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Transcription

1 CANDIDATE/ FICEHOLDER FORM C/OH CAMPAIGN FINANCE REPORT 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: {1) /.J' /~, S 3 CANDIDATE / MS I MRS / MR FIR ST Ml - FICEHOLDER NAME..... CKNAME LAST SUFFIX cto ixaaun1rv col I 1?:- flb.11j _ - 1'1='1 1-,1llSO R,,,,iza 4 CANDIDATE / ADDRESS / PO BOX: APT / SUITE #: CITY: STATE : ZIP CODE JUL FICEHOLDER MAILING ff.ye/ ('7/~cl~/~:/ b/(/~ ADDRESS EGE D Change of Address ~ p~/ ~ 7~,,9/...2- RECEIVED 5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION PRESIDENT'S ~ICE FICEHOLDER PHONE ( 7/fT c?tjf dd8"7 6 CAMPAIGN MS I MRS / MR FIRST Ml Receipt # TREASURER ~/~acld NAME... Processed NICKNA ~- SUFFIX Imaged ;;iz.m~ /oj - 7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE) ; APT / SUITE #; CITY; STATE ; ZIP CODE TREASURER ADDRESS (Residence or Business) 3.J3o // ~ 4 ~.,.-yo,d 67ftst,/ ~ - 7?f5B 8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER»s- PHONE 1/)) Y?ro uate Hand-delivered or Postmarked I Amount $ 9 REPORT TYPE D January 15 3oth day before election Runoff D D D 15th day after campaign 1reasurer appointment (Officeholder Only) D JuIy1s D 8th day before election D Exceeded $500 limit KFinal Report (Attach C/OH. FR) 10 PERIOD Month Day Year Month Day Year COVERED CJ~ / c'jc:2 / /7 THROUGH tj7/ /o / /7 11 ELECTION ELECTION DATE ELECTION TYPE Month Day Year D Primary ~Runoff D Other o'(;::, / /ti / / 7 D General D Speci~I 12 FICE FICE HELD (if any) 13 FICE SOUGHT (if known) A/tmL GO TO PAGE 2 6/~ ~ 0 P% 7 /'PS 4: ~<F~,./~,L.#-/...

2 CANDIDATE/ FICEHOLDER CAMPAIGN FINANCE REPORT 14 C/OH NAME FORM C/OH COVER SHEET PG Filer ID (Ethics Commission Filers} 16 NOTICE FROM POLITICAL COMMITTEE(S) 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. CANDIDATES AND FICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE SUCH S, CO MMITTEE TYPE COMM ITTEE NAME D O GENERAL specific CO MMITTE E ADDRE SS COMM ITTEE CA MPAIGN TREASURER NAME 0 Additional Pages COMMITTEE CAMPAI GN TREASU RER ADDRESS 17 CONTRIBUTION TOTALS 1. TOTAL POLITICAL CONTRIBUTIONS $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS}, UNLESS ITEMIZED $ 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS} $.x;t). 0 () TOTALS CONT RIBUTION BALANCE O UTSTANDING LOAN TOTALS 3. TOTAL POLITICAL S $100 OR LESS, UNLESS ITEMIZED 4. TOTAL POLITICAL S 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS TH E LAST DAY REPORTING PERIOD 6. TOTAL PRINCIPAL AMOUNT ALL OUTSTANDING LOAN S AS THE LAST DAY THE REPORTING PERIOD $ $ <J7~ -1.3 $ /~- IO $ AFFIDAVIT ~ I PAMELA L PAYNE I Notary ID # I I My Commission Expires I I I.,,,,.o,@ Jan 21, 2021 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 Signature ~didate or Office holder AFFIX N OTARY STAMP / SEAL ABO VE D-en / s-e I<. t.t ~u Jo.../-Al Sworn to and subscribed before me, by the said, this the day of TIA Jy, 20 / J, to certify which, witness my hand and seal of office. Pwwu.1A;t /J~ Peun~/Pi- L. /Jv!Ajn e S ignature of officer admin istering oath Printed na m e o f officer administering o ath Title of officer administering oath Forms provided by Texas Ethics Commission state.tx.us Revised 9/8/2015

