CANATE FCEHOLER FORM C/OH CAMPAGN FNANCE REPORT COVER SHEET PG 1 The C/OH nstruction Guide explains how to complete this form. 1 Filer (Ethics Commission Filers) 2 Total pages filed:. M? :. ~?'VtJ~. L. 3 CANATE/ MS MRS MR FRST Ml RCE US~NLY FCEHOLER C::l r =... NAME.,...:...... ate receive~,, c:j",... ~~ SUFFX < ~ ~ lj~k~o~st ~.r~ c: r, J:>~ :.;so ~ U1 ==ir 4 CANATE/ STATE; ZP COE of7'l FCEHOLER e MALNG ~'. ::r::..'.c.. ARESS :;u>... 0 Change of Address. ~ cj1,.. t: C' 0 co 5 CANATE/ AREA COE PHONE NUMBER EXTENSON :;o FCEHOLER ate Ha cj delivered or ate Postmarked PHONE 6 CAMPAGN MS/M;/MR L ;last ~M Ml Receipt # TREASURER NAME }.~.... S...... ate Processed NCKNAME LAST SUFFX ate maged Amount$ 7 CAMPAGN STATE; ZP COE TREASURER ARESS (Residence or Business) 8 CAMPAGN SON TREASURER PHONE 9 REPORT TYPE January 15 30th day before election Runoff g] July 15 8th day before election Exceeded $500 limit 15th day after campaign treasurer appointment (Officeholder Only) Final Report (Attach COH FR) 10 PERO Month ay Year Month ay Year COVERE THROUGH / JLo ~./ 30//10 11 ELECTON ELECTON ATE ELECTON TYPE 12 FCE Month ay Year Primary Runoff Other escription / / General Special PErl~~~~~~ 13 FCE SOUGHT (if known) GO TO PAGE 2 Forms provided by Texas Ethics Commission www.eth1cs.state.tx.us Rev1sed 9/8/2015
CANATE FCEHOLER CAMPAGN FNANCE REPORT FORM JC/OH COVER SHEET PG 2 14 JC/OH NAME 15 Filer (Ethics Commission Filers) 16 NOTCE FROM POLTCAL COMMTTEE(S) THS BOX S FOR NOTCE POLTCAL CONTRBUTONS ACCEPTE OR POLTCAL S MAE BY POLTCAL COMMTTEES TO SUPPORT THE CANATE/ FCEHOLER. THESE EXPENrrURES MAY HAVE BEEN MAE WTHOUT THE CANATE'S OR FCEHOLER'S KNOWLEGE OR CONSENT. CANATES AN FCEHOLERS ARE REQURE TO REPORT THS NFORMATON ONLY F THEY RECEVE NOTCE SUCH S. co COMMTTEE TYPE COMMTTEE NAME "";] 0GENERAL OsPECFC COMMTTEE ARESS <J1 ; ~...:rl_ lr c...,rq L"~:~: C~J 0 Additional Pages COMMTTEE CAMPAGN TREASURER NAME :oj (..') ~ 0 ::0 U1 co COMMTTEE CAMPAGN TREASURER ARESS 17 CONTRBUTON 1. TOTAL POLTCAL CONTRBUTONS $50 OR LESS (OTHER THAN TOTALS PLEGES, LOANS, OR GUARANTEES LOANS), UNLESS TEMZE... TOTALS 2. TOTAL POLTCAL CONTRBUTONS (OTHER THAN PLEGES, LOANS, OR GUARANTEES LOANS) 3. TOTAL POLTCAL S $100 OR LESS, UNLESS TEMZE $ $ $..... CONTRBUTON BALANCE OUTSTANNG LOAN TOTALS 4. TOTAL POLTCAL S 5. TOTAL POLTCAL CONTRBUTONS MANTANE AS THE LAST AY REPORTNG PERO 6. TOTAL PRNCPAL AMOUNT ALL OUTSTANNG LOANS AS THE LAST AY THE REPORTNG PERO $l3taot& $ 18 AFFAVT e Michelle Seay Netary hblic, SbtteiTna C iuloll 11NJ516.1...: 02107/2020 AFFX NOTARY STAMP SEALABOVE Sworn to nd subscribed before me, by the said JcrJ /Je~ day of /,, 20 J t, to certify which, witness my hand and seal of office., this the._/_._/_1a_l Printed name of officer administer" g oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
SUBTOTALS JC/OH 19 FLER NAME ro FORM JC/OH COVER SHEET PG 3 Filer (Ethics Commission Filers) 21 SCHEULE SUBTOTALS SUBTOTAL NAME SCHEULE AMOUNT!'," ~"'"'' 1. SCHEULEA(J)1: MONETARY POLTCAL CONTRBUTONS (JUCAL) OJ. $ = ~ :c~ :... ~ :.:J_. C _, 2. SCHEULE A2 : NONMONETARY (NKN) POLTCAL CONTRBUTONS ~ :. "f. s ]:;> r,r 3. SCHEULE B(J): PLEGE CONTRBUTONS (JUCAL) :::.::;,r '. $ (.)1 _, r'l 4. SCHEULE E(J): LOANS (JUCAL) ;.$:_:.:: :r:: _,c ~,_.. ()). 5. 5l... SCHEULE F1: POLTCAL S MAE FROM POLTCAL CONTRBUTONS ~ c.j 1:f ~ 6. SCHEULE F2: UNPA NCURRE OBLGATONS 7. 8. 9. SCHEULE F3: PURCHASE NVESTMENTS MAE FROM POLTCAL CONTRBUTONS $ SCHEULE F4: S MAE BY CRET CAR $ SCHEULE G: POLTCAL S MAE FROM PERSONAL FUNS $.. ~ 10. SCHEULE H: PAYMENT MAE FROM POLTCAL CONTRBUTONS TO A BUSNESS C/OH $ 11. SCHEULE 1: NONPOLTCAL S MAE FROM POLTCAL CONTRBUTONS $ 12. SCHEULE K: NTEREST, CRETS, GANS, REFUNS, AN CONTRBUTONS RETURNE $ TO FLER Forms provided by Texas Ethics Commission WWN. eth1cs. state. tx. us Rev1sed 9/8/2015
