FORM C/OH it CAMPAIGN FINANCE REPORT COVER SHEET PG 1 J~ 3 CANDIDATE/ MS/MRS/MR FIRST Ml ::; OFFICE USE ONLY OFFICEHOLDER

Transcription

1 \:b CANIATE/ FICEHOLER FORM C/OH it CAMPAIGN FINANCE REPORT COVER SHEET PG 1 J~,, ) Filer I (Ethics Commission Filers) 2 Total pages filed: The C/OH Instruction Guide explains how to complete this form. ~J 3 CANIATE/ MS/MRS/MR FIRST Ml ::; FICE USE ONLY FICEHOLER I~ NAME _Adolphus. ate Received.. NICKNAME LAST SUFFIX Anderson 4 CANIATE/ ARESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP COE FICEHOLER MAILING ARESS Change of Address 5504 Village Lane Austin, Texas ~ 5 CANIATE/ AREA COE PHONE NUMBER EXTENSION FICEHOLER PHONE ( 512 ) ate Hand-delivered or ate Postmarked 6 CAMPAIGN MS/MRS/MR FIRST Ml Receipt # TREASURER NAME Elena NICKNAME LAST SUFFIX Taylor ate Processed ate Imaged I Amount$ 7 CAMPAIGN STREET ARESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP COE TREASURER ARESS (Residence or Business) 3014 W. William Cannon #1922 Austin, Texas CAMPAIGN AREA COE PHONE NUMBER EXTENSION TREASURER PHONE ( 512 ) REPORT TYPE O January 15 IX] 30th day before electlon Runoff o Ju1y15 8th day before election Exceeded $500 limit 15th day after campaign treasurer appointment (Officeholder Only) Final Report (Attach C/OH - FR) 10 PERIO Month ay Year Month ay Year COVERE 7 / 25/ 2016 THROUGH 10 / 31 / ELECTION ELECTION ATE ELECTION TYPE Month ay Year 0 Primary 11/ 8 / 2016 OC] General Runoff Other escription Special 12 FICE FICE HEL (if any) 13 FICE SOUGHT (!f known) AIS Trustee, istrict 2 GO TO PAGE 2 Forms provided by Texas Ethics Commission Revised 9/8/2015

2 CANIATE/ FICEHOLER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 2 14 C/OH NAME I 15 Adolphus Anderson Filer I {Ethics Commission Filers) 16 NOTICE FROM THIS BOX IS FOR NOTICE POLITICAL CONTRIBUTIONS ACCEPTE OR POLITICAL EXPENITURES MAE BY POLITICAL COMMITIEES TO POLITICAL SUPPORT THE CANIATE/ FICEHOLER. THESE EXPENITURES MAY HAVE BEEN MAE WITHOUT THE CANIATE'S OR FICEHOLER :S, COMMITIEE(S) KNOWLEGE OR CONSENT. CANIATES AN FICEHOLERS ARE REQUIRE TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE SUCH EXPENITURES. COMMITTEE TYPE COMMITTEE NAME 0GENERAL OsPECIFIC COMMITTEE ARESS Additional Pages COMMITTEE COMMITTEE CAMPAIGN TREASURER NAME CAMPAIGN TREASURER ARESS 17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS $50 OR LESS (OTHER THAN TOTALS PLEGES, LOANS, OR GUARANTEES LOANS), UNLESS ITEMIZE $ 0 2, TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEGES, LOANS, OR GUARANTEES LOANS) $ 0 EXPENITURE TOTALS 3. TOTAL POLITICAL EXPENITURES $100 OR LESS, $ UNLESS ITEMIZE 0 4. TOTAL POLITICAL EXPENITURES $ CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINE AS THE LAST AY BALANCE REPORTING PERIO $ OUTSTANING 6. TOTAL PRINCIPAL AMOUNT ALL OUTSTANING LOANS AS THE LOAN TOTALS LAST AY THE REPORTING PERIO $ 18 AFFIAVIT 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 Adolphus "Andy" Anderson igitally signed by Adolphus "Andy' Ander,on fl:<n~adolphu, "Andy" Ander<on, o, OlJ, ..adolphu ~ ustln.rr.,om, c--us ate:1016.1l,0213:11:27-05'00' Signature of Candidate or Officeholder AFFIX NOTARY STAMP/ SEALABOVE 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 Forms provided by Texas Ethics Commission Revised 9/8/2015