3 SUBTOTALS - C/OH FORM C/OH COVER SHEET PG 3 19 FILER NAME 20 Filer ID (Ethics Commission Filers) 21 SCHEDULE SUBTOTALS SUBTOTAL NAME SCHEDULE AMOUNT 1. D SCHEDULE A 1: MONETARY POLITICAL CONTRIBUTIONS $ -5't:J().c,() 2. D SCHEDULE A2: NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS $ ~ t)t}c} 3. D SCHEDULE B : PLEDGED CONTRIBUTIONS $ -o- 4. D SCHEDULE E: LOANS $ - C) - 5. D : POLITICAL S MADE $ %7-7-/3 6. D SCHEDULE F2 : UNPAID INCURRED OBLIGATIONS $ D SCHEDULE F3: PURCHASE INVESTMENTS MADE $ D - - SCHEDULE F4: S MADE BY CREDIT CARD $ 0 9. D - SCHEDULE G : POLITICAL S MADE FROM PERSONAL FUNDS $ c) 10. D SCHEDULE H : PAYMENT MADE TO A BUSINESS C/OH $ D SCHEDULE I: NON-POLITICAL S MADE $ --D 12. D SCHEDULE K : INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS $ u - RETURNED TO FILER -

4 MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A1 2 FILER NAME The Instruction Guide explains how to complete this form. 1 Total pages Schedule A 1: i)u//s/4- b?-zc:j 3 Filer ID (Ethics Commission Filers) 4 5 Full name of contributor 0 out-of-state PAC (ID#: \ 7 Amount of contribution ($) 8 &/411 /kl f//t/,r p?t:j f;cjo. tj c) 6 Contributor address; City; State; Zip Code &/, /~/ 7Y. 7ff/.,J- Prid~;;;;;;ob :;}=;:;t:~, 5 c)/,4j:;mployer (See:;;;) Full name of contributor 0 out-of-state PAC (ID#: \ Amount of contribution ($)..... Contributor address; City; State; Zip Code Pri ncipal occupation / Job title (See Instructions) Employer (See Instructions) Full name of contributor 0 out-of-state PAC (ID# : \ Amount of contribution ($) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Full name of contributor 0 out-of-state PAC (ID#: Amount of contribution ($).. Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.

5 NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS SCHEDULE A2 2 FILER NAME The Instruction Guide explains how to complete this form. l)di/j 8;-ccJ,_,., 4 TOTAL UNITEMIZED IN-KIND POLITICAL CONTRIBUTIONS $ 1 Total pages Schedule A2 : 3 Filer ID (Ethics Commission Filers).. Contribution $ description a;,.,/ I. 7 /¾4' Contributor address; :7. hhl/4~ City; State; Zip Code ~tjo /4 ~t/z/ 5 6 Full name of contributor 0 out-of-state PAC (ID#: I 8 Amount of 9 In-kind contribution ~/ J)tJ'/ ~/f/qu,/'/4 /444' ll. 7~1107. c't1#~1- Dcheck if travel outside of Texas. Complete Schedule T. 10 Principal occupation I Job till~ (FOR NON-JUDICIAL) (See Instructions) 11 Employer (FOR NON-JUDICIAL)(See Instructions) 12 Contributor's principal occupation (FOR JUDICIAL) 13 Contributor's job title (FOR JUDICIAL) (See Instructions) 14 Contributor's employer/law firm (FOR JUDICIAL) 15 Law firm of contributor's spouse (if any) (FOR JUDICIAL) 16 If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL) Full name of contributor 0 out-of-state PAC (ID#: l Amount of In-kind contribution Contribution $ description Contributor address; City; State; Zip Code Principal occupation / Job title (FOR NON-JUDICIAL) (See Instructions) 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 SCHEDULE AS 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

