c^jne^cx. ADDRESS / PO BOX; APT/ SUITE «; CITY; STATE; ZIP CODE ScinencJc

Transcription

1 CANDIDATE / FICEHOLDER CAMPAIGN FINANCE REPORT FORM C/OH COVER SHEET PG 1 The C/OH Instruction Guide explains how to complete this form. 1 Filer ID (Ethics Commission Filers) 2 Total pages filed: 3 CANDIDATE/ FICEHOLDER NAME 4 CANDIDATE/ FICEHOLDER MAILING ADDRESS J Change of Address 5 CANDIDATE/ FICEHOLDER PHONE MS / MRS / MR Mr. J^ 5. T. NICKNAME LAST SUFFIX c^jne^cx. ADDRESS / PO BOX; APT/ SUITE «; CITY; STATE; ZIP CODE Annan Wq "OC ~fc\\ou> AREA CODE PHONE NUMBER ($0(0 ) L>~1%- )-2i% Dale Received FICE USE ONLY RECEIVED APR fl CITY SECRETARY'S CITYAMARILLO Dale Hand-delivered or Dale Postmarked 6 CAMPAIGN TREASURER NAME MS/MRS/ MR Mrs NICKNAME FIRST LAST.^ Rocoip! # Amount $ Dale Processed ScinencJc Dale Imaged 7 CAMPAIGN TREASURER ADDRESS (Residence or Business) STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; tv^mu L3a\n5borough Roq-3 A^ari Wo TX ~l \io^ 8 CAMPAIGN TREASURER PHONE AREA CODE PHONE NUMBER (<60(p) "rno ch^^^ 9 REPORT TYPE January 15 ] July 15 30thday before election I I Runoll I 15thdayafter campaign 1 ' ' ' treasurer appointment (Otliccholder Only) ] 8th day before election ] Exceeded S500 limit J Final Report (Anach C/OH -FR) 10 PERIOD COVERED Day M /\~* THROUGH Day 3 /^9> /Y\ 11 ELECTION ELECTION DATE ELECTION TYPE Month Day Year $/\j> /IT- Primary [>?T General J Runoll J Special I I Other Description 12 FICE FICE HELD (it any) 13 FICE SOUGHT (ilknown) -Amanita CvVy Cjou^cj \ GO TO PAGE 2 Forms provided by Texas Ethics Commission Revised 9/8/2015

2 CANDIDATE / FICEHOLDER CAMPAIGN FINANCE REPORT FORM C/OH COVER SHEET PG 2 14 C/OH NAME Jclj-^s 16 NOTICE FROM POLITICAL COMMITTEE(S) d- ScheneX 15 Filer ID (Ethics Commission Filers) THIS BOX IS FOR NOTICE POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL S MADE BY POLITICAL COMMITTEES TO SUPPORT THE CANDIDATE / FICEHOLDER. THESE S MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR FICEHOLDER'S KNOWLEDGE OR CONSENT. SUCH S. CANDIDATES AND FICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE COMMITTEE TYPE COMMITTEE NAME QGENERAL [^SPECIFIC COMMITTEE ADDRESS COMMITTEE CAMPAIGN TREASURER NAME j Additional Pages COMMITTEE CAMPAIGN TREASURER ADDRESS 17 CONTRIBUTION TOTALS TOTAL POLITICAL CONTRIBUTIONS $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS), UNLESS ITEMIZED $ \bo,oo TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS) $ b i30'00 TOTALS TOTAL POLITICAL S $100 OR LESS, UNLESS ITEMIZED $ \%O.Olp TOTAL POLITICAL S *W\~*-lA CONTRIBUTION BALANCE 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS THE LAST DAY REPORTING PERIOD ^<S>3P-5~t- OUTSTANDING LOAN TOTALS TOTAL PRINCIPAL AMOUNT ALL OUTSTANDING LOANS AS THE LAST DAY THE REPORTING PERIOD $ \so0.o > 18 AFFIDAVIT S#f% iflhara FRANCES HIBBS NOTARY PUBLIC, STATE TEXAS Commission Expires ] \/vww Iswear, or affirm, under penaltyof perjury, that the accompanying reportis true and correct and includes all information required to be reported by me under Title 15, Election Code. Signature of(cendidate or Officeholder AFFIX NOTARY STAMP/ SEALABOVE Sworn to and subscribed before me, by the said O f> j-fcsz Os»G/'^P/JCLA-,this the ^SH day of f~^~t()\t 20 / /,to certify which, witness my hand and seal of office. ^ftrrvncan I\JJ^ (jr?>l(c>fe ll>u> crki.q^rr-tor^ 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 Jousts o-??t)r\ex\cjc 20 Filer ID (Ethics Commission Filers) 21 SCHEDULE SUBTOTALS NAME SCHEDULE SUBTOTAL AMOUNT 1- \>Q SCHEDULE A1: MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A2: NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS 3- Q SCHEDULE B: PLEDGED CONTRIBUTIONS m Bf SCHEDULE E: LOANS SCHEDULE F1: POLITICAL S MADE FROM POLITICAL CONTRIBUTIONS 6- Q SCHEDULE F2: UNPAID INCURRED OBLIGATIONS 7- Q SCHEDULE F3: PURCHASE INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F4: S MADE BY CREDIT CARD & SCHEDULE G: POLITICAL S MADE FROM PERSONAL FUNDS 10. Q] SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO ABUSINESS C/OH 11 Q SCHEDULE I: NON-POLITICAL S MADE FROM POLITICAL CONTRIBUTIONS 12. SCHEDULE K: INTEREST, CREDITS. GAINS. REFUNDS. AND CONTRIBUTIONS RETURNEDTO FILER %?ytpco,00 $2H $ )5oo >o0 *9on.L>3 $o $o $0 $ \00-OQ $o $0 $ o Forms provided by Texas Ethics Commission Revised 9/8/2015

