M AREA CODE PHONE NUMBER EXTENSTON

Transcription

1 , :l CAND DATE FCEHOLDER CAMPAGN FNANCE REPORT FORM C/OH COVER SHEET PG 1 The COH lnstruction Guide explains how to complete this form. 3 CANDDATE / FCEHOLDER NAME \ MS / MRS.9 FRST M NCKNAME 1 Filer ld letnics Commission Filers) 2 Total pages filed: - T sureri Received FCE USEONLY 4 CANDDATE / FCEHOLDER MALNG ADDRESS [J cnange of Address 5 CANDDATE/ FCEHOLDER PHONE 6 CAMPAGN TREASURER NAME ]OX; APT / SUTE #; CW; STATE; ZP CODE *\ttl fuot,7f7. M AREA CODE PHONE NUMBER EXTENSTON (ax) 14L, Fr;1 MS /(Rs MR NCKNAME' k 1Kr0L, d' Hand-delivered or Postmarked Receipt# Processed lmaged Amountg 7 CAMPAGN TREASURER ADDRESS (Residence or Business) STREET ADDRESS (NO PO BOX Pf-EASE); ApT / SUTTE #; CfW; STATE; ZP CODE 1ot Daof+r D- o1 7x -)fiolu-e 8 CAMPAGN TREASURER PHONE (fla.) BER fr,t-o <)fu-) EXTENSON 9 REPORT TYPE n Januarv 15 ll tf tl 30th day belore election 8th day before election tl tl Runotf Exceeded $500limit T n 15th day after campaign feasurer apointment (Officeholder Only) Final Report (Aftach C/OH - FR) 10 PEROD COVERED Day Year 0l / ol /adf THROUGH Month Day 'i1 " "''*'l'v ' "'til iir, cl.o / 60 : 11. /ootf 11 ELECTON Month J^t= year r,/,/ lt /)La /gak n primary ffi,,^, u iiil ELECTON TYPE Runoff t] orhdi'^'' "o;;{t Description Special 12 offtce FCE HELD (if any) 13 FCE SOUGHT (if known) GO TO PAGE 2 Pry4 dt wi astu\er Forms provided by Texas Ethics Commission Revised 9/812A15

2 CANDDATE FCEHOLDER CAMPAGN FNANCE REPORT FORM C/OH COVER SHEET PG 2 14 C/OH NAME 0rnaf NOTCE FROM POLTCAL commttee(s) -.<! edk* 15 Filer ld (Ethics Commission Filers) THS BOX $ FOR {OTCE POUTrcAL OOTRBUTONS ACCEPTED OR POLTCAL EXPE{D]'URES ADE BY POLMCAL COfXffTEES To supfort THE clluor;re / oracexolden.,helt EnpEwnrrrEs rly,aw BEEN (ADE wffrr(nf rhe car@,nzb n wncanqoenb KttolttEoaE (n aot{6,ettt. cat{dtdateri ANo offtceholoers AnE neoutreo 11O FEFORT THS lllforl AflOtl ONLY lf HEY RECEVE NOTCE COMMTTEE TYPE COMMTTEE NAME fl eehenal -ljseeclrrc COMMTTEE ADDRESS COMMTTEE CAMPAGN TREASURER NAME t] Additional Pages COMMTTEE CAMPAGN TREASURER ADDRESS 17 CONTRBUTON TOTALS TOTALS CONTRBUTON BALANCE OUTSTANDNG LOAN TOTALS 18 AFFDAVT 1 TOTAL POLTCAL CONTRBUTONS $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS), UNLESS TEMZED $ a 2. TOTAL POLTCAL CONTRBUTONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS) $ d 3. TOTAL POLTCAL S $1OO OR LESS, $6 UNLESS TEMZED 4. TOTAL POLTCAL S $ 5)f,oo 5. TOTAL POLTCAL CONTRBUTONS MANTANED AS THE LAST DAY REPORTNG PEROD 6. TOTAL PRNCPAL AMOUNT ALL OUTSTANDNG LOANS AS THE LAST DAY THE REPORTNG PEROD $ il $ 41So swear, or affirm, under penalty of periury that the accompanying report is true and correct and i information required to be reported by me AFFX NOTARY STAMP/ SEALABOVE Sworn to and subscribed before ffi, by the said Signature of officer hdministering oath N\u 'h. L-C0ort Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www. ethics.state.tx. us Revised 9l8n015

