Filer 10 (E thi cs Commission Filers) Total pages filed: The C/OH Instruction Guide explains how to complete this form. Koh-er+o ...
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1 ,. CANIATE I FICEHOLER CAMPAIGN FINANCE REPORT FORM C /OH COVER SHEET PG 1 1 Filer 1 (E thi cs Commission Filers) 2 Total pages filed: The C/OH Instruction Guide explains how to complete this form. 3 CANIATE / FICEHOLER NAME MS I MRS I MR FIRST J)}r Mt Koh-er+o NICKNAME.. FICE USE ONLY.. ate Received(.".) SUFFIX LAST ARESS I PO BOX; APT I SU ITE #; l ;'l STATE; CITY; ZI P COE PHONE NUMBER 6 CAMPAIGN TREASURER NAME MS I MRS I MR '. - ;-:; EXTENS ION...:1,.;~ ~ 'l J!'-..),. FIRST rj..s. Receipt # Ml C / Otuo!J ' Cj. V.... Amount $ I ate Processed SU FFIX LAST ate Imaged b~/j, CAMPAIGN TREASURER ARESS ~)..:t:: ate H and de li v W~-~ or C11lQ Postmarked NICKNAME 7 :-;1 :.::: t:y -:; AREA COE.,:7 (.) 5 CANIATE/ FICEHOLER PHONE :a - :; ; ~ Ch a nge of Address -:.-- :::~ --~,.,._. f ' -1' FICEHOLER MAILING ARESS so-- - :: <:n oajj, 4 CANIATE / r-.) =- t STREET ARESS (NO PO BOX PLEASE); APT I SUITE #; CITY; STATE; ZIP COE ( R es idence or Business) 8 CAMPAIGN TREASURER PHONE 9 REPORT TYPE AREA COE PHONE NUMBER IJ2(January 15 3th day before election Runoff 15th day after campaign treasurer appointment (OIIiceholder On ly) 8th day before election Exceeded $5 limit Final Report (Attach CIOH- FR) July 15 1 PERIO COVERE Month ay ol / oj Month Year / '2.\5 Month ay / / Primary General c;+y + i c.+ 8 Runofl Year 31 / 2\5 Other escription Special 13 FICE HEL (if any) --:::[:) i <S ay ELECTION TYPE Year Lc:veo\o 12. / THROUGH ELECTION ATE 11 ELECTION 12 FICE EXTENSION FICE SOUGHT (if known) Counc.i\ J y GO TO PAGE 2 Forms provided by Texas Ethics Commission us Rev1sed 9/8/2 15
2 , CANIATE I FICEHOLER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 2 14 C /OH NAME Kola erm o~~\~ 15 Filer I (Ethics Commission Filers) 16 NOTICE FROM THIS BOX IS FOR NOTICE POLITICAL CONTRIBUTIONS ACCEPTE OR POLITICAL EXPENITURES MAE BY POLITICAL COMMITTEES TO POLITICAL SUPPORT THE CANIATE / FICEHOLER. THESE EXPENITURES MAY HAVE BEEN MAE WITHOUT THE CANIATE'S OR FICEHOLER'S COMMITTEE(S) KNOWLEGE OR CONSENT. CANIATES AN FICEHOLERS ARE REQUIRE TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE SUCH EXPENITURES. COMM ITTEE TYPE ~ENERAL OsPEC JFJC COMMITTEE NAME I "12-..t.-p A c \ Tex.ru 'Assad o. -hov) ot \2-.-eCI \1-ov s -:po\ ~ -h ca.\ ~ c.-+1 o VI Col-v!Ml't\-ee.. COM MITTEE ARESS t'. Q. bo)c.. '2.'l.L\Lo ~u~-hv\, COMMITTEE CAMPAIGN TREASURER NAME \~ \ <Q \to < - LL...4(p Addition al Pages K-cnjq ""b uvv~ l\- \lo..v\ WovYv!-e. r COMM ITTEE CAM PAIGN TREASURER ARE SS t>.o. po 1\ 2.2.-t.\-lp ~us-\. V\ \I) \ t?il.lo - 1-:v-t \o 17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS $5 OR LESS (OTHER THAN TOTALS PLEGES, LOANS, OR GUARANTEES LOANS ), UNLESS ITEMIZE $ 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEGES, LOANS, OR GUARANTEES LOANS) $ I,Ooo.oo EXPENITURE TOTALS 3. TOTAL POL ITICAL EXPENITURES $1 OR LESS, $ UNLESS ITEMIZE 4. TOTAL POLITICAL EXPENITURES $ \lt.l'ol CONTRIBUTION BALANCE 5. TOTAL PO LITICAL CONTRIBUTIONS MAINTAINE AS THE LAST AY REPORTING PERIO $ ~) 12JS. ~i OUTSTANING 6. TOTAL PRINCIPAL AMOUNT ALL OUTSTANING LOANS AS THE LOAN TOTALS LAST AY THE REPORTING PERIO $ I, 5oo. oo 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 ~-t:.t:jf'~~,~ ANGELITA ACEVES oodect~ ~~~[~ Notary Public. state or Texas \.,:..:~: My Commission Expires 'S>."'Jt" ~ A ~,,,,r;,~,~,,~... pr, \ signature of Candidate or Officeholder AFFIX NOTARY STAMP I SEAL ABOVE Sworn to and subscribed before me, by the said \2-ob.e. V' W b~ \ ~ i, this the t4-hl day of Jb "". \lq ':], 2 I lp, to certify which, witness my hand and seal of office. ~olat".a ~o.