ADDRESS / PO BOX; APT i SUITE #: CITY: STATE; ZIP CODE. [] January15 [] 30th day before election [] Runoff []

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, 3 CANDIDATE / MS / MRS / MR FIRST MI FICE USE ONLY FICEHOLDER NAME... 4 NICKNAME LAST SUFFIX Received,4.-ÿci - / # 4 CANDIDATE/ FICEHOLDER MAILING ADDRESS [] Change of Address 5 CANDIDATE/ FICEHOLDER PHONE 6 CAMPAIGN TREASURER NAME ADDRESS / PO BOX; APT i SUITE #: CITY: STATE; ZIP CODE AREA CODE PHONE NUMBER EXTENSION <ÿ<ÿi) ÿlÿ- g oÿ.ÿ, ==, =ÿs)ÿ./, FIRST# p/.4z//, /'],.ÿ r M I... SUFFIX " " " NICKNAME LAST ÿjtÿ y/ad,,, Harltl-delivÿred or Dale Postmarked laÿho Receipt # Amount Processed Imaged 7 CAMPAIGN TREASURER ADDRESS (Res dence or Business) STREET ADDRESS (NO<PO BOX PLEASE); ART)/ SUITE #" CITY; STATE; itzx ZIP CODE 8 CAMPAIGN TREASURER PHONE AREA CODE PHONE NUMBER EXTENSION 9 REPORT TYPE [] January15 [] 30th day before election [] Runoff [] v [] July15 ÿtstheaybeforeelection [] Exceedea5001imit [] 15th day after campaign treasurer appointment (Officeholder Only) Final Report (Attach CiOH - FR) 10 PERIOD COVERED Month Day Year.3/,9 /d#ld THROUGH Monlh Day Year 11 ELECTION ELECTION DATE ELECTION TYPE Month Day Year ] Primary [] Runoff [] General [] Special r,pt,on t / J 12 FICE FICE HELD (if any) 13 FICE SOUGHT (if known) /Tr,<D.;+ i 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... "ÿ /ÿ' ÿ t. =.jÿ, j ÿ ÿ 15 Filer ID (Ethics Commission Fliers) 16 NOTICE FROM " THIJBO"X IS FOR NOTICE OI.ÿ1 F POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL S MADE BY POLITICAL COMMITTEES TO POLITICAL SUPPORT THE CANDIDATE / FICEHOLDER. THESE S MAY HAVE BEEN MADE WITHOUT THE CANDIDATErS OR FICEHOLDERWS COMMITTEE(S) KNOWLEDGE OR CONSENT. CANDIDATES AND FICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE SUCH S, COMMITTEE TYPE --]GENERAL --ISPECIFIC COMMITTEE A[ÿ 3RESS COMMITTEE CAMPAIGN TREASURF-ÿ NAME / ÿ,ÿ [] Additional Pages 17 CONTRIBUTION TOTALS TOTAL POLITICAL CONTRIBUTIONS 50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS), UNLESS ITEMIZED TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS) J?yg < TOTALS CONTRIBUTION BALANCE OUTSTANDING LOAN TOTALS 3. 4, 5, 8. TOTAL POLITICAL S 100 OR LESS, UNLESS ITEMIZED TOTAL POLITICAL S TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS THE LAST DAY REPORTING PERIOD TOTAL PRINCIPAL AMOUNT ALL OUTSTANDING LOANS AS THE LAST DAY THE REPORTING PERIOD +-J JS?, Jl + iyz/f _.ÿ ÿ,.ÿ -,,,ÿ ÿ _o..v** -... ÿ,',4"ÿ, ÿ# o1"aÿiy,ÿ*" I swear, or affirm, under penalty,ÿ, of perjury, -ÿ that... the accompanying report is,ÿxÿ':; ÿ _ ÿ % ÿ ÿ true and correct and mcludes all lnformatÿon requÿred to be reported by me L.+ ÿ..fÿi Y..- ; ÿ'ÿ_,,ÿ under Ttrllÿl 5 Ele'ÿion Code..+..,.. "rt \"ÿ m... o,. Oÿ ÿ ÿ ÿ. ' / J ÿ / = l,,,o Jÿ['ÿ io= ÿ 'ÿf'. C tl,<,. /,,ÿ -,'.V.ÿ 'ÿ SI nature of Candidate or Oficeholder -,,ÿ, "-' I,.-**,+. ÿ 2e0 g -- #llllllltÿ, ] //..ÿ t" Sworn to andfisubscribed, before me, by the said ÿ/tj/(ÿ,i--ÿ/ÿ.+p--! Eÿ, ;+.ÿ+ (ÿ ÿ, Jjÿ..,this the +,ÿ: --) day of i,ÿ+,ÿ'ÿiÿ.)./l./ ], 20ÿ,-- to certify which, witness rny hand and sealof office. Ggzÿe ÿ+ officer administe(iÿg oÿaÿi Printed nametÿ of o;ficer administering ÿath' Title of off,lcer adÿ,,nidr,ng oath Forms provided by Texas Ethics Comrnission Revised 9/8/2015