3 POLTCAL EXPENDTU RES T/ADE FROM PERSONAL FUNDS {;1t-t'ffi SCHEDULE G ra rltt t f, PH \: t? EXPEND]TURE CATftO Advertising Expense Accounting/Banking Gonsulting Expense ContributionslDonations Made By Cand itjate/otf iceholdertpolitical Co m mittee CreditOard Payment Event Expense Fees Foodltseverage Elpense G lfvawardsfitiemo riab Expense LegalServices The nstruction Guide explains how to complete this form. Solicitatior/Fundraising Expense Transportation Equipment & Related Eryense Travel n District Travel Out Of District Other (enter a category not listed above) 1 Total pages Schedule G:.{ )L- 4 Lo-aLa- tf,. 2 FLER NAME fatrrr*r-:\- bpe* 5 Payeeli6me?rln# T1r,,s 6 Amount ($) 7 Payee address; City; State; Zip Code 133?f N 5r- i+ry-lv rl3 8 Sgqt,rr-^ -v afk (a) Category (SddC_ategories tisted atthe rop of this schedule) odl)0r-ke*,9 3 Filer ld (Ethics Commission Filers) f] if travd outside of Texas. Compbte Schedule T. t-l "n"* t Gheck if Austin, TX, officeholder living expense 9 Gomplete 9NLY if direct expenditure to benefit COH Candidate / Officeholder name Office sought Offi* h"ld Amount ($) Payee address; City; State; Zip Code [_l Reimburcementfrom politicalcontribr.rtions intended CategOU (See Categories listed at the top of this schedule) [_ Check if tavel oubide of Texas. Comptete Schedule T. l_l "n"ck if Austin, TX, officehoher living expense Gomplete glrlly if direct expenditure to benefit C/OH Gandidate / Officeholder name Office sought Office held Amount ($) Payee address; City; State; Zip Code n Reimbursementfrom t political contributions - intended Complete ONLY if direct expenditure to benefit COH CategOry (See Categories tisted at the top of this schedule) fl Check if savel oueide of Texas. Complete Schedule T. tf Check il Austin, TX, ofticehotder tiving expense Candidate / Officeholder name Office sought Offi"" h"td ATTACH ADDTONAL COP ES THS SCHEDU LE AS N E EDED Forms provided by Texas Ethics Commission www. ethics. state.tx. us Revised 9l8l20l5

4 S MADE BY CREDT CARD SCHEDULE F4 CATEGORES FOR BOx lo(a) Aah, ftbilrg Expens Elrent E F nse loan R paym irt/r imlil]b rndtt SdHtatiorvFundraising E)peJ 3e Aocounrinsi/BankinS F# Offic Oy rheadmenal Erpense Transportation Equiprnerta Relat d Exp ns c.;onsul0ng Epense Food8e\rorage Expense Polling E)(pense Travei n District Condbulions/Dondions illade By CrifyAwalds/ftbnodals Exp nse Printing Expense Travel Outof District Cd didate fficehold r/polilical Committee Legal S rvicss Salaries/Wagpdcontrac't hbor Oth r (enteracat gory notlisted abo\,g) 1 Total pages Schedule F4: 3-' 2 FLER NAME The nltruction Gulde erplalns how to complete this form. On,at- L $efifi 4 TOTAL UNTEMZED S CHARGED TO A CREDT CARD $ 6 5 O\r-}u-(tr 6 Prirk -]ilus 7 Amount ($) e {ow 's 8 Payee address; t333o ^) *r City; State; Zip Code \hry teb Gas* 10 rype of p--potitical Anr.rrrn.{{ 1tr155 J--t t] Non-Political (a) Category, (See Categories listed at the top of this schedule) Adurr+\:\nr Lr 3 Filer ld (Ethics Commission Filers) f] Check if travel outrsirje ol Texas. Complete Schedule T. t-l lcheck if Austin, TX, otliceholder living expense 11 Complete ONLY it direct Candidate / Officeholder name Offic sought Offlce held expenditure lo benefit CiOH Amount ($) Payee address; City; State; Zip Code TYPE Potitical t] Non-Political Gategor! (See Gategories listed at the top of this schedule) Description [-l Cn* it fiavel outside of Texas. Complete Scfiedr.da T. [-l an".k if Austin, TX, officeholder living expense Complete ONLY it direct Candidate / O{ticeholder name Office sought Olfice held expenditure to ben fit C/OH ATTACH ADDTONAL COPES THS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www. ethics. state.tx. us Revised