MONETARY POLTCAL CONTRBUTONS (JUCAL} SCHEULE A(J)1 1 Total pages Schedule A(J)1: 2 FLER NAME 3 ~r 10 ~(~thics C~issi~;Filers) ~,.. ' ::::::. ~. l.. c::..0 4 ate 5 Full name of contributor 0 7 out of state PAC 10#: ) Anount ~~ ~ontri~ution (~:::::: :.. U1 il... (~") f0!. ' (~) = ~ 6 :e:: Contributor address; City; State; Zip Code 'o """.. ~ '~ i_;;. ::~ ~ {J) ~....., ~ ' / ~ 8 Contributor's principal occupation 9 Contributor's job title 0 ~ ;o 10 Contributor's employer/law firm 11 Law firm of contributor's spouse (if any) f't l rj 12 f contributor is a child, law firm of parent(s) (if any) ate Full name of contributor 0 out of state PAC 10#: ) Amount of contribution ($) Contributor address; City; State; Zip Code Contributor's principal occupation Contributor's job title Contributor's employer/law firm Law firm of contributor's spouse (if any) f contributor is a child, law firm of parent(s) (if any) ate Full name of contributor 0 outofstate PAC 10#: ) Amount of contribution ($) Contributor address; City; State: Zip Code Contributor's principal occupation Contributor's job title Contributor's employer/law firm Law firm of contributor's spouse (if any) f contributor is a child, law firm of parent(s) (if any) ATTACH ATONAL COPES THS SCHEULE AS NEEE f contributor is outofstate PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission www.eth1cs.state.tx.us Rev1sed 9/8/2015
NONMONETARY (NKN) POLTCAL CONTRBUTONS SCHEULE A2 1 Total pages Schedule A2: 2 FLER NAME 3 Filer 10 (Ethics ~mmis~]qn Filerst=; < i { J c.r"' 4 TOTAL UNTEMZE NKN POLTCAL CONTRBUTONS. ~ ''' 5 ate 6 Full name of contributor 0 outofstale PAC (#: }l 8 Amount of. 9 lnkir'!li contributio~; ' 7 Contributor address; City; State; Zip Code $ Contribution $. : del:lcrtption, ' ~;3; ~ ~~ c~ c?:::; U1 "' 0 Check if travel outsid' of Tex~ Compi~Schedule T. 10 Principal occupation Job title (FOR NONJUCAL) (See nstructions) 11 Employer (FOR NONJUCAl)(See nstructions) 12 Contributor's principal occupation (FOR JUCAL) 13 Contributor's job title (FOR JUCAL) (See nstructions) 14 Contributor's employer/law firm (FOR JUCAL) 15 Law firm of contributor's spouse (if any) (FOR JUCAL) 16 f contributor is a child, law firm of parent(s) (if any) (FOR JUCAL) ate Full name of contributor 0 outofstate PAC (#:,l Amount of Contribution $ nkind contribution description Contributor address; City; State; Zip Code Principal occupation Job title (FOR NONJUCAL) (See nstructions) 0 Check if travel outside of Texas. Complete Schedule T. Employer (FOR NONJUCAL) (See nstructions) Contributor's principal occupation (FOR JUCAL) Contributor's job title (FOR JUCAL) (See nstructions) Contributor's employer/law firm (FOR JUCAL) Law firm of contributor's spouse (if any) (FOR JUCAL) f contributor is a child, law firm of parent(s) (if any) (FOR JUCAL) ATACH ATONAL COPES THS SCHEULE AS NEEE f contributor is outofstate PAC, please see nstruction guide for additional reporting requirements. Forms provided by Texas Ethics CommiSSOn www.eth1cs.state.tx.us Rev1sed 9/8/2015
