FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 1. 1 Filer ID (Ethics Commission Filers) 2 Total pages filed: ... Date Received NICKNAME LAST SUFFIX

Transcription

1 CANIATE I FICEHOLER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 1 The C/OH Instruction Guide explains how to complete this form. 1 Filer I (Ethics Commission Filers) 2 Total pages filed: 3 CANIATE/ MS I MRS I MA FIRST Ml FICEHOLER NAME t\ir. I('Jl1S'.... ate Received o 0 o I I I..... ' ~ NICKNAME LAST SUFFIX FICE USE ONLY 4 CANIATE/ ARESS I PO BOX; APT I SUITE #; CITY; STATE; ZIP COE FICEHOLER MAILING (Lf'J,.G, #i//wool L4f~t.e [)u//~! T>l 7~1-</8 ARESS Change of Address 5 CANIATE/ AREA COE PHONE NUMBER EXTENSION FICEHOLER PHONE (en~) '110- ~sqy- 6 CAMPAIGN MS/ MRS/ MA FIRST Ml Receipt# TREASURER MP \TA.SOI\J NAME... ' ate Processed NICKNAME LAST SUFFIX ate Imaged LGlflfO N <; 7 CAMPAIGN STREET ARESS (NO PO BOX PLEASE); APT I SUITE #; CITY; STATE; ZIP COE TREASURER ARESS (Residence or Business) Ill W. f;{jfj..iii/(r VA~ ~04}> f<ic#m.;q~n, 1'}_ 7~ ~/ 8 CAMPAIGN AREA COE PHONE NUMBER EXTENSION TREASURER (2-l'f ) PHONE Zto- L/llfJS ate Hand-delivered or ate Postmarked I Amount $ 9 REPORT TYPE January 15 3oth day before election Runoff c:i 8th day before election 0 July 15 Exceeded $500 limit 15th day after campaign treasurer appointment (Officeholder Only) Final Report (Attach C/OH FA) 10 PERIO Month ay Year Month ay Year COVERE 3/2.1/,b 'I / 27/ II:> THROUGH 11 ELECTION ELECTION ATE ELECTION TYPE Month ay Year 0 Primary ~eneral ~/' / '" Runoff 0 Other escription Special 12 FICE FICE HEL (if any) 13 FICE SOUGHT (if known) Rl c.ha-p::$1\j,~};> R I~ ltpf>l?ol\/ 151:> BoA~ Of=' Tfl.»,S'TP~ f;jf)afu> () F" T~ 'Tl;;~ 'PU\V6' 3 -pt.-ave 3 GO TO PAGE 2 Forms provided by Texas Ethics Commission Revised 9/8/2015

2 CANIATE I FICEHOLER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 2 14 C/OH NAME 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. COMMITTEE TYPE COMMITTEE NAME 0GENERAL OsPECIFIC COMMITTEE ARESS Additional Pages COMMITTEE CAMPAIGN TREASURER NAME COMMITTEE CAMPAIGN TREASURER ARESS 17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS $50 OR LESS (OTHER THAN TOTALS PLEGES, LOANS, OR GUARANTEES LOANS), UNLESS ITEMIZE $ EXPENITURE TOTALS 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEGES, LOANS, OR GUARANTEES LOANS) 3. TOTAL POLITICAL EXPENITURES $100 OR LESS, UNLESS ITEMIZE $ $.. ' 0 4. TOTAL POLITICAL EXPENITURES $ S/3.3~ CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINE AS THE LAST AY BALANCE REPORTING PERIO $ 1'11.,1 OUTSTANING 6. TOTAL PRINCIPAL AMOUNT ALL OUTSTANING LOANS AS THE LOAN TOTALS LAST AY THE REPORTING PERIO $ 18 AFFIAVIT f1i:p-;irici;;biitle1 I ~ ~.,,. Commaon E~Cptres L.!'~~-.. ~?.:t~~~~?..., 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. ~~ Signature of Candidate or Officeholder AFFIX NOTARY STAMP I SEALABOVE Sworn to and subscribed before me, by the said i~ (\'":::> 01\ver, this the d~ ~ ~tc.t. 20 '(p, to certify which, witness my hand and seal of office. d-~ &~ ~cc~kj~ ~~tt\~ ~ot-ev-l\ Signature of officer administering oath Printed name of officer administering oath Title of officer ad mln lst~~ oath Forms provided by Texas Ethics Commission Rev1sed 9/8/2015