~. fl,,~:1\to J\('l_f'VP"" o-kvv) Signatu9e of officer administering oath PrintecTname of officer administering oath Title of officezjdministering oath Forms provided by Texas Ethics Commission us Rev1sed 9/8/215
3 SUBTOTALS - C/OH FORM C/OH COVER SHEET PG 3 19 FILER NAME 2 Filer I (Ethics Commission Filers) 12--obe(+o oet\ L. 21 SCHEULE SUBTOTALS SUBTOTAL NAME SCHEULE AMOUNT 1. ' SCHEULEA1: MONETARY POLITICAL CONTRIBUTIONS $ \1. QQ SCHEULE A2: NON-MONETARY (IN-KIN) POLITICAL CONTRIBUTIONS $ SCHEULE B: PLEGE CONTRIBUTIONS $ SCHEULE E: LOANS $ 5. ' SCHEULE F1: POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS $ 4-\ l\. Co\ 6. SCHEULE F2: UNPAI INCURRE OBLIGATIONS $ SCHEULE F3: PURCHASE INVESTMENTS MAE FROM POLITICAL CONTRIBUTIONS $ SCHEULE F4: EXPENITURES MAE BY CREIT CAR $ SCHEULE G: POLITICAL EXPENITURES MAE FROM PERSONAL FUNS $ SCHEULE H: PAYMENT MAE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS C/OH $ SCHEULE 1: NON-POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS $ 12. SCHEULE K: INTEREST, CREITS, GAINS, REFUNS, AN CONTRIBUTIONS $ RETURNE TO FILER Forms provided by Texas Ethics Commission Revise d 9/8/215
4 MONETARY POLITICAL CONTRIBUTIONS SCHEULE A1 The Instruction Guide explains how to complete this form. 1 Total pages Schedu le A 1: 2 FILER NAME 3 Fi ler I (Ethics Comm ission Filers) 12 olo e v -\-o -n~lli 4 ate 5 Full name of contributor out-of-state PAC (I#: ) 7 Amount of contribution ($) 12-\ 2.1 I 15 Tf\EfAC/TNO.S ~6.SoGiCl hov! ot Reol+ors \J ooo. 6 Contributor address; City; State; Zip Code -:r.o. 'box 22.L\U> p IJ~hV)' T~ I B l(o ~- 224(p 8 Principal occupation I Job title (See Instructions) 9 Employer (See Instructions) \ ate Full name of contributor out-of-state PAC (I#: ) Amount of contribution ($).. Contributor address; City; State; Zip Code Principal occupation I Job title (See Instructions) Employer (See Instructions) ate Full name of contributor out-of-state PAC (I#: ) Amount of contribution ($) Contributor address; City; State; Zip Code Principal occupation I Job title (See Instructions) Employer (See Instructions) ate Full name of contributor out-of-state PAC (I#: ) Amount of contribution ($) Contributor address; C ity; State; Zip Code Principal occupation I 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 Rev1sed 9/8/215
5 POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUT IONS SCHEULE F1 EXPENITURE CATEGORIES FOR BOX 8(a) Adve rtis ing Expe nse 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 In istrict Contributions/onations Made By GifVAwards/Memorials Expense Printing Expense Travel Out Of 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 t o complete this f orm. 13 F il er I (Ethics Commissi on Fi lers) 1 Total pages Schedule F1 : 2 F ILER N A ME K 2 I olo.ev-to o.\\, 4 ate 5 Payee name -=p '(+y Ol \1.\ l5 ~ity 6 Amount ($) 7 Payee address; City; State; Z ip Code j\,1~. 