4 MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A1 ^dyy\rtfp The Instruction Quide explains how to complete this form. S. Sc^e/YiiL 4 5 Fullname of contributor Q oui-ot-stato PAC (ID»:. (W*W i.bu.r.k- i+ 6 P.Q' &9X 5Q3TQ- Ar^ar, ItoTX T^ffi Total pages Schedule A1: 3 7 *5oO oo Full name of contributor out-oi-state pac (id«:. 3/i5/ -q- >0l 5. Stare Dr. AwmllolK Tnl/q &}00'0O Full name of contributor Q oui-of-siate PAC (ID#:_ >kln Mc. 4- Ar$.Moddy Chvetal ^ \D0O,Ob Full name of contributor Q out-of-state PAC (ID#:. flober-v.urt\5 s/i/n- '^50.oD 33)0 S-fegfrns to A^^ar ATTACH ADDITIONALCOPIES THIS SCHEDULEAS NEEDED Ifcontributor is out-of-statepac, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission Revised 9/8/2015

5 MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A1 1 Total pages Schedule A1: Sorrier 4 S- t^ejncx 5 Full name of contributor Q out-of-state PAC (ID#:. U)\\\\<Xrr\ Price. 6 V-SOSIM)* felj >Wr; Ib "DC ~^\ lol> Full name of contributor out-of-state PAC (!Dtf: $ Tt >» feem-trget>p. >V\gri)lflTX ~? \i>\ 3j%h Full name of contributor out-ol-state PAC (IDS:. \0>o-l Dub VteiJl?c. Awxr\ Ila1% ^ i^h A.??00.CG z>h\n- zfrj\-*- 2>Hn- Full name of contributor out-of-state PAC (I0#:. Me- ± Mr$. ~To< \ t>erlen *\00 CO ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED If contributor isout-of-state PAC, please seeinstruction guide for additional reporting requirements. Formsprovided bytexas Ethics Commission Revised 9/8/2015

6 MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A1 Jo^ef) <^< Sd^e^cJc 4 5 Full name of contributor out-ol-state PAC (ID*:. SiAn^y Y\o^e'CsLsr\pbz_\\ 6 1 Total pages Schedule A1: 7 <t g-oo.od 8 9 zfah^- Full name of contributor Q out-of-state PAC (I0#: rl\cjc-]u^\tr p, 0. Bdv SottS A*xxn \ \o T% 1 [ \&\ \00>00 Full name of contributor Q out-of-state PAC (ID#:..)>«Jl1-3U>M?osao\ou^t Arnan \\ott T utf Principal occupation / Job title(see Instructions) f)00>06 Full name of contributor Q out-of-state PAC (I0#:. >j?*)l> SY\&r\. UJ^cJ *5oO'0O ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED If contributor is out-of-state PAC, please seeinstruction guide for additional reporting requirements. Forms provided bytexas Ethics Commission Revised 9/8/2015