3 SUBTOTALS- C/OH FORM C/OH COVER SHEET PG 3 19 FILER NAME 20 Filer I (Ethics Commission Filers) Kill~ 01--IV~ 21 SCHEULE SUBTOTALS SUBTOTAL NAME SCHEULE AMOUNT 1. SCHEULE A1: MONETARY POLITICAL CONTRIBUTIONS $ 2. 0 SCHEULE A2: NON-MONETARY (IN-KIN) POLITICAL CONTRIBUTIONS $ 3. 0 SCHEULE B: PLEGE CONTRIBUTIONS $ 4. SCHEULE E: LOANS $ 5. g' SCHEULE F1: POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS $ S/3.~s 6. SCHEULE F2: UNPAI INCURRE OBLIGATIONS $ 7. SCHEULE F3: PURCHASE INVESTMENTS MAE FROM POLITICAL CONTRIBUTIONS $ 8. 0 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 Rev1sed 9/8/2015

4 MONETARY POLITICAL CONTRIBUTIONS SCHEULE A1 1 Total pages Schedule A1 : 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 ate 5 Full name of contributor out-of-slate PAC (I/1-: ) 7 Amount of contribution ($) 6 Contributor address; City; State; Zip Code 8 Principal occupation I Job title (See Instructions) 9 Employer (See Instructions) ate Full name of contributor out-of-state PAC (I#: ) Amount of contribution ($) 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 (IU: J 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) ATIACH 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 1 Total pages Schedule A2: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 TOTAL UN ITEMIZE IN-KIN POLITICAL CONTRIBUTIONS $ 5 ate 6 Full name of contributor 0 out-of-state PAC (I#: l 8 Amount of 9 In-kind contribution Contribution $ description.. 7 Contributor address; City; State; Zip Code Check if travel outside of Texas. Complete Schedule T. 10 Principal occupation I 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 is a child, law firm of parent(s) (if any) (FOR JUICIAL) ate Full name of contributor 0 out-of-state PAC (ll'lll: l Amount of In-kind contribution Contribution $ description Contributor address; City; State; Zip Code Check if travel outside of Texas. Complete Schedule T. Principal occupation I 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) 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

6 PLEGE CONTRIBUTIONS SCHEULE B 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 Pledgor address; City; State; Zip Code 10 Principal occupation I Job title (See Instructions) 111 Employer (See Instructions) Check if travel outside of Texas. Complete Schedule T. ate Full name of pledgor out-of-state PAC (I#: l Amount In-kind contribution of Pledge$ description. Pledgor address; City; State; Zip Code Check if travel outside of Texas. Complete Schedule T. Principal occupation I Job title (See Instructions) I Employer (See Instructions) ate Full name of pledgor out-of-state PAC (I#: l Amount of. In-kind contribution Pledge$ description Pledgor address; City; State; Zip Code Principal occupation I Job title (See Instructions) I Employer (See Instructions) Check if travel outside of Texas. Complete Schedule T. ate Full name of pledgor out-of-state PAC (I#: l Amount of In-kind contribution Pledge$ description Pledgor address; City; State; Zip Code Principal occupation I Job title (See Instructions) I Employer (See Instructions) Check if travel outside 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 Commission Revtsed 9/8/2015

7 LOANS SCHEULE E 1 Total pages Schedule E: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 TOTAL UNITEMIZE LOANS $ 5 ate of loan 7 Name of lender 0 out-of-state PAC (I#: ) 9 Loan Amount($) 6 Is lender a financial 8 Lender address; City; State; Zip Code Institution? y N 10 Interest rate 11 Maturity date 12 Principal occupation I Job title (See Instructions) 13 Employer (See Instructions) 14 escription of Collateral 15 Check if personal funds were deposited into political account (See Instructions) 0 none 0 16 GUARANTOR 17 Name of guarantor 19 Amount Guaranteed ($) 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#: ) Loan Amount ($) Is lender Lender address; City; State; Zip Code a financial Institution? y N Interest rate Maturity date Principal occupation I Job title (See Instructions) Employer (See Instructions) escription of Collateral 0 none 0 Check if personal funds were deposited into political account (See Instructions) GUARANTOR Name of guarantor Amount Guaranteed ($) INFORMATION Guarantor address; City; Stale; Z ip 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 tor additional reporting requirements. Forms provided by Texas Ethics Commission Revised 9/8/2015