PLEGE CONTRBUTONS (JUCAL) SCHEULE B(J) 1 Total pages Schedule B(J): 2 FLER NAME 3 Filer (Ethics Commission Filers) OJ ~ i r...:> = l 4 TOTAL UNTEMZE PLEGES $ < r l > c... :.:: :;o ::=.; 5 ate 6 Full name of pledgor 0 outofstate PAC (#: 8 Amount. 9 R klnd co'mt!"ibutie;.;:: of Pledge$ desbdptiow 1... l.. (~! 1! 7 Pledgor address; City; State; Zip Code 10 Pledgor's principal occupation 11 Pledgor's job title... ~;;..n t... i ~ ':::>c: _,_ ~ J ::... " ""'~... :::..iul.. ~ f ~ ~... :::; Ul... ~ Check if travel outsi ~e of Te l>. ComPifS Schedule T. 12 Pledgor's employer/law firm 13 Law firm of pledgor's spouse (if any) 14 f pledgor is a child, law firm of parent(s) (if any) ate Full name of pledgor 0 outofstate PAC (#: } Amount nkind contribution of Pledge$ description Pledgor address; City; State; Zip Code Pledgor's principal occupation Pledgor's job title Check if travel outside of Texas. Complete Schedule T. Pledgor's employer/law firm Law firm of pledgor's spouse (if any) f pledgor is a child, law firm of parent(s) (if any) ate Full name of pledgor 0 outofstate PAC (#: } Amount nkind contribution of Pledge$ description Pledgor address; City; State; Zip Code Pledgor's principal occupation Pledgor's job title Check if travel outside of Texas. Complete Schedule T. Pledgor's employer/law firm Law firm of pledgor's spouse (if any) f pledgor is a child, law firm of parent(s) (if any) ATTACH ATONAL COPES THS SCHEULE AS NEEE f contributor is outofstate PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission www.eth1cs.state.tx.us Rev1sed 9/8/2015
LOANS (JUCAL) SCHEULE E(J) 1 Total pages Schedule E(J): 2 FLER NAME 3 Filer (Ethics Commission Filers).. ~ ~, C r j,..._:) = ':..} c:r" ~ n (_ 4 TOTAL UNTEMZE LOANS ' $ c:: :::n., ~ yr l., 5 ate of loan 7 Name of lender 0 outofstate PAC (#: ) 9 L~an Amou!:J~ ($) Ui ~~ :: ;rt'.?2:, :: C' 6 s lender 8 Lender address; City; State; Zip Code 10 lnt~ rest rat~::: c. :_:::,UJ,..: a financial ''.. nstitution? J: rn... 11 Ma Jrity d~ 1..0 y N 12 Lender's Principal Occupation 13 Lender's Job Title 14 Lender's Employer/Law Firm 15 Law Firm of lender's spouse (if any) 16 f lender is a child, law firm of parent(s) (if any) 17 escription of Collateral 18 Check if personal funds were deposited into political account (See nstructions) 0 none 19 GUARANTOR 20 Name of guarantor 22 Amount Guaranteed ($) NFORMATON 21 Guarantor address; City; State; Zip Code 0 not applicable 23 Guarantor's Principal Occupation 24 Guarantor's Job Title 25 Guarantor's Employer/Law Firm 26 Law Firm of guarantor's spouse (if any) 27 f guarantor is a child, law firm of parent(s) (if any) ATTACH ATONAL COPES THS SCHEULE AS NEEE f lender is outofstate PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revtsed 9/8/2015
POLTCAL S MAE FROM POLTCAL CONTRBUTONS SCHEULE F1 Advertising Expense Accounting/Banking Consulting Expense Contributions/onations Made By Candidate/Officeholder/Political Committee Credit Card Payment 1 Total pages Schedule Ft: 2 FLER NAME 4 ate 6 Amount ($) 5 Payee name CATEGORES FOR BOX 8(a) Event Expense Fees Food/Beverage Expense GifVAwards/Memorials Expense Legal Services Loan RepaymenVReimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor 7 Payee address; City; State; Zip Code ;~~ ~ :::_: Soliclfition/FUQdraising ~nse.,::;/' Tran~rtatior~Ruipmen~Aelateq::E)cpense Trave' n istrigt ~. C:;:?:J Travef 1 out Of ~t~et s_;:::: ~;.. rl Other (!'nter a category not,isted ab<l)laj _ ~. u; :.::.. ~~. ~:dtf; i :::::, ':30.. cj. '.~"'~ 8 (a) Category (See Categories listed at the top of this schedule) (b) escription 0 Check if travel outside of Texas. Complete Schedule T. 0 Check if Austin, TX, officeholder living expense 9 Complete ONLY if direct Candidate Officeholder name Office sought Office held ate Payee name Amount ($) Payee 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 Complete ONLY if direct Candidate Officeholder name Office sought Office held ate Payee name Amount ($) Payee 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 it Austin, TX, officeholder living expense Complete ONLY if direct Candidate Officeholder name Office sought Office held ATACH ATONAL COPES THS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