7 NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS SCHEDULE A2 1 Total pages Schedule A2: 4 TOTAL UNITEMI2ED IN-KIND POLITICAL CONTRIBUTIONS $0 5 6 Full name of contributor Q out-of-state pac (idi:_ 3/?/n- 7 8 Amount of Contribution $ ^ In-kind contribution description b"» Wboard A3 I ICheck if travel outside of Texas. Complete Schedule T. 10 Principal occupation / Job title (FOR NON-JUDICIAL) (See Instructions) Tl Employer (FOR NON-JUDICIAL)(See Instructions) 12 Contributor's principal occupation (FOR JUDICIAL) 14 Contributor's employer/law firm (FOR JUDICIAL) 13 Contributor's job title (FOR JUDICIAL) (See Instructions) 15 Law firm of contributor's spouse (if any) (FOR JUDICIAL) 16 Ifcontributor is a child, law firm of parent(s) (ifany) (FOR JUDICIAL) Full name of contributor Q out-of-state pac (ID*:. rthcro^$ ^?arr^--^~ Amount of Contribution $ HOI SlJ 9o44~i Ar^tr\\\omT%'^\icf\ Principal occupation / Job title (FOR NON-JUDICIAL) (See Instructions) In-kind contribution description Check if travel outside oftexas. Complete Schedule T. Employer (FOR NON-JUDICIAL)(See Instructions) Contributor's principal occupation (FOR JUDICIAL) Contributor's job title (FOR JUDICIAL) (See Instructions) Contributor's employer/law firm (FOR JUDICIAL) Law firm of contributor's spouse (if any) (FOR JUDICIAL) If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL) ATTACH ADDITIONAL COPIES THIS SCHEDULEAS NEEDED 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

8 NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS SCHEDULE A2 1 Total pages Schedule A2: 4 TOTAL UNITEMIZED IN-KIND POLITICALCONTRIBUTIONS $ 5 6 Full nameof contributor Q out-of-state pac (tot: 7 Contributor address; City; State; ZipCode \\o\ SuO 9oVK A n\)o~x^ -vwo*) 8 Amount of Contribution $ $2D0< 00 9 In-kind contribution description I ICheck if travel outside of Texas. Complete Schedule T. 10 Principal occupation / Job title (FOR NON-JUDICIAL) (See Instructions) H Employer (FOR NON-JUDICIAL)(See Instructions) 12 Contributor's principal occupation (FOR JUDICIAL) 14 Contributor's employer/law firm (FOR JUDICIAL) 13 Contributor's job title (FOR JUDICIAL)(See Instructions) 15 Law firm of contributor's spouse (if any) (FOR JUDICIAL) 16 Ifcontributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL) Full name of contributor Q out-of-state pac (tm:. Amount of Contribution $ In-kind contribution description Principal occupation / Job title (FOR NON-JUDICIAL) (See Instructions) Check if travel outside oftexas. Complete Schedule T. Employer (FOR NON-JUDICIAL)(See Instructions) Contributor's principal occupation (FOR JUDICIAL) Contributor's job title (FOR JUDICIAL) (See Instructions) Contributor's employer/law firm (FOR JUDICIAL) Law firm of contributor's spouse (if any) (FOR JUDICIAL) If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL) ATTACH ADDITIONAL COPIES THIS SCHEDULEAS NEEDED 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

9 LOANS SCHEDULE E ^CLwes X S>c^ /v^ 4 TOTAL UNITEMIZED LOANS 5 of loan 6 is lender a financial Institution? <B) 7 Nameoflender 8 Lender address; D out-of-statepac (ID#:. City; State; Zip Code Total pages Schedule E: I $o 9 Loan Amount ($) *boo >oo 10 Interest rate 11 Maturity date 14 Description of Collateral J2S none 16 GUARANTOR INFORMATION 17 Name ofguarantor 15 Check if personal funds were deposited into political iccpunt (See Instructions) 19 Amount Guaranteed ($) J^f not applicable 18 Guarantor address; City; State; Zip Code 20 Principal Occupation (See Instructions) 21 of loan Nameof lender out-of-state PAC(ID#:_ LoanAmount ($) ^) Is lender a financial Institution? fi) Lender address; City; State; Zip Code 1/?>U (bat^^^k Road Ar*)a.c>\ Wo Tt "FiioU Interest rate Maturity date Description of Collateral J?^; none GUARANTOR INFORMATION Name of guarantor Check if personal funds were deposited into political account (See Instructions) Amount Guaranteed ($) J23C not applicable Guarantor address; Principal Occupation (See Instructions) City; State; Zip Code ATTACH ADDITIONALCOPIES THIS SCHEDULE AS NEEDED If lender is out-of-state PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission Revised 9/8/2015

