CANDIDATE I 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 FICEHOLDER NAME 1 Filer ID (Ethics Commission Filers) 2 Total pages filed: Date Received... NICKNAME LAST SUFFIX I FICE USE ONLY 4 CANDIDATE! FICEHOLDER MAILING ADDRESS Change of Address 5 CANDIDATE! FICEHOLDER PHONE ( ) ADDRESS / P0 BOX; APT / SUITE #; CITY; STATE; ZIP CODE f AREA CODE PHONE NUMBER EXTENSION Date Hand-delivered or Date Postmarked 6 CAMPAIGN MS / MRS/ MR FIRST MI Rece pt # Amount TREASURER V NAME Date Processed........ NICKNAME LAST SUFFIX Dale Irf aged sm 7 CAMPAIGN TREASURER (Residence or Business) STREET ADDRESS (NO P0 BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE 1613 8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE ( )776-1- 1-1 7 9 REPORT TYPE El January 15 Ed 30th day before election Runoff LII July 15 8th day before election El 15th day after campaign treasurer appointment (Officeholder Only) Exceeded 500 fruit Final Report (Attach C/OH - FR) 10 PERIOD Month Day Year Month Day Year COVERED 0 THROUGH /j I Z0t3 11 ELECTION ELECTION DATE ELECTION TYPE LI Primary 1:1 Runoff LI Other Month Day Year // Special // 6 Description 12 FICE FICE HELD (it any) 13 FICE SOUGHT (if known) -.k GO TO PAGE 2 Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 918/201b
CANDIDATE I FICEHOLDER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 2 14 C/OH NAME ;V\e 2 Gkt 7L' 15 Filer ID (Ethics Commission Filers) 16 NOTICE FROM THIS BOX IS FOR NOTICE POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL S MADE BY POLITICAL COMMITTEES TO POLITICAL SUPPORT THE CANDIDATE / FICEHOLDER. THESE S MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR FICEHOLDER'S COMMITTEE(S) KNOWLEDGE OR CONSENT. CANDIDATES AND FICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE SUCH S. COMMITTEE TYPE COMMITTEE NAME GENERAL SPECIFIC COMMITTEE ADDRESS COMMITTEE CAMPAIGN TREASURER NAME Additional Pages COMMITTEE CAMPAIGN TREASURER ADDRESS 17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS 50 OR LESS (OTHER THAN TOTALS PLEDGES, LOANS, OR GUARANTEES LOANS), UNLESS ITEMIZED 2-2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS), TOTALS 3 TOTAL POLITICAL S 100 OR LESS, UNLESS ITEMIZED () - 4. TOTAL POLITICAL S CurKDsJ BALANCE ( q / 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS THE LAST DAY REPORTING PERIOD, OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT ALL OUTSTANDING LOANS AS THE LOAN TOTALS LAST DAY THE REPORTING PERIOD 18 AFFIDAVIT I swear, or affirm, Under penalty of perjury, that the accompanying report is ffi true and correct and includes all information required to be reported by me under Title 15, Election Code. thou Signature PJJAF-z ateor Officeholder AFFIX NOTARY STAMP / SEALABOVE Sworn to and subscribed before me, by the said -, this the day of, 20, to certify which, witness my hand and seal of office. 2) Signature of officr administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.statetx.us Revised 9/8/2015
SUBTOTALS C/OH FORM C/OH COVER SHEET PG 3 19 FILER NAME V\614ia. Gkze 21 SCHEDULE SUBTOTALS NAME SCHEDULE 20 Filer ID (Ethics Commission Filers) SUBTOTAL AMOUNT 1. SCHEDULEA1: MONETARY POLITICAL CONTRIBUTIONS 00-2. SCHEDULE A2: NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS 3 SCHEDULE B: PLEDGED CONTRIBUTIONS 4. SCHEDULEE: LOANS 5. SCHEDULE Fl: POLITICAL S MADE FROM POLITICAL CONTRIBUTIONS 6. SCHEDULE F2: UNPAID INCURRED OBLIGATIONS J 7 SCHEDULE F3: PURCHASE INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS 8. f 71 SCHEDULE F4: S MADE BY CREDIT CARD 9 SCHEDULE G: POLITICAL S MADE FROM PERSONAL FUNDS 10. El 11, El SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS C/OH SCHEDULE I: NON-POLITICAL S MADE FROM POLITICAL CONTRIBUTIONS 12 SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED TO FILER Forms provided by Texas Ethics Commission www.ethics.state.tx.us Hevisecl 9/8/2UTh