3 SUBTOTALS - C/OH FORM C/OH COVER SHEET PG 3 19 FILER NAME,.ÿ ÿ 20 Filer ID (Ethics Commission Filers) 21 SCHEDULE SUBTOTALS NAME SCHEDULE SUBTOTAL AMOUNT 1. dÿ SCHEDULE A1 : MONETARY POLITICAL CONTRIBUTIONS 3. Iÿ 4. [] SCHEDULE A2: NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS SCHEDULE B: PLEDGED CONTRIBUTIONS SCHEDULE E: LOANS 5. ÿ'ÿ SCHEDULE FI: POLITICAL S MADE FROM POLITICAl_ CONTRIBUTIONS 6. I--] 7. F-] 8. [ÿ] 9. I-q 10. [ [ÿ 12. [] SCHEDULE F2: UNPAID INCURRED OBLIGATIONS SCHEDULE F3: PURCHASE INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F4: S MADE BY CREDIT CARD SCHEDULE G: POLITICAL S MADE FROM PERSONAL FUNDS SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS C/OH SCHEDULE I: NON-POLITICAL S MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED TO FILER Forms provided by Texas Ethics Commission Revised 9/8/2015

4 MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A1 1 Total pages Schedule AI:ÿ 2 FILER NAMEÿj: f)ÿ,,,ÿ.ÿ/ÿ:ÿ7ÿiyÿ/ÿÿ",.. ÿ..ÿt/ÿÿÿ/ÿd/ÿ)/- 3 Filer ID (Ethics Commission Fliers) 4 5 Full name o.f contributorÿ ÿ,el out-of-state PAC (ID#:..) 7 ÿ..ÿlount of contribution () 6 Contributor ad#dress;ÿ., ÿ" 8 9 Full name of contributor [] out-opstate PAC (ID#:... ) Amount of contribution () ;ontr,buio r;ss;... City; Stat:; ZipOÿe ÿ/ i i Full nameÿf contributor. [] out-ofstaleÿpac (ID#:... ) Amount of contribution ()tt.=rÿ, ÿ'* ' " Coniribu;or address;" /... City;ÿode... %ÿl&f /ÿ'ÿÿÿ Full name of coÿntributor. [] 0ut-ÿfÿtate P,ÿC (IDÿ(I:..) Amount of contribution () Contributor address: ')qq t Employer (ÿ ee Instructions) I 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