6 POLITICAL S MADE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan RepaymenVReimbursement Solicitation/Fundralsing Expense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In District Contributions/Donations Made By GifVAwards/Memorials Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other ( enter a category not listed above) Credi! Card Payment The Instruction Gulde explains how to complete this form. 1 Total pages Schedule F1 : 2 FILER NAME 13 F iler ID (Ethics Commission Filers) 4 Dal % /~Is-- 5 ~./1/., /l_ sr~ 6 Amounf ($) 1 7 Payee address; C ity ; State; Zip Code /tj. 0/ /7~,,,,/,,;,:;: /4.-.,,._ "")7M/4 /_;}- 8 (a) Category(See Categories listed at the top of this schedule) (b) Desc ription fa,t/,8 ;?~~ D Check if Austin, TX, officeholder livi ng expense ~/Y-,e/S 9 Complete ONLY if direct Candidate I Officeholder name Office sought Office held ~/f'//;-- // t7 JS/ p.;4-~ ~ounf' ($ ) Payee address; '--' C ity; State; Zip Code ~71/ ~otjy A/ ~J~ 0~ 7x Category (See Categories listed at the top of this schedu le) Desc~iption ho~!/ /3,f t/~.#f,ii. /~,J?;,lt/ ~ - D Check if travel outside oftexas. Complete Schedule T. D Check ii Austin, TX, officeholder living expense Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefi t C/OH i r/15 he AJa~ Amo'unt ($ ) Payee addres s ; City; State; Zip C ode ' ;Jr.r~ E XPENDITURE /;//?e~,uz ~,fy' #,c/~ /,;m_ ~/k* ~ 7<,.,- ~., r C ategory (See Categories listed al the top of this schedule) fit?$/ o/k/.r.. _ D Check if Austin, TX, officeholder living expense,/klv/i,,r.,,f J'Qt.e/Jr Complete ONLY if direct Candidate I Officeholder name Office sought Office he ld ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission Revised 9/8/201 5

7 POLITICAL S MADE CATEGORIES FOR BOX S(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 Distri ct Contributions/Donations Made By GifVAwards/Memorials Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above) Credit Card Payment The Instruction Gulde explains how to complete this form. 1 Total pages Schedule F1 : 2 FILER NAME 13 Filer ID (Ethics Commission Filers) /~,ht/i)/: fh ~/2h Payeenam8h:. //_ ~ 7 1; /,,.,,,, ~/4/7or 6 Am~nt ($Y 7 Payee address; City; State; Zip Code :3c/. 17 //.;'~o ~/#/2 ~/t/ ~/4-a 8 (a) (b) D Check if Austin, TX, officeholder living expense ~~/4-=H-fd, 9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held ~/r/;7 /4a/ S Amoifiit ($)' Payee address; City ; State; Zip Code /:3;;. (,/ "7)# M-.r~.,/:tLJLJ ~/ / 4?1/ 77 ~~;ij d/f/1/ D Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held i~~7 4Lc;,/l/ 7~ g~~ Amount ($) Payee address; City ; State; Zip Code c23. If' 3.0r /41 /fl,46,bc/ja tf//4jo J?~c1/ d,,, //i#f /4- ~,e,'f/j /.i:_ D Check if Austin. TX, officeholder living expense Complete ONLY if direct Candidate I Officeholder name Office sought Office held ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED

8 POLITICAL S MADE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan RepaymenVReimbursement Solicitation/Fundraising Expense A=unting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In District Contributions/Donations Made By GifVAwards/Memorials Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above) Credit Card Payment The Instruction Gulde explains how to complete this form. 1 Total pages Schedule F1: 2 FILER NAME /-;}~,1(//,,fL ~2"0 13 Filer ID (Ethics Commission Filers) 4Dat~/~/ 7 5 r7ffic~-hl 6 Amm/nt ($( 7 P ayee address; C ity; Sta te; Zip Code ell ~7 8 (a) (b) /",&'/ / 5~~~. D Check if travel outside of Texas. Complete Schedule T. D Check if Austin. TX, officeholder living expense 9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held ~ )/1 ~/~e,c/f Amo unt ($) Payee address; C ity; State; Zip Code /J.7y //~tj ~~/!//~&' i) ///4e1?? Category (See Categori es listed at the top of this sched ule) ~~ f"' / 81' v" 7F97 ~m-7'a ~J#5/ 7 ;,:, /..J-,JE~A:- c:;)µ/j/~ ~,,u~-/~//. rnlr</'-f D Check if travel outside oftexas. Complete Schedule T. D Check if Austin, TX, officeholder living expense Complete ONLY if direct C a ndidate / Officeholder name Office sought O ffice held ~ J/j7 ~;//~,;; b1~'1~ Afno un( ($) Paye e address; C ity; State; Zip Code /j. ~r ~J{f',:E~r ~/)L) /d-/ $//4v /Y 7fl'/'> ~ ~cl/ g t/,;f/t~/f-- D Check if Austin. TX, officeholder living expense Complete ONLY if direct Candidate / Office holde r name Office sought Office held ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED Forms p rovided by Texas Ethics Commission Revised 9/8/2015

9 POLITICAL S MADE CATEGORIES FOR BOX 8(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 District Contributions/Donations Made By GifVAwards/Memorials Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal SeJVices Salaries/Wages/Contract Labor Other (enter a category not listed above) Credit Card Payment The Instruction Gulde explains how to complete this form. 1 Total pages Schedule F1 : 2 FILER NAME 4Da~/4~ 7 5 Payee n a me a/4' A#A'I'/< U/.A~~k 6 A rri6unt.1($) ' 7 Payee address; r C ity; State; Z ip Code ;ljtjo 7fo/ ~~;~ C//4~ 7X 7?J/:J.- 13 Filer ID (Ethics Commission Filers) 8 (a) Category (See Categories listed al the top of this schedule) (b) L,J,ta~.e ~ D Check if Austin, TX, officeho lder living expense _:Z"d,a: #7e'1Jt.de,/.S- 9 Complete ONLY if direct Candidate I Officeholder name Office sought Offic e held expenditure to benefit C/O H D;ft~l 6~ /< Amount ($} Payee address; City; State; Zip Code /l6-7r ~ttf?> ~~~A'- /#k ~//40/ ~ Category fajf~/c/ (See Categories listed al the top of this schedule) &~..-f,ic/j,1 _ D Check if travel outside oftexas. Complete Schedule T. D Check if Austin, TX, officeholder living expense Complete ONLY if direct Cand idate I Officeholde r name Office sought O ffice held ~/9fa7 r~al ~/~ $ Al'fiount ($) Payee address; City ; State; Zip Code 3~.J. /7 ~~,2-,s- g~av.7 o~ 4~ C17,,C-/, - 7/ '7:?f-2J- Category (See Categories listed al the lop of t{;s schedule) D Check if Austin, TX, officeho lder living expense ~/PS Complete ONLY if direct C a ndidate I Officeholde r name Office sought Offic e he ld ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED Forms p rovided by Texas Ethics Commission Revised 9/8/2015

10 POLITICAL S MADE 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 District Contributions/Donations Made By GifVAwards/Memorials Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other ( enter a category not listed above} Credit Card Payment The Instruction Gulde explains how to complete this form. 1 Total pages Schedule F1: 2 13 Filer ID (Ethics Commission Filers) FILER NAME/) btt a Rfi'Z 0 4 Dal~~,,,t// W /,l/ l"2,,e EL"~/.f' 6 AmOL.fnt ($) 7 Payee address; City; State; Zip Code ~-13 tf?~,a/. /?LJ/4/Z- G? /4,se, 72 /?Ji",/~ / 8 (a) (b) C/1-711/:J#?/,.; D Check if Austin, TX, officeholder living expense 777~-~# ~ _,.,~,z-'j'",t _. 9 Complete ONLY if direct Candidate I Officeholcfe"r name Office sought Office held ~~-2//7 d/o//4 _57};z, Am6'unt ($) 1 Payee address; City; State; Zip Code c:jf. tj7 7ivt/ Al. ~J4 //4~~ '/)(??J?/>-- C,,417Yl//l-/#~ ~A2«,,t:-,L)ttw~ ~~/// s/4-- D Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held ~ /-2-~7 ~ A//' /2 5~ Amount ($) Payee address; City; State; Zip Code /t?. T/ 7~~CJ /1"/ ~f.,# ~ /4d.?X 7? //.,,J-~ ~/!_A'-7'/?,,;; 7/9/a-,o~/l/' ~.1-". ---/.'"",e D Check if Austin, TX. officeholder living expense Complete ONLY if direct Candidate I Officehfflder'hame Office sought Office held ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED

11 POLITICAL S MADE CATEGORIES FOR BOX 8(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 District Contributions/Donations Made By GifVAwards/Memorials Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other ( enter a category not listed above) Credit Card Payment The Instruction Gulde explains how to complete this form. 1 Total pages Schedule F1 : 2 FILER NAME 13 Filer ID (Ethics Commission Filers) 4 D~~!fa7 /,/$?/ltftt?70 5 g,,;6 /~ ;;r.,,c/9-/7?/ / z._ 6 Arl}6unt ($}/' 7 Payee address; ~ ; State; Zip Code 7tt- otj &?//71-u c?or Pn?v,;//4 ~ - / 77< 7/"6't77 8 (a) (b) D Check if Austin, TX, officeholder living expense 5/f~/ ~#lov;_/ 9 Complete ONLY if direct Candidate I Officeholder name Office sought Office held ~ /~/7 L ~~~s- An1'ount ($) " Payee address; City; State; Zip Code -, D Check if travel outside oft exas. Complete Schedule T. D Check if Austin, TX, officeholder living expense /I :z( 1/3cJ. ~ R/f.tJ J ~LJ. '/ A.svJ TY?JJ'JP/ ;)..~ _;;;;~ >!!~-k ~ ~'71//P--/ Complete ONLY if direct Candidate I Officeholder name Office sought Office held ~ 3d /!? ~4-~Aw/< b~,1w-(!_k A'mount ($) Payee address; ' City; State; Zip Code ~ CJ p '77({1/ ~/5~/ 0/40/ ~?r.?/- 2 _g.,et1//c'. <!~L D Check if Austin. TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED

12 POLITICAL S MADE Advertising Expense Accounting/Banking Consulting Expense Contributions/Donations Made By Candidate/Officeholder/Political Committee Credit Card Payment CATEGORIES FOR BOX 8(a) Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services Loan Repayment/Reimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor The Instruction Gulde explains how to complete this form. Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other ( enter a category not listed above) 1 Total pages Schedule F1: 2 FILER NAME /),;-) ~?,: / /7 Amount ($S /t. rju 5 / //M/J'.f/4- /C#Zv (a) Category (See Categories listed at the top <Yf'lhis schedule) Filer ID (Ethics Commission Filers) (b) D Check if travel outside oftexas. Complete Schedule T. D Check if Austin, TX, officeholder living expense 9 Complete ONLY if direct Candidate I Officeholder name Office sought Office held Amount ($) Payee address; City; State; Zip Code D Check if travel outside oftexas. Complete Schedule T. D Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate I Officeholder name Office sought Office held Amount ($) Payee address; City; State; Zip Code D Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate I Officeholder name Office sought Office held ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED

13 CANDIDATE/ FICEHOLDER REPORT: DESIGNATION FINAL REPORT FORM C/OH - FR The Instruction Guide explains how to complete this form. Complete only if "Report Type" on page 1 is marked "Final Report" 1 C/OH NAME 2 Filer ID (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 a ointment on file. 4 FILER WHO IS NOT AN FICEHOLDER Complete A & B below only if you are not an officeholder. A. CAMPAIGN FUNDS Check only one: D 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 B. ASSETS income earned on political contributions in accordance with the requirements of Election Code, Check only one: D I do not retain assets purchased with political contributions or interest or other income from political contributions. D 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, , 5 FICEHOLDER Complete this section only If you are an officeholder D 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