~ CANIATE I FICEHOLER CAMPAIGN FINANCE REPORT FORM C/OH COVER SHEET PG 1 The C/OH Instruction Guide explains how to complete this form. 3 CANIATE/ FICEHOLER NAME MS/ MRS I MR FIRST 1 Filer I (Ethics Commission Rlers) Ms. Nedra. Robinson.... a... '.......... NICKNAME LAST SUFFIX Ml 2 Total pages filed: i1!) 17 ate Received FICE USE ONLY 4 CANIATE/ FICEHOLER MAILING ARESS Change of Address 5 CANIATE/ FICEHOLER PHONE 6 CAMPAIGN TREASURER NAME ARESS I PO BOX; APT I SUITE II; CITY; STATE; ZIP COE 3025 Gentilly Lane, Fort Worth, TX 76123 AREA COE PHONE NUMBER EXTENSION ( 817 ) 677-8672 MS /MRS/ MR FIRST Ml Mr. Charles Keeley..................... -..... NICKNAME LAST SUFFIX ate Hand-delivered or ate Postmarked Receipt II Amount $ I ate Processed ate Imaged 7 CAMPAIGN TREASURER ARESS (Residence or Business) STREET ARESS (NO PO BOX PLEASE); APT I SUITE II; CITY; STATE; 1300 Summit Ave, Ste 200 Fort Worth, TX 76102 ZIP COE 8 CAMPAIGN TREASURER PHONE AREA COE PHONE NUMBER EXTENSION ( 850 ) 459-5914 9 REPORT TYPE January 15 [i] 3oth day before election Runoff July 15 8th day before election [R] Exceeded $500 limit 15th day after campaign 0 treasurer appointment (OHiceholder Only) Final Report (Attach C/OH - FA) - 10 PERIO COVERE Month ay Year Month 04/07 /17 05/05 /17 THROUGH ay Year 11 ELECTION 12 FICE ELECTION ATE Month ay Year 05/06 /17 FICE HEL (il any) Primary ~General ELECTION TYPE RunoH Other escription Special 13 FICE SOUGHT (il known) Crowley ls Board Trustee, Place 1 GO TO PAGE 2 Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
CANIATE I FICEHOLER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 2 14 C/OH NAME 115 Filer I (Ethics Commission Filers) Nedra Robinson 16 NOTICE FROM THIS BOX IS FOR NOTICE POUTICAL CONTRIBUTIONS ACCEPTI: OR POLmCAL EXPENITURES MAE BY POLITICAL COMMITTEES TO POLITICAL SUPPORT THE CANIATE/ FICEHOLER. THESE EXPENCHTURES MAY HAVE BEEN AIAE Wff'HOUT THE CANIATE'S OR FICEHOLER'S COMMITTEE(S) KNOWLEGE OR CONSENT. CANIATES AN FICEHOLERS ARE REQUIRE TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE SUCH EXPENITURES. COMMITTEE TYPE COMMITTEE NAME 0GENERAL OsPECIFIC COMMITTEE ARESS COMMITTEE CAMPAIGN TREASURER NAME 0 Additional Pages COMMITTEE CAMPAIGN TREASURER ARESS 17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS $50 OR LESS (OTHER THAN TOTALS $ 244 PLEGES, LOANS, OR GUARANTEES LOANS), UNLESS ITEMIZE........ EXPENITURE 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEGES, LOANS, OR GUARANTEES LOANS) 3. TOTAL POLITICAL EXPENITURES $100 OR LESS, UNLESS ITEMIZE CATHERINE MONTALVO NOTARY PUBUC STATE TEXAS MY COMM. EXP. 9/18117 $ 794 TOTALS $ 57.01........ ' CONTRIBUTION 4. TOTAL POLITICAL EXPENITURES 998.73 $ 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINE AS THE LAST AY REPORTING PERIO BALANCE $ 48.74....... OUTSTANING 6. TOTAL PRINCIPAL AMOUNT ALL OUTSTANING LOANS AS THE LOAN TOTALS LAST AY THE REPORTING PERIO $ 0 e 18 AFFIAVIT 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 ~ '[_cf1_, Signature of Candidate or Officeholder AFFIX NOTARY STAMP I SEALABOVE Sworn''m subsc lbed befme me. by the said J!tdra day of It/J;IJS/1/7, this the 9 1 /J!/ 20 / J, to certify which, witness my hand and seal of office. J.. &!1~& IJJm121Yt?!d!Jto/Je /J11nhJtJ Jefit11//lj Signature of officer administering oath Printed name of officer administering oath Title of offlt!e'r administering oath Forms provided by Texas Ethics Commission www.eth1cs.state.tx.us Rev1sed 9/B/2015