3 SUBTOTALS - C/OH FORM C/OH COVER SHEET PG 3 19 FILER NAME 20 Filer I (Ethics Commission Filers) Adolphus Anderson 21 SCHEULE SUBTOTALS SUBTOTAL NAME SCHEULE AMOUNT 1. SCHEULEA1: MONETARY POLITICAL CONTRIBUTIONS $ SCHEULE A2: NON-MONETARY (IN-KIN) POLITICAL CONTRIBUTIONS $ SCHEULE B: PLEGE CONTRIBUTIONS $ 4. SCHEULE E: LOANS $ 5. SCHEULE F1: POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS $ 6. SCHEULE F2: UNPAI INCURRE OBLIGATIONS $ SCHEULE F3: PURCHASE INVESTMENTS MAE FROM POLITICAL CONTRIBUTIONS $ SCHEULE F4: EXPENITURES MAE BY CREIT CAR $ 9. IKJ SCHEULE G: POLITICAL EXPENITURES MAE FROM PERSONAL FUNS $ SCHEULE H: PAYMENT MAE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS C/OH $ 11. SCHEULE I: NON-POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS $ 12. SCHEULE K: INTEREST, CREITS, GAINS, REFUNS, AN CONTRIBUTIONS $ RETURNE TO FILER Forms prov1ded by Texas Ethics Commfss1on Revised 9/8/2015

4 MONETARY POLITICAL CONTRIBUTIONS SCHEULE A1 The Instruction Gulde explains how to complete this form. 1 Total pages Schedule A1: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 ate 5 Full name of contributor out-of-state PAC (l#: I 7 Amount of contribution ($) 6 Contributor address; City; state; Zip Code 8 Principal occupation/ Job title (See Instructions) 9 Employer (See Instructions) ate Full name of contributor 0 out-of-state PAC {I#: I Amount of contribution ($) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) ate Full name of contributor out-of-state PAC (I#: I Amount of contribution ($) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) ate Full name of contributor oul-of-state PAC (I#: I Amount of contribution ($) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission Revised 9/8/2015

5 NON-MONETARY (IN-KIN) POLITICAL CONTRIBUTIONS SCHEULE A2 The Instruction Guide explains how to complete this form. 1 Total pages Schedule A2: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 TOTAL UNITEMIZE IN-KIN POLITICAL CONTRIBUTIONS $ 5 ate 6 Full name of contributor out-of-state PAC {I#:, B Amount of 9 In-kind contribution Contribution $ description 7 Contributor address; City; State; Zip Code Ocheck if travel outside of Texas. Complete Schedule T. 10 Principal occupation / Job title (FOR NON-JUICIAL) (See Instructions) 11 Employer (FOR NON-JUICIAL)(See Instructions) 12 Contributor's principal occupation (FOR JUICIAL) 13 Contributor's job title (FOR JUICIAL) (See Instructions) 14 Contributor's employer/law firm (FOR JUICIAL) 15 Law firm of contributor's spouse (if any) (FOR JUICIAL) 16 If contributor ls a child, law firm of parent{s) (if any) (FOR JUICIAL) ate Full name of contributor 0 out-oi-slale PAC (I#: l Amount of In-kind contribution Contribution $ description Contributor address; City; State; Zip Code Ocheck if travel outside of Texas. Complete Schedule T. Principal occupation/ Job title {FOR NON-JUICIAL) (See Instructions) Employer (FOR NON-JUICIAL)(See Instructions) Contributor's principal occupation (FOR JUICIAL) Contributor's job title (FOR JUICIAL) (See Instructions) Contributor's employer/law firm (FOR JUICIAL) Law firm of contributor's spouse (if any) (FOR JUICIAL) If contributor Is a child, law firm of parent(s) (if any) (FOR JUICIAL) ATIACH AITIONAL COPIES THIS SCHEULE AS NEEE If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements. Forms provided bytexas Ethics Commission Revised 9/8/2015