10 POLITICAL S MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F1 Advertising Expense Accounting/Banking Consulting Expense Contributions/Donations Made By Candidate/Officeholder/Political Committee Credit Card Payment CATEGORIES FOR BOX8(a) Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services Loan Repayment/Reimbursement OfficeOverhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor Soficitation/Furtdraising Expense Transportation Equipment& Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) 1 Total pages Schedule F1: 4 6 Amount ($) \*Xo>fft 5 Payee name Sam's Oub 7 Payee address; City; State; Zip Code (a) Category (See Categorieslistedat the topof thisschedule) pcn^toa e^pe/^e (b) Description pcio-ver \r\\l fer push Cftej^ ICheck Htravel outside oftexas. Complete ScheduleT. I ICheck ifaustin. TX, officeholder living expense 9 Complete ONLY ifdirect Candidate / Officeholder name \\*>in Amount ($) Payee name U)alM*rV 4 H<US> Payee address; City; State; Zip Code Category (See Categoriesfistedat the topofthisschedule) hnoviao >p J\5 ^ Description QQ& *&xk- fcr Du^K CAfdb I I ICheck iftravel outside oftexas. Complete ScheduleT. Check If Austin. TX. officeholder living expense Complete ONLY if direct Candidate/ Officeholder name Office hetd Payee name loe^vbom 5^ Co Amount ($) Payee address; City; State; Zip Code ICO ister-'^a-^ A^. Arr^r\\\o T* TUo/ Category (See Categories listed at the top of this schedule) advierv^nq -?{>en5c Description COi^pCl^n S\fJO$ I ICheck iftravel outside oftexas. Complete Schedule T. I ICheck if Austin. TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name ATTACH ADDITIONALCOPIES THIS SCHEDULEAS NEEDED Forms provided bytexas Ethics Commission Revised 9/8/2015

11 POLITICAL S MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F1 CATEGORIES FOR BOX8(a) Advertising Expense Accounting/Banking Consulting Expense Contributions/Donations Made By CandkJate/Offfcertolder/Political Committee Credit CadPayment 1 Total pages Schedule F1: 4 jr*tn 6 Amount ($) Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services Loan Repayment/Reimbursement OfficeOverhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/ContractLabor Jcu^g^ ^. StM^^ 5 Payee name 7 Payee address; City; State; Zip Code HMO S-CWAVer Solicttation/Fundraising Expense Transportation Equipment &Related Expense Travel In District TravelOutOf District Other(entera category not listed above) (a) Category (SeeCategories listedat the topolthisschedule) (b) Description O^V»c, 5U pli S I I ICheckiftravel outside oftexas. Complete ScheduleT. ICheck if Austin. TX, officeholder living expense 9 Complete ONLY if direct Candidate / Officeholder name Payee name Amount ($) Payee address; City; State; Zip Code Category (SeeCategories listed at thetopolthis schedule) OjWrYi&in^ *per6 _ Description NJCtrd, S'\^C\^> I ICheck if travel outside oftexas. CompleteSchedule T. L_J Check if Austin, TX. officeholder living expense Complete ONLY ildirect Candidate / Officeholder name s/qjn- Payee name 6^ P Ae>$oc>(x\e5 Amount ($) 1 \HQ>OD Payee address; City; State; Zip Code %0?> S. PoW. Category (See Categories listedat the topofthisschedule) atvoecvtsiaq e*^>er6. Description l I fo*n\ bcxajfov ^-t>\^^ Check if traveloutsideoftexas. Complete ScheduleT. I Check il Austin. TX. officeholder living expense Complete ONLY il direct Candidate / Officeholder name Formsprovided bytexas Ethics Commission ATTACH ADDITIONAL COPIES THISSCHEDULE AS NEEDED Revised 9/8/2015

12 POLITICAL S MADE FROM PERSONAL FUNDS SCHEDULE G Advertising Expense Accounting/Banking Consulting Expense Contributions/Donations Made By Candidate/Officeholder/PoliticalCommittee Credit Card Payment CATEGORIES FOR BOX8(a) EventExpense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services Loan Repayment/Reimbursement OfficeOverhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/ContractLabor The Instruction Guide explains how to complete this form Solicitation/Fundralsing Expense Transportation Equipment& Related Expense Travel In District Travel OutOf District Other(enter a category not listedabove) 1 Total pages Schedule G: 4 6 Amount ($) *loo>od 8 "Ts^TReimbursement from Jr>*politicalcontributions intended Josefs S. Sc^^ci. 5 Payee name C\\S c& Arr\aCi Mo 7 Payee address; City; State; Zip Code bo^ < >L ~V^\Asict^ Ar^\an \\o Tf\ ^R\0) (a) Category (See Categories listed at the topofthisschedule) Fees (b) Description \1, \ jf\a - ffjf ICheckil travel outside oftexwcomplete ScheduleT. Check if Austin. TX. officeholder living expense 9 Complete ONLY il direct Candidate / Officeholder name Payee name Amount ($) Payee address; City; State; Zip Code Reimbursementfrom political contributions Category (See Categorieslistedat the topofthisschedule) (b) Description ICheck iftravel outside oftexas. Complete ScheduleT. I I Check il Austin, TX. officeholder living expense Complete ONLY if direct Candidate / Officeholder name Payee name Amount ($) Payee address; City; State; Zip Code Reimbursementfrom political contributions Category (See Categories listedat the top ofthis schedule) (b) Description ICheckif travel outside of Texas. Completo ScheduleT. I Check if Austin. TX. officeholder living expense Complete ONLY il direct Candidate / Officeholder name ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED Forms provided bytexas Ethics Commission Revised 9/8/2015