5 POLTCAL S MADE FROM poltttcal CONTRBUTTONS SGHEDULE F1 Advertising Expense Accounting/Banking Consulting Expense ContributionslDonations Made By Candidate/Off iceholder/political Committee CreditOard Payment 1 Total pages Schedule Fl.*{ 4 u.r - \5- \f 2 FLER NAME CATEGORES FOR BOx 8(a) Event Expense Fees Foocl/Beverage Experne Loan Repayment/Reimtnrsenrent Office OverheacURental Expense poiling Expense GitVAwards/Memorials Expense printing Etqense Legal Services Salaries/Wages/Confact Labor The nstruction Guide explains how to complete this form. OrvtftL j- Oftcfr tr.^ 3ocrc-\ 5 6 Amount ($) + 5oD 7 Payee address; 1qs N. trte"c Gity; State; Zip Code f-tt3s ry{la Munf.tt Tff 1&r3 ) (a) Category (See Caregories tisted atrhe top of tii, J.n"Oul").AA.l r"li5"tl3 e'{(hv Sof icitatio nlf undraising Expense Transportation Equipment & Related Expense Travel ln District TravelOut Ot District Other (enter a category not liste{l above) 3 Filer ld (Ethics Commission Filers) l--l Cnr* if travet outside of Texas. Gomptete Schedule T. [_l,n"ck if Austin, TX, officehotder living expense 9 Complete ONLY if direct Candidate / Officeholder name expenditure to benefit C/OH Office sought Office held Amount ($) Payee address; Gity; State; Zip Gode i HXPENDTURE Category (See Categories tisted atthe top of this schedule) Description l-l an* if tavel outside of Texas. Complete ScheduleT. [-l an"ck if Austin, TX, officeholder tiving expense Comptete ONLY if direct expenditure to benefit C/OH Candidate / Officeholder name Office sought Office held Amount ($) Payee address; Category (See Categories listed at the top of this schedule) Description l-l a*"* if tavel outside of Texas. Complete Schedule T. l--l Cn"ck if Austin, TX, officeholder living expense Complete ONLY if direct expenditure to benefit COH Candidate / Officeholder name Office sought Office held ATTACH ADDMONAL COPES THS SCHEDULE AS NEEDED Forms provided by Texas Ethics Gommission us Revised 9l8l20fi