6 PLEGE CONTRIBUTIONS SCHEULE B The Instruction Guide explains how to complete this form. 1 Total pages Schedule B: 2 FILER NAME 3 Filer I {Ethics Commission Filers) 4 TOTAL UNITEMIZE PLEGES $ 5 ate 6 Full name of pledgor out-of-state PAC (I#: ) 8 Amount.9 In-kind contribution of Pledge$ description 7 Pledger address; City; State; Zip Code 10 Principal occupation/ Job title (See Instructions) I 11 Employer (See Instructions) 0 Check if travel outside of Texas. Complete Schedule T. ate Full name of pledger 0 out-of-state PAC (I#: ) Amount In-kind contribution of Pledge$ description Pledger address; City; State; Zip Code Principal occupation / Job title (See Instructions) ate I Employer (See Instructions) 0 Check if travel outside of Texas. Complete Schedule T. Full name of pledger out-of-state PAC (I#: ) Amount of In-kind contribution Pledge$ description Pledger address; City; State; Zip Code 0 Check if travel outside of Texas. Complete Schedule T. Principal occupation / Job title (See Instructions) I Employer (See Instructions) ate Full name of pledger 0 out-of-slate PAC (I#: ' Amount of In-kind contribution Pledge$ description Pledger address; City; State; Zip Code Principal occupation / Job title {See Instructions) I Employer (See Instructions) Ocheck II travel outsid e of Texas. Complete Schedule T. ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE If contributor Is out-of-state PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Comm1ss1on Revised 9/8/2015

7 LOANS SCHEULE E The Instruction Gulde explains how to complete this form. 1 Total pages Schedule E: 2 FILER NAME 3 Filer 1 {Ethics Commission Filers) 4 TOTAL UNITEMIZE LOANS $ 5 ate of loan 7 Name of lender 0 out-of-state PAC {10ft: I 9 Loan Amount($) 6 Is lender a flnancial 8 Lender address; City; State; Zip Code Institution? y N 10 Interest rate 11 Maturity date 12 Principal occupation / Job title (See Instructions) 13 Employer (See Instructions) 14 escription of Collateral 15 Check If personal funds were deposited into politlcal account (See Instructions) none 16 GUARANTOR 17 Name of guarantor 19 Amount Guaranteed ($) INFORMATION 0 not applicable 18 Guarantor address; City; State; Zip Code 20 Principal Occupation (See Instructions) 21 Employer (See Instructions) ate of loan Name of lender 0 out-of-state PAC (I#: I Loan Amount($) Is lender Lender address; City; State; Zip Code a financial Institution? y N Interest rate Maturity date Pr!ncipal occupation I Job title (See Instructions) Employer (See Instructions) escription of Collateral none Check if personal funds were deposited into political account {See Instructions) GUARANTOR Name of guarantor Amount Guaranteed{$) INFORMATION Guarantor address; City; State; Zip Code 0 not applicable Principal Occupation (See Instructions) Employer (See Instructions) ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE If lender is out-of-state PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Comm1ss1on Revised 9/8/2015

8 POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS SCHEULE F1 EXPENITURE CATEGORIES FOR BOX S(a) Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense Accounting/Banking Fees Office overhead/rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel ln islrict Contributions/onations Made By GitvAwards/Memorials Expense Printing Expense Travel Out Of istrict Candldate/Officeholder/Polllical Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above) Credit Card Payment The Instruction Guide explains how to complete this form. 1 Total pages Schedule F1: 2 FILER NAME 13 Filer I (Ethics Commission Fliers) 4 ate 5 6 Amount ($) 7 Payee address; City; State; Zip Code 8 (a) Category (See Categories listed at the top of this schedule) (b) escription 0 Check if travel outside of Texas. Complete ScheduleT. 0 Check!I Austin, TX, oftlceholder living expense EXPENITURE 9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held ate Amount ($) Payee address; City; State; Zip Code Category (See Categories Usted al the top of this schedule) escription 0 Check lf travel outside of Texas. Complete Schedule T. 0 Check If Austin, TX, officeholder llving expense EXPENITURE Complete ONLY if direct Candidate/ Officeholder name Office sought Office held ate Amount ($) Payee address; City; State; Zip Code Category (See Categories listed at the top of this schedule) escription 0 Check if travel outside of Texas. Complete Schedule T. 0 Check if Austin, TX, officeholder llving expense EXPENITURE Complete ONLY if direct Candidate / Officeholder name Office sought Office held ATIACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Revised 9/8/2015

