2/14/2011 THROUGH 4/4/2011
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1 CANDIDATE / OFFICEHOLDER FORM C/OH CAMPAIGN FINANCE REPORT Cover Sheet pg 1 The C/OH Instrution Guide explains how to omplete this form. 3. CANDIDATE / OFFICEHOLDER NAME 1. ACCOUNT # (Ethis Commission filers) MS / MRS / MR FIRST MI Mr Luis D 2. Total Pages Filed: 7 OFFICE USE ONLY Reeived NICKNAME LAST SUFFIX None Sepulveda Sr 4. CANDIDATE / OFFICEHOLDER MAILING ADDRESS Change of Address Address/PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE 515 Goodman Street Dallas TX Hand-delievered or Postmarked 5. CANDIDATE / OFFICEHOLDER PHONE AREA CODE PHONE NUMBER EXTENSION (214) Reeipt # Amount 6. CAMPAIGN TREASURER NAME 7. CAMPAIGN TREASURER ADDRESS (Residene or business) 8. CAMPAIGN TREASURER PHONE MS / MRS / MR FIRST MI Mr Luis D NICKNAME LAST SUFFIX None Sepulveda Sr Proessed Imaged STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE 515 Goodman Street Dallas TX AREA CODE PHONE NUMBER EXTENSION (214) REPORT TYPE 3th Day Before Main Eletion 1. PERIOD COVERED 2/14/211 THROUGH 4/4/ ELECTION ELECTION DATE ELECTION TYPE 5/14/211 General 12. OFFICE OFFICE HELD (if any) 13. OFFICE SOUGHT (if known) Counil Distrit NOTICE OF DIRECT CAMPAIGN BY OTHER INDIVIDUALS ** Diret ampaign expenditures are ampaign expenditures made by others without the andidate's prior onsent or approval Candidates are required to dislose this information only if they reeive notifiation of the diret ampaign expenditure. ** NAME ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE additional pages GO TO PAGE 2
2 CANDIDATE / OFFICEHOLDER REPORT: FORM C/OH SUPPORT & TOTALS COVER SHEET PG 2 15 C/OH NAME 16 ACCOUNT #(Ethis Commission filers) 17 NOTICE FROM POLITICAL COMMITTEE(S) ** This box is for notie of politial ontributions aepted or politial expenditures made by politial ommittees to support the andidate/offieholder. These expenditures may have been made without the andidate's or offieholder's knowledge or onsent. Candidates and offieholders are required to report this information only if they reeive notie of suh expenditures.** COMMITTEE TYPE COMMITTEE NAME additional pages GENERAL COMMITTEE ADDRESS SPECIFIC COMMITTEE CAMPAIGN TREASURER NAME COMMITTEE CAMPAIGN TREASURER ADDRESS 18 CONTRIBUTION TOTALS 1. TOTAL POLITICAL CONTRIBUTIONS OF 5 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED... TOTALS 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) 3. TOTAL POLITICAL S OF 5 OR LESS, UNLESS ITEMIZED TOTAL POLITICAL S CONTRIBUTION BALANCE 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF REPORTING PERIOD... OUTSTANDING LOAN TOTALS 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORTING PERIOD 19 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the aompanying report is true and orret and inludes all information required to be reported by me under Title 15, Eletion ode. AFFIX NOTARY STAMP / SEAL ABOVE ***ELECTRONICALLY CERTIFIED*** Signature of Candidate or Offieholder Sworn to and subsribed before me, by the said, this the 14th day of, April 2, 11 to ertify whih, witness my hand and seal of offie. Signature of offier administering oath Printed name of offier administering oath Title of offier administering oath
3 POLITICAL CONTRIBUTIONS OTHER THAN PLEDGES OR LOANS SCHEDULE A The Instrution Guide explains how to omplete this form 1 Total pages Shedule A: 1 of 3 3 ACCOUNT # (Ethis Commission filers) 4 5 Ms Jessia L Sepulveda No 6 7 3/1/ Goodman Dallas, TX Avo Marzwanian No 321 Fairfield Lane Highland Village, TX /3/ Employeer (See Instrutions) Housewife Vina Marzwanian No 3/3/ Fairfield Lane Highland Village, TX 7577 Sam Almasri No 3/3/ MKinney St Dallas, TX 7524 Isedoro Hurtado No 3/6/ Painter 322 Tres Logos Ln Dallas, TX If ontributor is out-of-state PAC, please see instrution guide for additional reporting requirements.