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al 1 Total pages Schedule Al: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 Date 5 Full name oi contributor E out-of-state PAC (ID#: 7 Amount of contribution () z c 6 LO(O &, Piciec NC' 37 V5 8 9 Date Full name of contributor D out-of-state PAC (td#: Amount of contribution () 9.O0 (j QV- 1OOI4 Pk T)( Date Full name of contributor LI out-of-state PAC (ld#: Amount of contribution () - Contributor address; City; - State; - Zip Code 2f4O Ro1eo i Avo 0 7, Y 7797 - - Date Full name of contributor LI out-of-state PAC (ld#: Amount of contribution () 3Dt eà\je ouclltx, 15N7 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 wwwethics.state.txus Revised 9/8/2015
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al 1 Total pages Schedule Al: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 Date 5 Full name of contributor J out-of-state PAC (ld#: 7 Amount of contribution () tk Gozô (2 ( 6 Contributor address; City; sate; Zip Code q 0 '* TX 71'3.Ị 8 9 Date Full name of contributor out-of-state PAC (ld#: Amount of contribution () Date Full name of contributor D out-of-state PAC (ID#: Amount of contribution () Date Full name of contributor D out-of-state PAC (ld#: Amount of contribution () 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 www.ethics.state.tx.us Revised 9/8/2015
S MADE BY CREDIT CARD SCHEDULE F4 CATEGORIES FOR BOX 10(a) Advertising Expense Even! 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 District Contributions/Donations Made By Gift/Awards/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) 1 Total pages Schedule F4: 2 FILER NAME, c tc& 4 TOTAL UNITEMIZED S CHARGED TOACREDIT CARD 5 Date '/) Ii% 6 Pay e name OW C Vi ec 7 Amount () 8 Payee address; City; State; Zip Code MI bi TYPE [J Political El Non-Political 3 Filer ID (Ethics Commission Filers) 10 (a) Category (See Categories listed at the top of this schedule) (b) Description Check if travel outside of Texas. Complete Schedule T. EliCheck if Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held Date Payee name Amount () Payee address; City; State; Zip Code TYPE Political El Non-Political Category (See Categories listed at the top of this schedule) Description Check if travel outside of Texas. Complete Schedule T. LII 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 Forms provided by Texas Ethics Commission wwwethicsstatetxus Revised 9/8/2015
POLITICAL S MADE FROM PERSONAL FUNDS SCHEDULE G 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 District Contributions/Donations Made By Gift/Awards/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 1 Total pages Schedule G: 2 FILER NAME IV%trJ G-ctze-- 4 Date 5 Payee name Go- (C&a#&) 6 Amount () 7 Payee address; City; State; Zip Code Po 0ox & Ca w&ivl 6O(7 eimbursementfrom / political contributions intended 3 Filer ID (Ethics Commission Filers) 8 (a) Category (See Categories listed at the top of this schedule) (b) Description O Check if travel oulside of Texas. CompLte Schedule T. Check if Austin, TX, officeholder living expense 9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held Date CA Ui &- il'ol'o Payee name v Ck,ia Ca Amount () Payee address; City; State; Zip Code from 1Reimbursement political contributions 0, X 67 1 Covo\ I 1_ 60 7 intended Category (See Categories listed at the top of this schedule) Ci (b) Description LII Check if travel outside of Texas. Complete Schedule T. LIII Check it Austin, TX, officeholder living expense Complete ONLY if direct Candidate I Officeholder name Office sought Office held Date Payee name Amount () Payee address; City; State; Zip Code Reimbursement from political contributions intended Category (See Categories listed at the top of this schedule) (b) Description Check if travel outside of Texas. Complete Schedule T. 11111 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 Forms provided by Texas Ethics Commission www.ethicsstatetx.us Revised 9/8/2015