9 UNPAI INCURRE OBLIGATIONS SCHEULE F2 EXPENITURE CATEGORIES FOR BOX 10(a) Advertising Expense Event Expense Loan RepaymenVReimbursement Solicitation/Fundraising Expense Accounting/Banking Fees Otftce Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Po\Ung Expense Travel In istrict Contributions/onations Made By GifVAwards/Memorials Expense Printing Expense Travel Out Of istrict Candldate/Officeho!der/Polilical Committee Legal Services Salaries/Wages/Contract labor Other (enter a category not listed above) The Instruction Gulde explains how to complete this form. 1 Total pages Schedule F2: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 TOTAL UNITEMIZE UNPAI INCURRE OBLIGATIONS $ 5 ate 6 7 Amount {$) 8 Payee address; City; State; Zip Code 9 TYPE EXPENITURE Political Non-Political 10 (a) Category (See Categories listed al the top of this schedule) (b) escription 0 Check if travel Otttside oftexas. Complete Schedtt\e T. EXPENITURE Check ti Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate I Officeholder name Office sought Office held ate Amount ($) Payee address; City; State; Zip Code TYPE EXPENITURE Political Non-Political Category (See Categories listed at the lop of lhis schedule) escription 0 Check if travel outside oftexas. Complete Schedule T. 0 Check if Austin, TX, officeholder living expense EXPENITURE Complete ONLY If direct Candidate / Officeholder name Office sought Office held expenditure to benelit G/OH ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Revised 9/8/2015

10 PURCHASE INVESTMENTS MAE FROM POLITICAL CONTRIBUTIONS SCHEULE F3 The Instruction Guide explains how to complete this form. 1 Total pages Schedule F3: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 ate 5 Name of person from whom investment is purchased 6 Address of person from whom investment is purchased; City; State; Zip Code 7 escription of investment 8 Amount of investment ($) ate Name of person from whom investment is purchased Address of person from whom investment is purchased; City; State; Zip Code escription of investment Amount of investment ($) ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Revised 9/8/2015

11 EXPENITURES MAE BY CREIT CAR SCHEULE F4 EXPENITURE CATEGORIES FOR BOX 10(a) Advertising Expense Event Expense Loan Repayment/Reimbursement Sollcitation/Fundraising Expense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Pollfng Expense Travel In istrict Gontribulions/onatlons Made By GlfVAwards/Memorials Expense Prinling Expense Travel Out Of istrict Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above) The Instruction Guide explains how to complete this form. 1 Total pages Schedule F4: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 TOTAL UNITEMIZE EXPENITURES CHARGE TOA CREIT CAR $ 5 ate 6 7 Amount ($) 8 Payee address; City; State; Zip Code 9 TYPE EXPENITURE Political Non-Political 10 (a) Category (See Categories listed at the top of this schedule) (b) escription Check if travel outside of Texas. Complete Schedule T. EXPENITURE Check lf Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held ate Amount ($) Payee address; City; State; Zip Code TYPE EXPENITURE Political Non-Political Category (See Categories listed al the lop of this schedule) escription Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, offjceholder living expense EXPENITURE Complete ONLY if direct Candidate / Officeholder name Office sought Office held ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Revised 9/8/2015

12 POLITICAL EXPENITURES MAE FROM PERSONAL FUNS SCHEULE G EXPENITURE CATEGORIES FOR BOX 8{a) Advertising Expense Event Expense Loan RepaymenVRelmbursement So1icitation/Fundralsing Expense Accounting/Banking FeM Office overhead/rental Expense Transportation Equipment & Related Expense consulting Expense Food/Beverage Expense PolHng Expense Travel In istrict Contributions/onations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out or istrict Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above) Credit Card Payment The Instruction Guide explains how to complete this form. 1 Total pages Schedule G: 2 FILER NAME I 3 Filer I (Ethics Commission filers) Adolohus Anderson 4 ate 5 8/30/2016 Super Cheap Signs 6 Amount {$) 7 Payee address; City; State; Zip Code Reimbursementfrom 9200 Waterford Center Blvd. Suite 100 Austin, Texas political contributions intended 8 (a) Category (See Categories listed at the top of this schedule) (b) escription 0 Check if travel outside o!texas. Complete Schedule T. EXPENITURE Printing Expense 0 Check if Austin, TX, officeholder living expense 9 Complete ONLY ii direct Candidate / Officeholder name Office sought Office held ate Amount ($) Payee address; City; State; Zip Code Reimbursementfrom political contributions Intended Category (See Categories listed at the top of this schedule) (b) escription 0 Check if travel oulslde o!texas. Complete Schedule T. EXPENITURE 0 Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held ate Amount ($) Payee address; City; State; Zip Code Reimbursement from political contributions intended Category (See Calegorles listed al the top of this schedule} (b) escription Check if travel outside of Texas. Complete Schedule T. EXPENITURE 0 Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held ATIACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Comm1ss1on Revised 9/8/2015