UNPA NCURRE OBLGATONS SCHEULE F2 Advertising Expense Accounting/Banking Consulting Expense Contributions/onations Made By Candidate/Officeholder/Political Committee CATEGORES FOR BOX 10(a) Event Expense Fees Food/Beverage Expense GifV Awards/Memorials Expense Legal Services Loan RepaymenVReimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor Solicitation/Fundraising Expense Transportation Equipment & R~lated Expense Travelln..Pistricf_: d..'"" Travel tit Of l.st<ict / Other (e;:'ter a c"!e'g~ry not ~ abo~:, : c::::. :::::~ 1 Total pages Schedule F2: 2 FLER NAME 3 Filer ~ (Ethics ~cimmi;. il;l.n Fit~.~ <11 ~ rn 4 TOTAL UNTEMZE UNPA NCURRE OBLGATONS $ 5 ate 6 Payee name..,. 7 Amount ($) 8 Payee address; City; State; Zip Code 9 TYPE Political NonPolitical 10 (a} Category (See Categories listed at the top of this schedule) (b) escription Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate Officeholder name Office sought Office held ate Payee name Amount ($) Payee address; City; State; Zip Code TYPE Political 0 NonPolitical 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 Complete ONLY if direct Candidate Officeholder name Office sought Office held ATTACH ATONAL COPES THS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revtsed 9/8/2015
PURCHASE NVESTMENTS MAE FROM POLTCAL CONTRBUTONS SCHEULE F3 1 Total pages Schedule F3: 2 FLER NAME 3 Filer (Ethics Commission Filers) 4 ate 5 Name of person from whom investment is purchased. ' ; 6 Address of person from whom investment is purchased; City; Stat~; ' r 1'' 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 ATONAL COPES THS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethrcs.state.tx.us Revrsed 9/8/2015
S MAE BY CRET CAR SCHEULE F4 CATEGORES FOR BOX 10(a) a. :.> Soli~ itation/~tndr~jsing ~~nse ~; Advertising Expense Event Expense Loan Repayment'Reimbursement Accounting/Banking Fees Office Overhead'Rental Expense Tran portation. Eqw_ pmerli& Relat~t(;~se Trav lin 1stnct _ ~ ',.,.,.._... Contributions/onations Made By Printing Expense Trav 1 Out Of1)isJrict!i!.P : ; Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor (enteracategory no isted a~~<f! 1 Consulting Expense Food/Beverage Expense GifVAwards/Memorials Expense Polling Expense 1 : ~ :~c:~ 1 Total pages Schedule F4: 2 FLERNAME i 3 Filer (Ethic~pom~ion Fifers). :~.....,. 4 TOTAL UN TEMZE S CHARGE TO A CRET CAR $.... '" 5 ate 6 Payee name 7 Amount ($) 8 Payee address; City; State; Zip Code 9 TYPE Political 0 NonPolitical 10 (a) Category (See Categories listed at the top of this schedule) (b) escription Check if travel outside of Texas. Complete Schedule T Check if Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate Officeholder name Office sought Office held ate Payee name Amount ($) Payee address; City; State; Zip Code TYPE 0 Political 0 NonPolitical Category (See Categories listed at the top of this schedule) escription Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, ohiceholder living expense Complete ONLY if direct Candidate Officeholder name Office sought Office held ATTACH ATONAL COPES THS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.eth1cs.state.tx.us Rev1sed 9/8/2015