SUBTOTALS- C/OH FORM C/OH COVER SHEET PG 3 19 FILER NAME 20 Filer I (Ethics Commission Filers) 21 SCHEULE SUBTOTALS NAME SCHEULE SUBTOTAL AMOUNT 1. [i] SCHEULEA1 : MONETARY POLITICAL CONTRIBUTIONS $ 794 2. 3. SCHEULE A2: NON-MONETARY (IN-KIN) POLITICAL CONTRIBUTIONS $ SCHEULE B: PLEGE CONTRIBUTIONS $ 4. SCHEULE E: LOANS $ 5. [!] SCHEULE F1 : POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS $ 998.73 6. SCHEULE F2: UNPAI INCURRE OBLIGATIONS $ 7. SCHEULE F3: PURCHASE INVESTMENTS MAE FROM POLITICAL CONTRIBUTIONS $ a. SCHEULE F4: EXPENITURES MAE BY CREIT CAR $ 9. [!] SCHEULE G: POLITICAL EXPENITURES MAE FROM PERSONAL FUNS $ 46.94 10. 11. 12. SCHEULE H: PAYMENT MAE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS C/OH $ SCHEULE 1: NON-POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS $ SCHEULE K : INTEREST, CREITS, GAINS, REFUNS, AN CONTRIBUTIONS RETURNE TO FILER $ Forms provided by Texas Ethics Commission www.eth1cs.state.tx.us Rev1sed 9/8/2015
2 MONETARY POLITICAL CONTRIBUTIONS FILER NAME Nedra Robinson SCHEULE A1 1 Total pages ~c~ AJ 3 Filer I (Ethics ~mmission Filers) 4 ate 5 Full name of contributor 0 out-of-state PAC (1011: \ 8 04/11/17 6 Gerard Hudspeth -. Contributor address; 606 Wilson Street enton, TX 76205 City;.... State; Zip Code 9 7 Amount of contribution ($) $49 ate Full name of contributor 0 out-of-state PAC (ION: ) Amount of contribution ($) Vince Adams.. 04/12/17 Contributor address; City; State; Zip Code $100 6337 WARWICK HILLS R Fort Worth, TX 76132 ate Full name of contributor 0 out-of-state PAC (t11: ) Amount of contribution ($) 04/12/17 Ramon Romero Contributor address; City; State; Zip Code $100 ate Amount of contribution ($) Full name of contributor 0 out-of-state PAC (II: l 04/20/17 Andre McEwing....... $100 Contributor address; City; State; Zip Code 3301 Chancellorsville r. Forest Hill, TX 76140 ATTACH AmONAL COPIES THIS SCHEULE AS NEEE If contributor Is out-of-state PAC, please see Instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission www.ethtcs.state.tx.us Revtsed 9/B/2015
~. MONETARY POLITICAL CONTRIBUTIONS SCHEULE A1 1 To:J~J;c~u l e At : 2 FILER NAME Nedra Robinson 3 Filer I (~ics Commission Filers) 4 ate 5 Full name of contributor out-of-state PAC (10# : I 8 evoyd Jennings 04/20/17 6 Contributor address; 4551 Parkwood r. Forest Hill, TX 76140 City; State; Zip Code.... - 9 7 Amount of contribution ($) $45 ate Full name of contributor Edmond Moss 04/21/17 Contributor address; out-of-state PAC ( 1 0~! _j City; State; Zip Code.... Amount of contribution $100 ($) ate Full name of contributor out-of-state PAC (low : l Amount of contribution ($) Michael Campbell 04/22/17.. $150 Contributor address; City; State; Zip Code ate Full name of contributor out-of-state PAC (Iit: J Amount of contribution ($) evan Allen 04/24/17...... 0 Contributor address; City; State; Zip Code PO BOX 182087 Arlington, TX 76096 $50 ATTACH AmONAL COPIES THIS SCHEULE AS NEEE If contributor Is out-of-state PAC, please see Instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revrsed 9/8/2015
MONETARY POLITICAL CONTRIBUTIONS SCHEULE A1 2 FILER NAME Nedra Robinson 1 Total ~dl.o h e~ A1 : 3 Filer I (E'!Jcs Commission Filers) 4 ate 5 Full name of contributor 0 out-of-state PAC (ION: _j Tia Cole 05/02/17 6 Contributor address; City; State; Zip Code 7 Amount of contribution ($) $50 8 9 ate Full name of contributor Jarrett Jackson 0 out-of-state PAC (1 01: l Amount of contribution ($) 05/02/17 Contributor address; 7800 Landmark Ridge Fort Worth, TX 76133 City; State; Zip Code $50 ate Full name of contributor 0 out-of-state PAC (If: l Amount of contribution ($) Contributor address; City; State; Zip Code ate Full name of contributor 0 out-of-state PAC (10#: l Amount of contribution ($) Contributor address; City; State; Zip Code ATTACH AmONAL COPIES THIS SCHEULE AS NEEE If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission www.ethtcs.state.tx.us Revtsed 9/8/2015