13 PAYMENT MAE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS C/OH SCHEULE H EXPENITURE CATEGORIES FOR BOX S(a) Advertising Expense Event Expense Loan RepaymenVReimbursement Sol!cltat!on/Fundrals!ng Expense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In istrict Contributions/onations Made By GlfVAwardS/Memorials Expense Printing Expense Travel Out Of islricl Candldate/Offlceholder/Polilical Committee Legal SeN!ces Salaries/Wages/Contract Labor Other (enter a category not listed above) Credit Card Payment The Instruction Guide explains how to complete this form, 1 Tolal pages Schedule H: 2 FILER NAME l 3 Filer I (Ethics Commission Filers) 4 ate 5 Business name 6 Amount{$) 7 Business address; City; State; Zip Code 8 (a) Category {See Categories listed at the lop of this schedule) (b) escription Check if travel outside oftexas. Complete Schedule T. EXPENITURE Check if Austin, TX, officeholder living expense 9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held ate Business name Amount ($) Business address; City; State; Zip Code Category (See Categories llsted at the top o! this schedule) escription Check if travel outside oftexas. Comptete Schedule T. Check if Austin, TX, oft!ceholder living expense EXPENITURE Complete ONLY if direct Candidate / Officeholder name Office sought Office held ate Business name Amount ($) Business address; City; State; Zip Code Category (See Categories llsted at the top of this schedule) escription Check if travel outside of Texas. Complete Schedule T. Check If Austin, TX, ofllceholder l!vlng expense EXPENITURE Complete ONLY if direct Candidate / Officeholder name Office sought Office held ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Revised 9/8/2015

14 NON-POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS SCHEULE I The Instruction Guide explains how to complete this form. 1 Total pages Schedule I: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 ate 5 6 Amount ($) 7 Payee address; City; State; Zip Code 8 {a)category (See lnstructlons for examples of acceptable (b) escription (See instructions regarding type of Information categories.) required.) EXPENITURE ate Amount ($) Payee address; City; State; Zip Code EXPENITURE Category (See Instructions for examples of acceptable categories.) escription {See instructions regarding type of information required.) ate Amount ($) Payee address; City; State; Zip Code EXPENITURE Category (See instructions for examples or acceptable categories.) escription (See Instructions regarding type of Information required.) ate Amount ($) Payee address; City; state; Zip Code EXPENITURE Category (See instructions for examples of acceptable categories.) escription {See instructions regarding type of information required.) ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Revised 9/8/2i 5

15 INTEREST, CREITS, GAINS, REFUNS, AN CONTRIBUTIONS RETURNE TO FILER SCHEULE K The Instruction Gulde explains how to complete this form. 1 Total pages Schedule K: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 ate 5 Name of person from whom amount is received 8 Amount($) 6 Address of person from whom amount is received; City; State; Zip Code 7 Purpose for which amount is received Check if political contribution returned to tiler ate Name of person from whom amount is received Amount{$) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received Check if political contribution returned to filer ate Name of person from whom amount is received Amount($) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received Check if political contribution returned to filer ate Name of person from whom amount is received Amount($) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received Check If political contribution returned to filer ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Revised 9/8/2015