POLTCAL S MAE FROM PERSONAL FUNS SCHEULE G Advertising Expense Accounting/Banking Consulting Expense Contributions/onations Made By Candidate/Officeholder/Political Committee Credit Card Payment 1 Total pages Schedule G: 6 Amount ($) $().,6e ~eimbursementfrom ~ political contributions intended CATEGORES FOR BOX 8(a) Event Expense Fees Food/Beverage Expense GitVAwards/Memorials Expense Legal Services Loan RepaymenVReimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor 8 (a) Category (See Categories listed at the top of this schedule). 9 Complete ONLY if direct Candidate Officeholder name Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel n istrict Travel Out Of istrict Other (enter a c~ory not~ abo~. Filer to ~~ : ~ ~ (EttiiCS"Qomrniston F;.sj''r'.. ~r== :.;i ~ c :;:;; (b) escription Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense Office sought u v :>.. (.)1. Office held cjrr (r":) "" l,_. ". ~. ate Payee name Amount ($) Payee address; City; State; Zip Code Reimbursement from political contributions intended 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 Complete ONLY if direct Candidate Officeholder name Office sought Office held ate Payee name Amount($) Payee address; City; State; Zip Code Reimbursement from political contributions intended Category (See Categories listed at the top of this schedule) escription Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate Officeholder name Office sought Office held ATACH ATONAL COPES THS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.eth1cs.state.tx.us Rev1sed 9/8/2015
PAYMENT MAE FROM POLTCAL CONTRBUTONS TOA BUSNESS C/OH SCHEULE H CATEGORES FOR BOX B(a) Advertising Expense Event Expense Loan RepaymenVReimbursement Solicitation/Fundraising Expense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel n istrict Contributions/onations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of istrict Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (e~r a ca~ory not 1ip.!51 above) Credit Card Payment ~~ ~o~ ~ :;: 1 Total pages Schedule H: 2 FLER NAME 4 ate 5 Business name! 13 to Filer (Ethics: Commission Fll6ts) _ c:::,...,~, ):~.:.. r U1 ~=ir. r. f "l 't 6 Amount ($) 7 Business address; City; State; Zip Code 2:.:! ~...J L~ ~...:::.. ~... ;;Ju)....., E:i c.n ; 8 (a) Category (See Categories listed at the top of this schedule) (b) escription Check if travel outside ol Texas. Compete Schedule T. Check if Austin, TX, officeholder living expense :u UJ 9 Complete ONLY if direct Candidate Officeholder name Office sought Office held ate Business name Amount ($) Business address; City; State; Zip Code Category (See Categories listed at the top of this schedule) escription Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate Officeholder name Office sought Office held ate Business name Amount ($) Business address; City; State; Zip Code Category (See Categories listed at the top of this schedule) escription Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, olficeholder living expense Complete ONLY if direct Candidate Officeholder name Office sought Office held ATACH ATONAL COPES THS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.eth1cs.state.tx.us Rev1sed 9/8/2015
NONPOLTCAL S MAE FROM POLTCAL CONTR 8 UTONS SCHEULE 1 Total pages Schedule 1: 2 FLER NAME 3 Filer (Ethics Commission Filers) 4 ate,. c Cl" r~~ ~ 5 Payee name CJ : = < c: ):; 6 Amount ($) 7 Payee address; City; State; Zip Code 8 :::::: : (._ r:== _.,...