NON-MONETARY (IN-KIN) POLITICAL CONTRIBUTIONS SCHEULE A2 1 Total pages Schedule A2: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 TOTAL UNITEMIZE IN-KIN POLITICAL CONTRIBUTIONS $ 5 ate 6 Full name of contributor out-of-state PAC (lot: l 8 Amount of 9 In-kind contribution Contribution $ description.. 7 Contributor address; City; State; Zip Code Check if travel outside of Texas. Complete Schedule T. 10 Principal occupation I Job title (FOR NON-JUICIAL) (See Instructions) 11 Employer (FOR NON-JUICIAL)(See Instructions) 12 Contributor's principal occupation (FOR JUICIAL) 13 Contributor's job title (FOR JUICIAL) (See Instructions) 14 Contributor's employer/law firm (FOR JUICIAL) 15 Law firm of contributor's spouse (if any) (FOR JUICIAL) 16 If contributor is a child, law firm of parent(s) (if any) (FOR JUICIAL} ate Full name of contributor out-of-state PAC ( to~ : ).. Contributor address; City; State; Zip Code Amount of Contribution $ In-kind contribution description Principal occupation I Job title (FOR NON-JUICIAL) (See Instructions) Check if travel outside of Texas. Complete Schedule T. Employer (FOR NON-JUICIAL)(See Instructions) Contributor's principal occupation (FOR JUICIAL) Contributor's job title (FOR JUICIAL) (See Instructions) Contributor's employer/law firm (FOR JUICIAL) Law firm of contributor's spouse (if any) (FOR JUICIAL) If contributor is a child, law firm of parent(s) (if any) (FOR JUICIAL) ATTACH AmONAL COPIES THIS SCHEULE AS NEEE 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
PLEGE CONTRIBUTIONS SCHEULE B 2 FILER NAME 1 Total pages Schedule 8: 3 Filer I (Ethics Commission Filers) 4 TOTAL UNITEMIZE PLEGES $ 5 ate 6 Full name of pledgor 0 out-of-state PAC (I#: I 8 Amount. 9 In-kind contribution of Pledge$ description 7 Pledgor address; City; State; Zip Code 10 Principal occupation I Job title (See Instructions} 111 Check if travel outside of Texas. Complete Schedule T. ate Full name of pledgor 0 out-of-state PAC (10#: I Amount In-kind contribution of Pledge$ description Pledgor address; City; State; Zip Code I Check if travel outside of Texas. Complete Schedule T. Employer (See Instructions} ate Full name of pledgor 0 out-of-state PAC (1011: I Amount of In-kind contribution Pledge$ description Pledgor address; City; State; Zip Code I Check if travel outside of Texas. Complete Schedule T. Employer (See Instructions} ate Full name of pledgor 0 out-of-state Amount of In-kind contribution PAC (1011: I Pledge$ description Pledgor address; City; State; Zip Code I Check if travel outside of Texas. Complete Schedule T. ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE 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
LOANS SCHEULE E 1 Total pages Schedule E: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 TOTAL UNITEMIZE LOANS 5 ate of loan 7 Name of lender 0 out-<>1-state PAC (IM: ) $ 9 Loan Amount($) 6 Is lender a financial Institution? y N 8 Lender address; City; State; Zip Code 10 Interest rate 11 Maturity date 12 13 14 escription of Collateral 0 none 16 GUARANTOR 17 Name ofguarantor INFORMATION 15 Check if personal funds were deposited into political account (See Instructions) 0 19 Amount Guaranteed ($) 18 Guarantor address; City; State; Zip Code 0 not applicable 20 Principal Occupation (See Instructions) 21 ate of loan Name of lender 0 out-<>1-state PAC (IM: ) Loan Amount($) Is lender a financial Institution? y N Lender address; City; State; Zip Code Interest rate Maturity date escription of Collateral 0 none GUARANTOR Name of guarantor INFORMATION Check if personal funds were deposited into political account (See Instructions) 0 Amount Guaranteed ($) Guarantor address; City; State; Zip Code 0 not applicable Principal Occupation (See Instructions) ATTACH AmONAL COPIES THIS SCHEULE AS NEEE If lender 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
POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS SCHEULE F1 EXPENITURE CATEGORIES FOR BOX S(a) Advertising Expense Event Expense Loan Repeyment/Reirrbursement Sollcitat1on/Fundralslng Expense Accounting/Barl<lng Fees Office Ovemead/Rental Expense Transportation Equipment & Related Expense Consulting Expense FoodiBeverage Expense Polling Expense Travel In istrict Contr1butlons/onat1ons Made By GlfVAwards/Memoriats Expense Prlnting Expense Travel Out Of lstrlct Candldate/Officeholder/Polltlcal Committee Legat Services Salaries/Wages/Contract Labor O!her (enter a category not listed above) Credl! Card Payment 1 Total pages Schedule F1 : 2 FILER NAME 13 Filer I (Ethics Commission Filers) Nedra Robinson I 4 ate 5 Payee name 04/19/17 Vista print 6 Amount ($) 7 Payee address; City; State; Zip Code $672.51 8 (a) Category (See Categories listed at the top of this schedule) (b) escription Check ~travel outside of Texas. Complete Schedule T. Printing Expense Check if Austin, TX, ohiceholder living expense EXPENITURE 9 Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit C/OH ate Payee name 05/04/17 One Stop Printing Amount ($) Payee address; City; State; Zip Code $216.50 611 University rive Fort Worth, TX 76102 Category (See Categories listed atlhe lop of I his schedule) escription Check ff travel oulslde of Texas. Complete Schedule T. Printing Expense Check If Auslln, TX, ohiceholder living expense EXPENITURE Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit C/OH ate Payee name 05/04/17 Robodial.org Amount ($} Payee address; City; State; Zip Code $148.13 Category (See Calegories lisled allhe top of lhis schedule) escription Check ij travel oulslde of Texas. Complete Schedule T. Advertising Expense Check if Austin, TX, ohiceholder living expense EXPENITURE Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit C/OH ATTACH AmONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.eth1cs.state.tx.us Rev1sed 9/8/2015
UNPAI INCURRE OBLIGATIONS SCHEULE F2 EXPENITURE CATEGORIES FOR BOX 10(a) Advertising Expense Event Expense Loan Repayment/Reimbursement Solicltation/Fundralslng Expense Accounti"'J"Barl<ing Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consullfng Expense Food/Beverage Expense Polling Expense Travel in istrict Contributions/onations Made By GifVAwardshvtemorials Expense Printing Expense Travel Out Of istrict Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contmct Labor Other (enter a category not listed above) 1 Total pages Schedule F2: 2 FILER NAME 3 Filer I {Ethics Commission Filers) 4 TOTAL UNITEMIZE UNPAI INCURRE OBLIGATIONS $ 5 ate 6 Payee name 7 Amount {$) 8 Payee address; City; State; Zip Code 9 TYPE EXPENITURE Political Non-Political 10 EXPENITURE {a) Category (See Categories listed at the top olthls schedule) (b) escription Check ntravel outside oitexas. Complete Schedule T. Check If Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit CIOH ate Payee name Amount {$) Payee address; City; State; Zip Code TYPE EXPENITURE Political Non-Political EXPENITURE 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 I Officeholder name Office sought Office held expenditure to benefit C/OH ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethics.state.tx.us Rev1sed 9/8/2015
PURCHASE INVESTMENTS MAE FROM POLITICAL CONTRIBUTIONS SCHEULE F3 1 Total pages Schedule F3: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 ate 5 Name of person from whom investment is purchased 6 Address of person from whom investment is purchased; City; State; Zip Code 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 AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethics.state.tx.us Rev1sed 9/8/2015
EXPENITURES MAE BY CREIT CAR SCHEULE F4 EXPENITURE CATEGORIES FOR BOX 1O(a) Advertising Expense Event Expense loan Repayment!Reimbursement Sollcltatlon/Fundralsing Expense Accounting/Banking Fees OffiCe OVerhead/Rental Expense Transportation Equipment& Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel in 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 (enter a category not listed above) 1 Total pages Schedule F4: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 TOTAL UNITEMIZE EXPENITURES CHARGE TO A CREIT CAR $ 5 ate 6 Payee name 7 Amount ($) 8 Payee address; City; State; Zip Code 9 10 TYPE EXPENITURE EXPENITURE Political 0 Non-Political (a) Category (See Categories listed allhe lop of this schedule) (b) escription 0 Checl< ntravel outside oftexas. Complete Schedule T. Check il Austin, TX, officeholder living expense 11 Complete ONLY if direct expenditure to benefit C/OH Candidate I Officeholder name Office sought Office held ate Payee name Amount ($) Payee address; City; State; Zip Code TYPE EXPENITURE Political Non-Political Category (See Categories listed at the lop of this schedule) escription 0 Check if travel outside oftexas. Complete Schedule T. 0 C h ec~ if Austin, TX, officeholder living expense EXPENITURE Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit CIOH ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revfsed 9/8/2015
POLITICAL EXPENITURES MAE FROM PERSONAL FUNS SCHEULE G EXPENITURE CATEGORIES FOR BOX S(a) Advertising Expense Event Expense Loan Repayment/Reirrbursement Sollcitation/Fundralslng Expense Accountil'l()'Banking Fees Office Ovemead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In 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 (enter a category not listed above) Credit card Payment 1 Total pag7 Schedule G: 2 FILER NAME I 3 Filer I (Ethics Commission Filers) Nedra Robinson 4 ate 04/22/17 6 Amount ($) 8 $46.94 0 Reimburscrnenllrom pollllcal contrlbullons Intended EXPENITURE 5 Payee name Vistaprint 7 Payee address; City; State; Zip Code (a) Category (See Categories IIsled at!he lop ollhis schedule) Printing Expense (b) escription 0 Check~ travel oulside of Texas. Complete Schedule T. 0 Check if Auslln, TX, ohiceholder living expense 9 Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure lo benefil CIOH ate Payee name Amount ($) Payee address; City; State; Zip Code Reimbursementfrom political contributions Intended EXPENITURE Category (See Categories listed at the top of this schedule) (b) escription 0 Check ~travel OUiside of Texas. Complete Schedule T. 0 Check If Austin, TX, officeholder living expense Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit CIOH ate Payee name Amount ($) Payee address; City; State; Zip Code 0 Reimbursementfrom political contributions Intended EXPENITURE Category (See Categories listed at the top of!his schedule) (b) escription 0 Chock~ travel au!side of Texas. Complete Schedule T. 0 Check if Austin, TX, ohiceholder living expense Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit C/OH ATTACH AmONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethfcs.state.tx.us ReVIsed 9/8/2015
PAYMENT MAE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS C/OH SCHEULE H EXPENITURE CATEGORIES FOR BOX 8(a) Advertising Expense Eveht Expeose Loao Ropaytn(!h!A'IolmbuiJ!cmefit Solicitation/Fundraising Expense Accounting/Banking Fees OHice Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverwo Expense Polling Expense Travel In istrict Contributions/onations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of istrict Candidate/Officeholder/Polnical Commntee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above) Crodit Card Payment 1 Total pages Schedule H: 2 FILER NAME 13 Filer I (Ethics Commission Filers) 4 ate 5 Business name 6 Amount($) 7 Business address; City; State; Zip Code 8 EXPENITURE (a) Category (See Categories listed at the top of this.schedule) (b) escription Check ntravel outside oftel<ss.complete Schedule T. Check if Austin, TX, ohiceholder living expense 9 Complete ONLY if direct expenditure to benefit CIOH Candidate I Officeholder name Office sought Office held ate Business name Amount ($) Business address; City; State; Zip Code EXPENITURE Category (See Categories listed at the top of this schedule) escription Check ntravel outside o!tel<ss.complete Schedule T. Check if Austin, TX, ohiceholder living expense Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit CIOH ate Business name Amount ($) Business address; City; State ; Zip Code EXPENITURE Category (See Categories listed at the top of this sahndulc) escription Check If travel outside oflexas. Complete Schedule T. Check If Austin, TX, otiiceholder living expense Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit CIOH ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethics.state. tx.us Revised 9/8/2015