6 LOANS SCHEDULE E 2 FLER NAME The nstruction Guide explains how to complete thls form. 0(YYrt-f 3 {h'c,-- 1 Total 4 TOTAL UNTEMZED LOANS $6 5 of loan (.t- t5 -tt- 6 ls lender a financial nstitution? r-.a y fi) L/ 7 Name of lender 12 Principal occupation / Job titte (See nstructions) 6" CaruUAnk 14 Description of Collateral 16 GUARANToR NFORMATON *(^rpticabte fl out-of-state PAC (ld#, Ornhp Lender address; -lot Do!)lt\ O,- 3arr\ rlnrcn -T{ -)RtttoU 17 Name of guarantor lb 'Guarani.; "liress; ' ' i',rt' ' 'si*, 13 Employer (See nstructions) 3e\f ofn,dtov ocl Schedule E: Tses 3 Filer ld (Ethics Commission Filers) LoanAmount ($),s aoo 1O nteiest rate 'g 11 Maturity date d 15 Check if personal fund3 were heposited into potitical account (See nstructions) tr )rocode 20 Principal Occupation (See nstructions) 21 Employer (See nstructions) 19 Amount Guaranteed ($) of loan Name of lender fl out-of-state PAG (tdr; Loan Amount ($) ls lender a financial nstitution? YN Principal occupation / Job title (See nstructions) uenoe, aaor"s"; citv, State; zi:ipcode Employer (See nstructions) nterest rate Maturity date Description of Collateral t] none GUARANTOR NFORMATON Name of guarantor Check if personal funds were deposited into political account (See nstructions) n Amount Guaranteed ($) Guarantor address; City; State; Zip Code t] not applicable Principal Occupation (See nstructions) Employer (See nstructions) ATTACH ADDTONAL COPES THS SCHEDULE AS NEEDED t lender ie out-of-state PAC, please see nstruollon gulde lor additlonal reporting rsqulrements. Forms provided by Texas Ethics Commission www. eth ics. state.tx. us Revised 9/812015

7 MONETARY POLTCAL CONTRBUTONS SCHEDULE A1 The nstruction Guide explains how to complete this form. 1 Total pages Schedule Al : 2 FLER NAME 3 Filer ld (Ethics Commission Filers) 4 5 Full name of contributor fl our-of-state pac (rd#: Amount of contribution ($) 6 Contribrto, address; City; State; Zip Code 8 Principal occu pation / Job title (See nstructions) Employer (See lnstruc;tions) Full name of contributor fl our-of-srate pac (ld#. Amount of contribution ($) Gontribuio, address; City; State; ApGode Principal occupration / Job title (See nstructions) Employer (See nstruc tions) Full name of contributor f] our-of-state pac (rd#: Amount of contribution ($) Contributor address; City; State; Zip Code Principal occupration / Job title (See nstructions) Employer (See nstruc tions) Full name of contributor fl out-of-state pac (rd#: Amount of contribution ($) Contributor address; City; State; Zip Code Principal occupation / Job title (See nstructions) Employer (See lnstructions) ATTACH ADDTNONAL COPES THS SCHEDULE AS NEEDED lf contributor ls out'ot-state PAC, please see nslruction gulde for addltlonal reportlng rcqulrements. Forms provided by Texas Ethics Commission us Revised 9/8/2015

8 SUBTOTALS. C/OH 19 FLER NAME Oflrnu- 21 SCHEDULE SUBTOTALS NAME SCHEDULE FORM C/OH COVER SHEET PG 3 20 Filer ld (Ethics Gommission Filers) SUBTOTAL AMOUNT 1 l_j SCHEDULEAl: MONETARY POLTCALCONTRBUTONS $ 2. Ll SCHEDULEA2: NON-MONETARY(N-KND)POLTCALCONTRBUToNS $ 3. t] schedule B: pledged contrtbuttons $ 4- N6"EDULEE: L.ANS $5,O@ 5. - n-/,'-schedule Fl: POLT]CAL S MADE FROM POLTCAL CONTRBUTONS $ 6. t_l SCHEDULE F2: UNPAD NCURRED OBLGATONS $ 5oo 7. sohedule F3: purchase of TNVESTMENTS MADE FRoM polrrrcal contrtbutrons $ 8. M"HEDUL E F4: S MADE BY CREDT CARD $5ooo -/ 9. k.fschedule G: polrrlcal EXPEND TURES MADE FRoM PERSoNAL FUNDS s5. /')0O 10. f, sohedule H: payment MADE FRoM pollrlcal contrrbutrons ro A BUsrNEss of c/oh $ 11. tr schedule r: NoN-poLrflcAL EXpENDrruREs MADE FRoM polrrcal contrrbunons $ 12. l-l SCHEDULE K: NTEREST, CREDTS, GANS, REFUNOS, AND CONTRBUTONS RETURNEDTO FLER $ Forms provided by Texas Ethics Commission www. eth ics. st ate. tx. us Revised 9/8/2015