~...,.l :.P11.. :::;r=.. (.J1 ~)0... l.?, c:)c...... _,. : (a) Category (See instructions for examples of acceptable (b) escription (See instructins regifdr'i9;type iii:ji,formaii<l,n categories.) requ1red.) >.J :;o... :.j <J1 0?J ate Payee name Amount ($) Payee address; City; State; Zip Code Category (See nstructions for examples of acceptable categories.) escription (See instructions regarding type of information required.) ate Payee name Amount ($) Payee address; City; State; Zip Code Category (See nstructions for examples of acceptable categories.) escription (See instructions regarding type of information required.) ate Payee name Amount ($) Payee address; City; State; Zip Code Category (See nstructions for examples of acceptable categories.) escription (See instructions regarding type of information required.) ATTACH ATONAL COPES THS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethtcs.state.tx.us Revtsed 9/8/2015
NTEREST, CRETS, GANS, REFUNS, AN CONTRBUTONS RETURNE TO FLER SCHEULE K 1 Total pages Schedule K: 2 FLER NAME 3 Filer (Ethics Comm i.~,sion 1 Filers) ~~ ~ ~ c ' c:::n ):> 4 ate 5 Name of person from whom amount is received 8 ~~ou~.j.$) :::o c::: :::o r~ 6 Address of person from whom amount is received; City; State; Zip Code 2";:rl. J... C.J1 ir 1 c)rn ~ c;;c:j ~ :~.:.,1 c: ; :.; {..!).. ~ 7 Purpose for which amount is received 0 Check if political contributitn retu%d to f~.. _, ~ ate Name of person from whom amount is received Amount($) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received 0 Check if political contribution returned to filer ate Name of person from whom amount is received Amount($) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received 0 Check if political contribution returned to filer ate Name of person from whom amount is received Amount($) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received 0 Check if political contribution returned to filer ATTACH ATONAL COPES THS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethics.state.tx.us Rev1sed 9/8/2015
OUTSTANNG LOANS SCHEULE L 1 Total pages Schedule L: 2 FLER NAME 3 Filer (Ethics Commission Filers) LENER 4 Name of lender NFORMATON GUARANTOR NFORMATON not applicable LENER NFORMATON 5 Lender address; City; State; Zip Code <.. r':.'1 = t CJ 0" J> _,_ 1 71 l c... ' _.. c:: 7:J _... ~ i 6 Name of guarantor " l :::: U'l l! c ) ft1 i... "i :: C.:>l"") 7 Guarantor address; City; State; Zip Code (= :~~Ul Name of lender Lender address; City; State; Zip Code = (r P! r ::.~.. ~..,,,_.. ::0..0 GUARANTOR NFORMATON Name of guarantor not applicable Guarantor address; City; State; Zip Code LENER NFORMATON Name of lender Lender address; City; State; Zip Code GUARANTOR NFORMATON Name of guarantor not applicable Guarantor address; City; State; Zip Code LENER NFORMATON Name of lender Lender address; City; State; Zip Code GUARANTOR NFORMATON Name of guarantor not applicable Guarantor address; City; State; Zip Code ATTACH ATONAL COPES THS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethics.state.tx.us Rev1sed 9/8/2015
~ ~ ~ ASSETS VALUE AT $500 OR MORE SCHEULE M 1 Total pages Schedule M: 2 FLER NAME 3 Filer (Ethics Commission Filers) 4 escription of Asset r : ::.:> co,~ <. 1 = ):.:;.!.. c J 0" 7! i L <:...J escription of Asset ' U1 ==1r orr: T i 2: C)Ci ' ;_,., escription of Asset escription of Asset :.~jf.j} ~. ~ ~ 0 ;;o.0.. CJ1 ~ ( escription of Asset escription of Asset escription of Asset escription of Asset escription of Asset escription of Asset escription of Asset ATTACH ATONAL COPES THS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
