ADDRESS 1 SOURCE OF BENEFIT 2 BENEFIT A NAME AND ADDRESS SOURCE OF BENEFIT BENEFIT NAME AND ADDRESS SOURCE OF BENEFIT BENEFIT -mini NAME AND ADDRESS SOURCE OF BENEFIT BENEFIT COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02/21/2013 Texas Ethics Commission .0. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 DD 1-B00-7352939) LEGISLATIVE CONTINUANCES PART 18 If the requested information is not applicable, indicate that on Page 2 of the Cover Sheet. Identify any legislative continuance that you have applied for or obtained under section 30.003 of the Civil Practice and Remedies Code, or under another law or rule that requires or permits a court to grant continuances on the grounds that an attorney for a party is a member or member-elect of the legislature. NAME OF PARTY REPRESENTED DATE RETAINED STYLE, CAUSE NUMBER, COURTS: JURISDICTION DATE OF CONTINUANCE APPLICATION WAS CONTINUANCE El YES No NAME OF PARTY REPRESENTED DATE RETAINED STYLE, CAUSE NUMBER, COURT, 8: JURISDICTION DATE OF CONTINUANCE APPLICATION WAS CONTINUANCE El YES NO COPY AND ATTACH ADDITIONAL PAGES AS NECESSARY Revised 02/21/2013 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989] PERSONAL FINANCIAL STATEMENT AFFIDAVIT The law requires the personal financial statement to be verified. The verification page must have the signature of the individual required to file the personal financial statement, as well as the signature and stamp or seal of office of a notary public or other person authorized by law to administer oaths and affirmations. Without proper verification, the statement is not considered filed. I swear, or affirm, under penalty of perjury, that this financial statement covers calendar year ending December 31, 2012, and is true and correct and includes all information . uired to be reported by me under chapter 572 of the Governmen e. - Signature of Eiler - STATE OF TEXAS My Comm. Exp. Apt 13- 2015 Sworrm andsupscribed before me' by the said . this the K54 day of 20 . to certify which. witness my hand and seal of office. O/lat, Signature of officer ath Print name of officer administering oath Title of officer administering oath Revised 02/21/2013