5 MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A1 2 FILER NAME - I -. ÿ. -/. - 1 Total pages Schedule AI: 2! 3 Filer ID (Ethics Commission Fliers) 4, 5 Full name of contributor [] out-of-state PAC (ID#:.) ' ÿ y,ÿ,... c-r,... 7 Amount of contribution () 8 6 Contributor address; 206tZ ol,,#+ ÿ:ÿp,. ÿ.ÿ /?I. 9 D=t, ] Full name of contributor [] 0ul-ol-state PAC (ID#:... ),ÿ//... Amount of contribution () Contributor address: siÿ/ÿ,ÿ(7,/4 ÿ/xÿ ÿ ÿn, Full name of contributor [] oul-of-state PAC (ID#:... ) Amount of contribution ().ÿÿ,ÿ,.lt..ÿ,if... Contributor address: FuJI name, of contributor [] Cut-of-state PAC (IO#: _) Amount of contribution () p - _,ÿ : :, ;,l<d- >:ÿ,. ' l ÿl! " <7ÿ A'FrACH 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 MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A1 FILER NAME / 1 Total pages Schedule AI: 3 Filer ID (Ethics Commission Filersj 4 5 Full name of contributor [] out-of-state PAC (ID#:.) 7 Amount of contribution () ' ÿ 6 Contributor add4ÿss; 8 9 Full name of contributor [] out-of-state PAC (ID#:... ) Amount of contribution () l,i j.. ÿ.ÿort ÿaÿdÿ.drÿes:2t'ÿ'ÿ.ÿcity State Zl Cod ÿ.2 f.,-/x :/ f - oiÿcupation / Job title (See Instructions),, ÿr ÿ ÿnstructions)- Full name of contributor [] out-of-state PAC (ID#:... ) Amount of contribution () Contributor address; I Full name of contributor [] out-of-state PAC (ID#: Amount of contribution () I... Contributor address; 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 9/8/201

7 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 BOX 8(a) Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services Lean Repayment/Reimbu rsement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) 1 Total pagÿscheduÿl: 2 FILER NAME /'ÿ -ÿ ÿ,,ÿ.,, 3 Filer ID (Ethics Commission Fliers) i ate 'zf'4 [i 5 Payeeÿna.e ÿ1.ÿ..f'/ """7 " '" ÿ'q//i!ÿ! 7 (a) Category (See Categories listed at the top of Ihis schedule) (b) Description [ÿ] Check if travel outside of Texas. Complete Schedule T,,ÿ / C4t.ÿ bÿ [ÿ Cheek if Austin, TX, officehoider livh, g expense 9 hild J,dÿ,qt (i) "ssn P a'yee addresst; City;?kÿ ZiP C fitiÿ s-i & ", Category (See Categoiies listed at the top of this schedule) J?/tmo Description [ÿ Check ff travel outside of Texas. Complete Schedule T, E_ÿ_ Cheek if Austin, TX, officeholder living expense Category (See Categories listed ÿthe top of lhis schedule),ÿ I Description Eÿ Check if travel outside of Texas. Complete Schedule T. -] Check if Austin. TX, officeholder living expense # ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission Revised 9/8/2015

8 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 -1- Total pages Schedule FI: CATEGORIES FOR BOX 8(a) Event Expense Fees Food/Beverage Expense Gift!Awards/Memorials Expense Legal Services Loan RepaymenVReimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries!Wages/Contract Labor 2 FILER NA E.. ÿ " ÿ, ÿ, o Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) 3 Filer ID (Ethics Commission Fliers) 5,. ( "' ÿ i,ÿ..,,ÿ ;ÿ"ÿ "/ ÿ'ÿ I 7 - ' - City; StaG; Zip Code ' (a) Category (See Categories listed at the top of It)is schedule) (b) Description [ÿ Check if travel outside of Texas, Complete Schedule T, Eÿ Check it Austin, TX, officeholder living expense Amount Category (See Categories listed at the top of this schedule) Description..ÿ,ÿ't"ÿ- i/.ÿ [] Clÿeck if Austin, TX, officeholder living expense &F51;,ÿ'ÿdÿt//ÿ' Eÿ]Ch eckiftravel ou tside of ]exas. Complete Schedule r.. ount ().,,ÿ, ategory [See Categories listed at the top of ÿs schedule) / Description D Check if travel outside of Texas, Complete Schedule T, []Check if Austin, TX, officeholder living expense Candidate / Officeholder name Office sought Office held ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission Revised 9/8/2015

