S/1 / / J CANDIDATE / O F F I C E H O L D E R CAMPAIGN FINANCE R E P O R T FORM C/OH COVER SHEET PG 1 GO TO PAGE 2
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1 CANDDATE / O F F C E H O L D E R CAMPAGN FNANCE R E P O R T FORM C/OH COVER SHEET PG 1 The C/OH nstructon Gude explans how to complete ths form. 1 Fler D (Ethcs Commsson Flers) 2 Total pages fled: 5" 3 CANDDATE/ FCEHOLDER NAME FLRST Date Receved RCE USE ONLY 4 CANDDATE/ FCEHOLDER MALNG ADDRESS ADDRESS / PO BOX; APT / SUTE #; CTY; STATE; ZP CODE Change of Address 5 CANDDATE/ FCEHOLDER PHONE AREA CODE PHONE NUMBER Date Hand-delvered or Date Postmarked 6 CAMPAGN NAME MS / MRS / MR NCKNAME FRST LAST S. Ml ReoelDtW Amount $ Date Processed Date maged 7 CAMPAGN ADDRESS STREET ADDRESS (NO PO BOX PLEASE); APT / SUTE #; GTY; STATE; (Resdence or Busness) 8 CAMPAGN PHONE AREA GODE PHONE NUMBER 9 REPORT TYPE January 15 30th day before electon Runoff July 15 Q sth day before electon Exceeded$500lmt 15th day after campagn ' ' treasurer appontment (Offceholder Only) Fnal Report (Attach G/OH - FR) 10 PEROD COVERED THROUGH 11 ELECTON ELECTON DATE S/1 / / J Prmary [^'"General ELECTON TYPE Runoff O Other Descrpton Specal 12 FCE FCE HELD (f any) 13 FCE SOUGHT (f known) GO TO PAGE 2
2 Texas Ethcs Commsson P.O. Box Austn, Texas (512) (TDD ) CANDDATE / O F F C E H O L D E R S U P P O R T & TOTALS REPORT: FORM C/OH COVER SHEET PG 2 14 C/OH NAME 16 ACCOUNT* (Ethcs Commsson Flers) 16 NOTCE FROM POLTCAL COMMTTEE(S) THS BOX S FOR NOTCE POUTCAL CONTRBUTONS ACCEPTED OR POLTCAL EXPENDTURES VADE BY POLTCAL COMMTTEES TO SUPPORT THE CANDDATE / FCEHOLDER. THESE EXPENDTURES MAY HAVE BEEN MADE WTHOUTTHE CANDDATE'S OR FCEHOLDER'S KNOWLEDGE OR CONSENT. CANDDATES AND FCEHOLDERS ARE REQURED TO REPORT THS NFORMATON ONLY F THEY RECEVE NOTCE SUCH EXPENDTURES. COMMTTEE TYPE COMMTTEE NAME GENERAL COMMTTEE ADDRESS SPECFC COMMTTEE CAMPAGN NAME addtonal pages COMMTTEE CAMPAGN ADDRESS 17 CONTRBUTON TOTALS TOTAL POLTCAL CONTRBUTONS $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS), UNLESS TEMZED TOTAL POLTCAL CONTRBUTONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS) EXPENDTURE TOTALS TOTAL POLTCAL EXPENDTURES $100 OR LESS, UNLESS TEMZED 4. TOTAL POLTCAL EXPENDTURES CONTRBUTON BALANCE OUTSTANDNG LOAN TOTALS TOTAL POLTCAL CONTRBUTONS MANTANED AS THE LAST DAY REPORTNG PEROD TOTAL PRNCPAL AMOUNT ALL OUTSTANDNG LOANS AS THE LAST DAY THE REPORTNG PEROD ^ 30f $ 5/ s^o 18 AFFDAVT swear, or affrm, under penalty of perjury, that the accompanyng report /^%JOm DAVE WARREN l^'vp'*! MY COMMSSON EXPRES JULY 21, 2018 s true and correct and ncludes all nformaton reqjr^to be reported by me under Ttle 15, Electon Code. ^ ^ - ^ / Sgnature of Canddate or Offceholder AFFX NOTARY STAMP / SEALABOVE Sworn to and subscrbed before me, by tte ' day of \ACn U 20 sad tts the to certfy wtch, wtness my hand and seal of offce. Sg nature of offcer admnsterng oath Prnted name of offcer admnsterng oath Ttle of offcer admnsterng oath Revsed 07/28/2014
3 SUBTOTALS - COH FORM c/oh COVER SHEET PG 3 19 FLER NAME J J 20 Fler D (Ethcs Commsson Flers) 21 SCHEDULE SUBTOTALS NAME SCHEDULE SUBTOTAL AMOUNT 1- Q SCHEDULEA1: MONETARY POLTCAL CONTRBUTONS $ 2. Q SCHEDULE A2: NON-MONETARY (N-KND) POLTCAL CONTRBUTONS $ 3. Q SCHEDULE B: PLEDGED CONTRBUTONS $ 4. ~/^ SCHEDULE E: LOANS $ 5- [y]'' SCHEDULE F1: POLTCAL EXPENDTURES FROM POLTCAL CONTRBUTONS $ 6. SCHEDULE F2; UNPAD NCURRED OBLGATONS $ 7. Q SCHEDULE F3: PURCHASE NVESTMENTS FROM POLTCAL CONTRBUTONS $ - Q SCHEDULE G: POUTCAL EXPENDTURES FROM PERSONAL FUNDS $ 9- SCHEDULEH: PAYMENT FROM POLTCAL CONTRBUTONS TO A BUSNESS C/OH $ 10. SCHEDULE!: NON-POLTCAL EXPENDTURES MADE FROM POLTCAL CONTRBUTONS $ ^ f 1 1 SCHEDULE K: NTEREST, CREDTS, GANS, REFUNDS, AND CONTRBUTONS 1 RETURNEDTO FLER $