8 POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS SCHEULE F1 EXPENITURE CATEGORIES FOR BOX 8(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 In istrict Contributions/onations Made By Gift/Awards/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 to complete this form. 1 Total pages Schedule F1 : 2 FILER NAME J 3 Filer I (Ethics Commission Filers) I 4 ate 5 tflr/t(p K/l.IJ 0/,IV/fffl- Gil ArE VINE SIGN-A -(l.ami+ 6 Amount ($) 7 Payee address; City; State; Zip Code go$.~i f$1 s. pfjou;y S'TUgt GIAPEV!NE) T)l 7'US/ 8 (a) Category (See Categories listed at the top of this schedule) (b) escription Check if travel outside oftexas. Complete Schedule T. /t-t>vt!~11 SIN fr Check if Austin, TX, officeholder living expense EXPENITURE 9 Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit CIOH ate '1/~/14 F~oex orp,e;e :?o'/. <Jlf tlho N. on r ~om; 12/CI-I~,ON ) r)l 7S'fl$() Category (See Categories listed at the top of this schedule) escription Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense EXPENITURE p~!1\/r/n(,., Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit CIOH ate Category (See Categories listed at the top of this schedule) escription Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense EXPENITURE Complete ONLY If direct Candidate I Officeholder name Office sought Office held expenditure to benefit CIOH ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Rev1sed 9/8/2015

9 UNPAI INCURRE OBLIGATIONS SCHEULE F2 EXPENITURE CATEGORIES FOR BOX 10(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 In istrict Contributions/onations Made By Gift/Awards/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) 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 at the top ol this schedule) (b) escription 0 Check if travel outside ol Texas. Complete Schedule T. EXPENITURE 0 Check il Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate I Officeholder name Office sought Office held ate TYPE EXPENITURE Political Non-Political 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 living 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 Rev1sed 9/8/2015

10 PURCHASE INVESTMENTS MAE FROM POLITICAL CONTRIBUTIONS SCHEULE F3 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 P07:56 IN EXPENITURES MAE BY CREIT CAR SCHEULE F4 EXPENITURE CATEGORIES FOR BOX 1 O(a) Advertising Expense Event Expense Loan RepaymenVReimbursement 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) 1 Total pages Schedule F4: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 TOTAL UN ITEMIZE EXPENITURES CHARGE TO A CREIT CAR $ 5 ate 6 7 Amount ($) 8 Payee address; City; State; Zip Code 9 TYPE EXPENITURE Political 0 Non-Political 10 (a) Category (See Categories listed at the top ol this schedule) (b) escription 0 Check if travel outside ol Texas. Complete Schedule T. EXPENITURE 0 Check if Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate I Officeholder name Office sought Office held ate TYPE EXPENITURE Political Non-Political Category (See Categories listed at the top of this schedule) escription Check if travel outside oitexas. Complete Schedule T. Check il Austin, TX, olliceholder living 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 Revised 9/8/2015

12 P07:56 IN POLITICAL EXPENITURES MAE FROM PERSONAL FUNS SCHEULE G EXPENITURE CATEGORIES FOR BOX B(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 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 1 Total pages Schedule G : 2 FILER NAME J 3 Filer I (Ethics Commission Filers) 4 ate 5 6 Amount ($) 7 Payee address; City; State; Zip Code 0 Reimbursementfrom political contributions intended 8 (a) Category (See Categories listed at the top of this schedule) (b) escription 0 Check if travel outside of Texas. Complete Schedule T. EXPENITURE 0 Check if Austin, TX, officeholder living expense 9 Complete ONLY if direct Candidate I Officeholder name Office sought Office held ate 0 Reimbursementfrom political contributions intended Category (See Categories listed at the top of this schedule) (b) escription Check if travel outside of Texas. Complete Schedule T. EXPENITURE Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate I Officeholder name Office sought Office held ate [] Reimbursement from political contributions intended Category (See Categories listed at the top of this schedule) (b) escription 0 Check if travel outside of Texas. Complete Schedule T. EXPENITURE 0 Check if Austin, TX, officeholder living expense 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 Rev1sed 9/8/2015