5(p llq~\ SaY\ J)dri o ~ve,. lc;.v-cd.o 1 \'( \BoL\5 8 (a) Category (See Categories listed at the top ol this schedule) (b) escription Check if travel outside of Texas. Complete Schedule T. E v-eva- t. x~e-v\se. Check if Austin, TX, officeholder living expense EXPENITURE bo..:s 9 Complete ONLY if di rect Candidate I Officeholde r na m e O ffice soug ht Office held ate Ol\2o\\5 Payee na m e c.asa C,\r) vis ljvvl M-evc.cuio Amount ($) Pay e e address; C ity; State; Z ip Code -1VF1.lo :r ~ v, O.t~r.) -T L ~v.-cclo 1 T)( \ <-\ Category (See Categories listed at the top of this sched ul e) Eve(/\+ Ex.t'eVlS~ EXPENITURE escri ption Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense.s e-\-to o\ Gup-p\ le_s Complete ONLY if direct Candidate I Officeho lder na m e O ffice soug ht Office h e ld ate \OlOStts Payee name 6 lowoy\ivevse.. Amount ($) Payee address; C ity; State; Z ip Code 4~' () :PC'\{\~ C..,ivG\.e.,vr. I S-\-e. ~ ~V\ove.r-, M' 2\ Ol.(o Category (See Categories listed at the top of this schedule) escription P URPOS E Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX. off iceholder living expense EXPENITURE :E:.veV\t 'Ex? e.v1se.. ':J) e: cor Ct-\-\ CJ V\S Complete ONLY if direct Candidate I O fficeho lder nam e O ffice soug ht O ffice he ld ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Revtsed 9/8/215
6 POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS SCHEULE F1 EXPENITURE CATEGORIES FOR BOX 8(a) Adve rti s ing Expe n s e Event Expense Loan RepaymenVReimbursement Solicitation/Fundraising Expense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & R elated Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In istrict Contributions/onations Made By Giff/Awards/Memorials Expense Printing Expe nse Travel Out Of istrict Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above) Cred it Card Payment The Instruction Guide explains how to complete this form. 1 Total pag es Schedule F1 : 2 FILER NAME'K. 2 aloe v-\-o by\\i 13 Filer I (Ethics Commission Filers) 4 ate 5 Payee name \\2(&,\15 H-E"b 6 Amount ($) 7 Payee address; City; State; Zip Code &t6. B~ 2\ W. :be\ Mo.r '"b\vd.. Loveclo) n 'l<qol\ \ 8 (a) Category (See Categories listed at the top ol this schedule) (b) escription Check il travel outside ol Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense EXPENITURE E\J-eVtt GA?eVlse food }b-eve v4'\]e. Ex -p-ev'l s e 9 Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit CIOH ate \\\o2.\\5 Payee name IbC Amount ($) Payee address ; City; State; Zip Code $l otVl Oevrtav~O L C\,Ye.M) \)( \ Jo'-\ Category (See Categories listed at the top of this schedul e) escription Check if travel outside ol Texas. Complete Schedule T. bo..nk fe_e_, Check if Au stin, TX, olficeholder living expense EXPENITURE Serv, c.e ~r5e Compl ete ONLY if direct Candidate I Officeholder name Office sought Office held ate Payee name Amount ($) Payee address; City; State; Zip Code Category (See Categories listed at the top of this schedule) escription Check if travel outside of Texas. Complete Schedule T. Check if. Austin, TX, olficeholder livi ng expense EXPENITURE Complete ONLY if direct Candidate I Officeholder name Office sought Office held ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission us Revised 9/8/215
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