9 POLITICAL S MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F1 Advertising Expense Accounting/Banking Consulting Expense Contributions/Donations Made By Candidate/Of fice holder/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 SalariesANagesiContraet Labor Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) I Total pages Schedule ÿ.ÿ FI: 2 FILERÿAME /% ÿ.ÿ 3 Filer ID (Ethics Commission Fliers) 4 ÿjÿj//ÿ.ÿÿ1jÿ/ 5 Payee ha/he ÿ H 6 AmoLint () (a) Category (See Categories listed at the top of this schedule) ---]Check if travel outside of Texas Complete Schedule T. Eÿ Check if Austin, TX, officeholder living expense Amount () ' Yi ss; tcategory (See g Description [ÿ Check if travel outside of Texas. Complete Schedule T. Eÿ Clÿeck if Austin. TX, officeholder living expense.ÿ1ÿÿ/ unt (ÿ Paybe address; ' y; State; Zip Code /-iw5.. - K Category (See Categ:ies list ed aÿp( of tiÿ;ihedule) Description [ÿ Check if travel outside of Texas. Complete Schedule T. F/iÿÿ Eÿ Check if Austin, TX, officeholder living expense ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED 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 BOX 8(a) EventExpense Fees Food/Beverage Expense Gifb"Awards/Memodals Expense LegalServiees Loan Repayment/Reimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/WagesiCont tact Labor Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) I Total pages Sche 2 FILER NAM 3 Filer ID (Ethics Commission Fliers) 5 6 Amount () 7 City; Zip Codf 8 (a) Category (See Categories listed at the top of this schedule) (b) Descriptio/ [ÿ Check if travel outside of Texas. Complete Schedule T. 9 /City; State;/'Zip Code Category (See Categories listed at the top el this schedule) Description [ÿ Check if travel outside of Texas, Complete Schedule T. [ÿ] Check if Austin, TX, officeholder living expense./ÿ9 unt ().4 Payee nÿme t *,, lth/," Category (See Categories listed at the top of this schedule) ;ription []Check if travel outside of Texas. Complete Schedule T. [ÿ Check if Austin, TX, officeholder living expense Complete _O.Iÿ.LY if direct Candidate! Officeholder name Office sought Office held ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED i Forms provided by Texas Ethics Commission Revised 9/8/2015

11 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 1 Total pages SchWe F1 CATEGORIES FOR BOX 8(a) EventExpense Fees Food/Beverage Expense Giÿ'Awards/Memorials Expense LegalSewices Loan Repayment/Reimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) 3 Filer ID (Ethics Commission Fliers) 4 " ÿ" "J ÿ; 6 Am ciunt (ÿ.ÿ.ÿ/ÿa#r -t 8 5 ÿi!ÿ.ji/.ÿ, ÿ.ÿ:6 ÿj ÿif4 7 //-/'2' i/v, (a) Category (See Categor es isled at the top of h s schedu eÿ (b) ion [ÿ Check if travel outside of Texas. Complete Schedule T. Iÿ] Check if Austin, TX, officeholder living expense 9 /Og Category (See Categories listed at the top of this schedule) I ---]Check if travel outside of Texas. Complete Schedule T. 1ÿ Check if Austin. TX, officeholder living expense L, andfdate i Officeholÿer name Office sought Office held ; "7ÿÿlÿStaÿtt;; ';,p Code Category (See Categories listed at the top of lhis schedule) Descriptioÿ D Check if travel outside of Texas, Complete Schedule T, -ÿ ÿft(ÿ. ÿ "ÿÿÿ 'ÿ: [ÿ Check if Austin, TX, officeholder living expense ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission Revised 9/8/2015