13 P07:56 IN PAYMENT MAE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS C/OH SCHEULE H EXPENITURE CATEGORIES FOR BOX B(a) Advertising Expense Event Expense Loan RepaymenVReimbursement 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 1 Total pages Schedule H: 2 FILER NAME 13 Filer I (Ethics Commission Filers) 4 ate 5 Business name 6 Amount {$) 7 Business address; City; State; Zip Code 8 (a) Category (See Categories listed at the top of this schedule) (b) escription 0 Check if travel outside of Texas. Complete Schedule T. EXPENITURE 0 Check if Austin, TX, officeholder living expense 9 Complete ONLY if direct Candidate I Officeholder name Office sought Office held ate Business name Amount ($) Business 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 living expense EXPENITURE Complete ONLY if direct Candidate I Officeholder name Office sought Office held ate Business name Amount ($) Business address; City; State; Zip Code Category (See Categories listed at the top of this 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 I Officeholder name Office sought Office held ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Revised 9/8/2015

14 P07:56 IN NON-POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS SCHEULE I 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 Instructions for examples of acceptable (b) escription (See Instructions regarding type of information categories.) required.) EXPENITURE ate EXPENITURE Category (See instructions for examples of acceptable categories.) escription {See instructions regarding type of information required.) ate EXPENITURE Category {See instructions for examples of acceptable categories.) escription (See Instructions regarding type of information required.) ate 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 Revtsed 9/8/2015

15 P07:56 IN INTEREST, CREITS, GAINS, REFUNS, AN CONTRIBUTIONS RETURNE TO FILER SCHEULE K 1 Total pages Schedule K: 2 FILER NAME 3 Flier I (Ethics Commission Filers) 4 ate 5 Name of person from whom amount is received 8 Amount($) 6 Address of person from whom amount is received; City; State; Zip Code 7 Purpose for which amount is received Check if political contribution returned to filer ate Name of person from whom amount is received Amount($) 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($) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received Check if political contribution returned to filer ate Name of person from whom amount is received Amount($) 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 ATIACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Rev1sed 9/8/2015

16 P07:56 IN IN-KIN CONTRIBUTIONS OR POLITICAL EXPENITURES FOR TRAVEL OUTSIE TEXAS SCHEULE T 1 Total pages Schedule T: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 Name of Contributor I Corporation or Labor Organization I Pledgor I Payee 5 Contribution I Expenditure reported on: Schedule A2 Oschedule 8 Schedule 8(J) Schedule C2 Schedule Schedule F1 Schedule F2 Schedule F4 schedule G Schedule H Schedule COH-UC Schedule 8-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 I Corporation or Labor Organization I Pledgor I Payee Contribution I Expenditure reported on: Schedule A2 Oschedule 8 Schedule 8(J) Schedule C2 Schedule Schedule F1 Schedule F2 Schedule F4 schedule G Schedule H Schedule COH-UC Schedule 8-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 I Corporation or Labor Organization I Pledgor I Payee Contribution I Expenditure reported on: Schedule A2 schedule 8 Schedule 8(J) Schedule C2 Schedule Schedule F1 Schedule F2 Schedule F4 schedule G Schedule H Schedule COH-UC Schedule 8-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) ATIACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission Revised 9/8/2015

17 P07:56 IN CANIATE I FICEHOLER REPORT: ESIGNATION FINAL REPORT FORM C/OH - FR Complete only if "Report Type" on page 1 is marked "Final Report" 1 C/OH NAME 2 Filer I (Ethics Commission Filers) 3 SIGNATURE 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. 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: 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 contributions. I understand that 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 political 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: 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, Signature of Candidate 5 ACEHOLER 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