4 POLITICAL CONTRIBUTIONS OTHER THAN PLEDGES OR LOANS SCHEDULE A The Instrution Guide explains how to omplete this form 1 Total pages Shedule A: 2 of 3 3 ACCOUNT # (Ethis Commission filers) 4 5 Alfonzo Carmona No 6 7 3/6/ Gaston Dallas, TX Alfonzo Carmona No 3/6/ Gaston Dallas, TX Employeer (See Instrutions) Franiso Carmona No 3/6/ Gaston Dallas, TX John M Lozano No 3/15/ Starlight Rd Dallas, TX Beth Villarreal No 3/25/ Constable Pt 5 41 S. Bekley Ave Dallas, TX 7523 If ontributor is out-of-state PAC, please see instrution guide for additional reporting requirements.
5 POLITICAL CONTRIBUTIONS OTHER THAN PLEDGES OR LOANS SCHEDULE A The Instrution Guide explains how to omplete this form 1 Total pages Shedule A: 3 of 3 3 ACCOUNT # (Ethis Commission filers) 4 5 Roman M Gonzalez No 6 7 2/27/ Texas Dr Dallas, TX Employeer (See Instrutions) If ontributor is out-of-state PAC, please see instrution guide for additional reporting requirements.
6 LOANS SCHEDULE E The Instrution Guide explains how to omplete this form 1 Total pages Shedule E: 1 of 1 3 ACCOUNT # (Ethis Commission filers) 4 TOTAL OF UNITEMIZED LOANS: -> -> -> -> -> -> -> -> 5 of loan 6 Is lender a finanial Institution? Y 2/15/211 ON 7 Name of lender out-of-state PAC (ID#: ) 9 Loan Amount () Luis D Sepulveda Sr. None 1. 8 Lender address; City; State; Zip Code 515 Goodman Street Dallas, TX Retired Justie of the Peae 1 Interest rate % 11 Maturity date 14 Desription of Collateral X none 15 GUARANTOR INFORMATION 16 Name of guarantor 18 Amount Guaranteed () X not appliable 17 Guarantor address; City; State; Zip Code 19 Prinipal Oupation 2 Employer of loan Name of lender out-of-state PAC (ID#: ) Loan Amount () Is lender a finanial Institution? Lender address; City; State; Zip Code Interest rate Y N Maturity date Desription of Collateral none GUARANTOR INFORMATION not appliable Name of guarantor Guarantor address; City; State; Zip Code Amount Guaranteed () Prinipal Oupation Employer If lender is out-of-state PAC, please see instrution guide for additional reporting requirements.
7 Texas Ethis Commission P.O. Box 127 Austin, Texas (512) POLITICAL S SCHEDULE F 1 Total pages Shedule F: 3 ACCOUNT # (Ethis Commission Filers) 1 of 1 4 Advertising Expense Aounting/Banking Consulting Expense Event Expense Fees 5 Gift/Awards/Memorials Expense Legal Servies Food/Beverage Expense Polling Expense Printing Expense 3/25/211 Edwards & Patterson Signs CATEGORIES FOR BOX 8(a) Salaries/Wages/Contrat Labor Soliitation/Fundraising Expense Travel In Distrit Travel Out Of Distrit Offie Overhead/Rental Expense The Instrution Guide explains how to omplete this form. Loan Repayment/Reimbursement Transportation Equipment & Related Expense Contributions/Donations Made By Candidate/Offieholder/Politial Committee OTHER (enter a ategory not listed above) 6 Amount () 7 Payee address; City; State; Zip Code 4733 Don Drive Dallas, TX PURPOSE (a) Category (See ategories listed at the top of this shedule) (b) Printing Expense Signs Desription 9 Complete ONLY if diret Candidate / Offieholder name Offie sought Offie held 3/15/211 Dallas County Eletions Amount () Payee address; City; State; Zip Code Stemmons Freeway Dallas, TX 7527 PURPOSE Category (See ategories listed at the top of this shedule) Advertising Expense Desription Piked up Complete ONLY if diret Candidate / Offieholder name Offie sought Offie held 3/31/211 Reilly Ehols Printing, In. Amount () Payee address; City; State; Zip Code 17.6 P.O. Box Dallas, TX PURPOSE Category (See ategories listed at the top of this shedule) Printing Expense Desription piked up Complete ONLY if diret Candidate / Offieholder name Offie sought Offie held 4/4/211 Dalton Mailing Servies, In. Amount () Payee address; City; State; Zip Code 2478 Southwell Rd Dallas, TX PURPOSE Category (See ategories listed at the top of this shedule) Advertising Expense Mailing Desription Complete ONLY if diret Candidate / Offieholder name Offie sought Offie held ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
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