NKN CONTRBUTONS OR POLTCAL S FOR TRAVEL OUTSE TEXAS SCHEULE T 1 Total pages Schedule T: 2 FLER NAME 3 Filer (Ethics Commission Filers) 4 Name of Contributor Corporation or Labor Organization Pledgor Payee 5 Contribution Expenditure reported on: 0 Schedule A2 0 Schedule B 0 Schedule B(J) 0 Schedule F2 0 Schedule F4 Oschedule G 6 ates of travel 7 Name of person(s) traveling 8 eparture city or name of departure location 0 Schedule C2 0 Schedule H 9 estination city or name of destination location 10 Means of transportation Purpose of travel (including name of conference, seminar, or other event) l.,, r..j Ul.. (_)'i o c::>c: _. '".,) 0; ~" :..~~.,..., fj~ i5...... 0 0 ;o Name of Contributor Corporation or Labor Organization Pledgor Payee Contribution Expenditure reported on: 0 Schedule A2 0 Schedule B 0 Schedule C2 0 Schedule 0 Schedule B(J) 0 Schedule F1 0 Schedule F2 0 Schedule F4 Oschedule G 0 Schedule H 0 Schedule COHUC 0 Schedule 8SS 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 Corporation or Labor Organization Pledgor Payee Contribution Expenditure reported on: 0 Schedule A2 0 Schedule B 0 Schedule B(J) 0 Schedule C2 0 Schedule 0 Schedule F1 0 Schedule F2 0 Schedule F4 Oschedule G 0 Schedule H 0 Schedule COHUC 0 Schedule BSS 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) ATACH ATONAL COPES THS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethtcs.state.tx.us Rev1sed 9/8/2015
CANATE FCEHOLER REPORT: ESGNATON FNAL REPORT FORM C/OH FR Complete only if "Report Type" on page 1 is marked ""Final Report'' 1 C/OH NAME 2 Filer (Ethics Commission Filers) 3 SGNATURE r;',;j, = 1 < ~:' i c;:: :f;> 1,!_... (,_ ;;J. : _ ~ c:: :::0 do not expect any further political contributions or political expenditures in connection with my candidacy)! understand ttfat desi~i!i ing a report as a final report terminates my campaign treasurer appointment. also understand that m~y not ac~t arlyi1:am~ contributions or make any campaign expenditures without a campaign treasurer appointment on file. ' : C? l'l c., : ~.::)o j c: ::'~; N Signatu_r_e o_f_c_a_nd+f ate 1 ~ficehc5er i ~ 0 4 FLER WHO S NOT AN FCEHOLER l Complete A & B below only if you are not an officeholder. A. CAMPAGN FUNS Check only one: do not have unexpended contributions or unexpended interest or income earned from political contributions. have unexpended contributions or unexpended interest or income earned from political contributions. understand that may not convert unexpended political contributions or unexpended interest or income earned on political contributions to personal use. also understand that must file an annual report of unexpended contributions and that may not retain unexpended contributions or unexpended interest or income earned on political contributions longer than six years after filing this final report. Further, understand that must dispose of unexpended political contributions and unexpended interest or income earned on political contributions in accordance with the requirements of Election Code, 254.204. B. ASSETS Check only one: do not retain assets purchased with political contributions or interest or other income from political contributions. do retain assets purchased with political contributions or interest or other income from political contributions. understand that may not convert assets purchased with political contributions or interest or other income from political contributions to personal use. also understand that must dispose of assets purchased with political contributions in accordance with the requirements of Election Code, 254.204. Signature of Candidate 5 FCEHOLER Complete this section only if you are an officeholder am aware that remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer on file. am also aware that will be required to file reports of unexpended contributions if, after filing the last required report as an officeholder, 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 www.ethics.state.tx.us Revised 9/8/2015