NON-POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS SCHEULE I 1 Total pages Schedule 1: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 ate 5 Payee name 6 Amount ($) 7 Payee address; City; State; Zip Code 8 (a)category (See instructions lor examples of acceptable (b) escription (See Instructions regarding type of Information categories.) required.) EXPENITURE ate Payee name Amount ($) Payee address; City; State; Zip Code Category (See instructions for examples of acceptable escription (See Instructions regarding type of information categories.) required.) EXPENITURE ate Payee name Amount ($) Payee address; City; State; Zip Code EXPENITURE Category (See instructions for examples of acceptable categories.) escription (See Instructions regarding type of information required.) ate Payee name Amount ($) Payee address; City; State; Zip Code Category (See instructions lor examples of acceptable escription (See Instructions regarding type of Information categories.) required.) EXPENITURE ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethtcs.state.tx.us Rev1sed 9/8/2015
INTEREST, CREITS, GAINS, REFUNS, AN CONTRIBUTIONS RETURNE TO FILER SCHEULE K 1 Total pages Schedule K: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 ate 5 Name of person from whom amount is received 8 Amount($) 6 Address of person from whom amount is received; City; State; Zip Code 7 Purpose for which amount is received Check if political contribution returned to filer ate Name of person from whom amount is received Amount($) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received Check if political contribution returned to filer ate Name of person from whom amount is received Amount($) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received Check if political contribution returned to filer ate Name of person from whom amount is received Amount($) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received Check if political contribution returned to filer ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.ethics.state.tx.us Rev1sed 9/8/2015
IN-KIN CONTRIBUTIONS OR POLITICAL EXPENITURES FOR TRAVEL OUTSIE TEXAS SCHEULET 1 Total pages Schedule T: 2 FILER NAME 3 Filer I (Ethics Commission Filers) 4 Name of Contributor I Corporation or Labor Organization I Pledgor I Payee 5 Contribution I Expenditure reported on: Schedule A2 Oschedule 8 Schedule 8(J) Schedule C2 Schedule Schedule F1 Schedule F2 0 Schedule F4 schedule G schedule H 0 Schedule COH-UC 0 Schedule 8-SS 6 ates of travel 7 Name of person(s) traveling 8 eparture city or name of departure location 9 estination city or name of destination location 10 Means of transportation 111 Purpose of travel (including name of conference, seminar, or other event) Name of Contributor I Corporation or Labor Organization I Pledgor I Payee Contribution I Expenditure reported on: Schedule A2 Osct.ledule 8 Schedule 8(J) Schedule C2 Schedule Schedule F1 Schedule F2 Schedule F4 schedule G Oschedule H Schedule COH-UC 0 Schedule 8-SS 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) I Name of Contributor I Corporation or Labor Organization I Pledgor I Payee Contribution I Expenditure reported on: Schedule A2 schedule 8 Schedule B(J) Schedule C2 Schedule Schedule F1 Schedule F2 Schedule F4 schedule G 0 Schedule H Schedule COH-UC 0 Schedule 8-SS 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 I Purpose of travel (including name of conference, seminar, or other event) ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE Forms provided by Texas Ethics Commission www.eth1cs.state.bcus Rev1sed 9/8/2015