16 IN-KIN CONTRIBUTIONS OR POLITICAL EXPENITURES FOR TRAVEL OUTSIE TEXAS SCHEULET The Instruction Guide explains how to complete this form. 1 Total pages Schedule T: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 Name of Contributor I Corporation or Labor Organization/ Pledgor / Payee 5 Contribution / Expenditure reported on: 0 Schedule A2 Oschedule B Schedule B(J) Schedule C2 Schedule 0 Schedule F1 Schedule F2 Schedule F4 Oschedule G Oschedule H Schedule GOH-UC Schedule B-SS 6 ates of travel 7 Name of person(s) traveling 8 eparture city or name of departure location 9 estination city or name of destination location 10 Means of transportation 11 Purpose of travel {including name of conference, seminar, or other event) Name of Contributor/ Corporation or Labor Organization/ Pledgor / Payee Contribution/ Expenditure reported on: 0 Schedule A2 Oschedule B Schedule B(J) 0 Schedule C2 Schedule 0 Schedule F1 Schedule F2 Schedule F4 Oschedule G schedule H 0 Schedule GOH-UC Schedule B-SS ates of travel Name of person(s) traveling eparture city or name of departure location estination city or name of destination location Means of transportation Purpose of travel (including name of conference, seminar, or other event) Name of Contributor/ Corporation or Labor Organization/ Pledgor I Payee Contribution/ Expenditure reported on: Schedule A2 schedule B Schedule B(J) Schedule C2 Schedule Schedule F1 Schedule F2 0 Schedule F4 Oschedule G Schedule H Schedule GOH-UC Schedule B-SS ates of travel Name of person(s) traveling eparture city or name of departure location estination city or name of destination location Means of transportation Purpose of travel (including name of conference, seminar, or other event) ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Revised 9/8/2015

17 CANIATE/ FICEHOLER REPORT: ESIGNATION FINAL REPORT FORM C/OH - FR The Instruction Guide explains how to complete this form. Complete only if "Report Type" on page 1 is marked "Final Report'' 1 C/OHNAME 2 Fifer I {Ethics Commission Filers) 3 SIGNATURE Adolphus Anderson I do not expect any further political contributions or political expenditures in connection with my candidacy. I understand that designating a report as a final report terminates my campaign treasurer appointment. I also understand that I may not accept any campaign contributions or make any campaign expenditures without a campaign treasurer appointment on file.,,.,.,.,,... ~1"""\c+,'-"'""l""'d"" Adolphus "Andy" Anderson.,..._,,.,.,.,,.,.,..,.,.,,,.,,,.,,...,, '"'"""""..,,..,.,,..,.,,_.,,.,.,,,,.,.,.., 1m,1010n~ "'""'-<><W Signature of Candidate I Officeholder 4 FILER WHO IS NOT AN FICEHOLER.. Complete A & B below only if you are not an officeholder... A. CAMPAIGN FUNS Check only one: 00 I do not have unexpended contributions or unexpended interest or income earned from political contributions. I have unexpended contributions or unexpended interest or income earned from political 'Coiltributions. I understand lhat I may not convert unexpended political contributions or unexpended interest or income earned on political contributions to personal use. I also understand that I must file an annual report of unexpended contributions and that I may not retain unexpended contributions or unexpended interest or income earned on politlcal contributions longer than six years after filing this final report. Further, I understand that I must dispose of unexpended political contributions and unexpended interest or income earned on political contributions in accordance with the requirements of Election Code, B. ASSETS Check only one: IX) I do not retain assets purchased with political contributions or interest or other income from political contributions. I do retain assets purchased with political contributions or interest or other income from political contributions. I understand that I may not convert assets purchased with political contributions or interest or other income from political contributions to personal use. I also understand that I must dispose of assets purchased with political contributions in accordance with the requirements of Election Code, O)gttally,l9ned by Adolphus '/lody' AOO,,.on Adolphus "Andy" Anderson :~:;:::t~;;:~,,~!~f 0"' a!e;20l lc17;01--05'00' Signature of Candidate 5 FICEHOLER.. Complete this section only if you are an officeholder.. I am aware that I remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer on file. I am also aware that I will be required to file reports of unexpended contributions if, after filing the last required report as an officeholder, I retain political contributions, interest or other income from political contributions, or assets purchased with political contributions or interest or other income from political contributions. Signature of Officeholder Forms provided by Texas Ethics Commission Revised 9/8/2015