4 LOANS SCHEDULE E The nstructon Gude explans how to complete ths form. 1 Total pages S^edule E: 3 Fler D (Ethcs Commsson Flers) 4 TOTAL UNTEMZED LOANS $ 5 Date of loan 7 Name of lender D out-of-state PAC (D#: ) 9 Loan Amount ($) 6 s lender a fnancal nsttuton? Y 0 8 Lender address; Cty; State; Zp Code 10 nterest r a t ^ ^ ^ 11 Maturty date 12 Prncpal occupaton / Job ttle (See nstructons) 13 Employer (See nstructons). 14 Descrpton of Collateral 1 1 none 16 GUARANTOR NFORMATON 17 Name of guarantor 15 Check f personal funds were deposted nto poltcal account (See nstructons) 4g.aJ} J^/- OS fa 19 Amount Guaranteed ($) 18 Guarantor address; Cty; State; Zp Code 1 1 not applcable 20 Prncpal Occupaton (See nstructons) 21 Employer (See nstructons) Date of loan Nameof lender H out-of-state PAC (D#: ) Loan Amount ($) s lender a fnancal nsttuton? Y N Lender address; Cty; State; Zp Code nterest rate Maturty date Prncpal occupaton / Job ttle (See nstructons) Employer (See nstructons) Descrpton of Collateral 1 1 none GUARANTOR NFORMATON Name of guarantor Check f personal funds were deposted nto poltcal account (See nstructons) Amount Guaranteed ($) Guarantor address; Cty; State; Zp Code 1 1 not applcable Prncpal Occupaton (See nstructons) Employer (See nstructons) ATTACH ADDTONAL COPES THS SCHEDULE AS NEEDED f lender s out-of-state PAC, please see nstructon gude for addtonal reportng requrements.
5 POLTCAL EXPENDTURES FROM POLTCAL CONTRBUTONS SCHEDULE F1 EXPENDTURE CATEGORES FOR BOX 8(a) Advertsng Expense Event Expense Loan Repayment/Rembursement Solctaton/Fundrasng Expense Accountng/Bankng Fees Offce Ovettead/Rental Expense Transportaton Equpment & Reated Expense Consultng Expense Food/Beverage Expense Pollng Expense Travel n Dstrot Contrbutons/Donatons Made By Gft/Awards/Memo rals Expense Prntng Expense Travel Out Of Dstrct Canddate/Offceholder/Poltcal Commttee Legal Servces SalarlesA/Vages/Contract Labor Otfer (enter a category not lsted above) The nstructon Gude explans how to complete ths form. 1 Total pages Schedule F1: 1 2 FLER NAME f f l X 3 Fler D (Ethcs Commsson Flers) 4 Date ^ 5 Payee name <» 6 Amount ($) 7 Payee address; Cty; State; Zp Code. j 8 (a) Category (See categores lsted at the top of ths schedule) (b) Descrpton EXPENDTURE 1 Check f travel outsde of Texas, complete Schedule T 1 Check f Austn, TX, offceholder lvng expense 9 Complete ONLY f drect Canddate / Offceholder name Offce sought Offce held expendture to beneft C/OH Date Payee name Amount ($) Payee address; Cty; State; Zp Code ll SO Category (See categores lsted at the top of ths schedule) Descrpton EXPENDTURE 1 Check f trave! outsde of Texas, compete Schedule T Check f Austn, TX, offceholder lvng expense 1 / ^ Complete ONLY f drect Canddate / Offceholder name Offce sought Offce held expendture to beneft C/OH Date Payee name Amount ($) Payee address; Cty; State; Zp Code Category {See categores lsted at the top of ths schedule) Descrpton EXPENDTURE 1 Check f travel outsde of Texas, complete Schedule T ' 1 Check f Austn, TX, offceholder lvng expense Complete ONLY f drect Canddate / Offceholder name Offce sought Offce held expendture to beneft C/OH ATTACH ADDTONAL COPES THS SCHEDULE AS NEEDED
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Texas Ethcs Commsson RO. Box 12070 Austn, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989 CANDDATE FCEHOLDER FORM COH CAMPAGN FNANCE REPORT COVER SHEET PG 1 The COH nstructon Gude explans how to complete
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