CAMPAIGN FINANCE REPORT COVER SHEET PG 1

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Transcription:

Texas Ethcs Commsson RO. Box 12070 Austn, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989 CANDDATE FCEHOLDER FORM COH CAMPAGN FNANCE REPORT COVER SHEET PG 1 The COH nstructon Gude explans how to complete ths form. 1 ACCOUNT # 2 Total pages fled: (EthlcsCommlsmonFlers) 3 CANDDATE FCEHOLDER NAME MS ÿrs MR FfRST M &C'KNÿ,ME... dst' :ÿ... SUFFX ' ' ' Receved FCE USE ONLY 4 CANDDATE FCEHOLDER MALNG ADDRESS [] change of address 5 CANDDATE FCEHOLDER PHONE ADDRESS PC BOX; APT SUTE #; CTY; STATE; ZP CODE f j,, j AREA CODE PHONE NUMBER EXTENSON Hand-delvered or Postmarked Recept # Amount Processed 6 CAMPAGN MSMRSMR FRST M maged, \ ;, NAME ' - NCKNAME LAST SUFFX 7 CAMPAGN STREETADDRESS (NO PC BOX PLEASE); APTt SUTE #; CTY; STATE; ADDRESS (resdenceorbusness) ' ;ÿ, }, L,., Lÿ 7" l;.. )ÿ ZP CODE CAMPAGN PHONE AREA CODE PHONE NUMBER EXTENSON 9 REPORT TYPE ] January 15 ] 30th day before electon [] Runoff ] 15th day after campagn treasurer appontment (offceholder only) ] July 15 ] 8th day before electon [] Exceeded $500 lmt ] Fnal report (Attach COH - FR) 10 PEROD COVERED THROUGH 11 ELECTON ELECTON DATE ELECTON TYPE ] Pnmanj [] Runoff [] General [] Specal 12 FCE FCE HELD (f any) 13 0FFCESOUGHT (f known) -,, ' j. GO TO PAGE 2 www.ethcs.state.tx.us Revsed 09282011

Texas Ethcs Commsson P.O. Box 12070 Austn, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989' CANDDATE FCEHOLDER REPORT: SUPPORT & TOTALS FORM COH COVER SHEET PG 2 14 COH NAME ÿ'ÿ ÿ'! ÿ['} ' ' ' : - ÿ, [ÿ,\ ' ÿ : 15 ACCOUNT# (Ethcs Commsson Flers) 16 NOTCE FROMÿj THS BOX S FOR NOTCE POLTCAL CONTRBUTONS ACCEPTED OR POUTCAL EXPENDTURES MADE BY POLTCAL COMMTTEES TO SUPPORT THE POLTCAL COMMTTEE(S) CANDDATE FCEHOLDER, THEsEEXPENDÿTURESMAYHAÿEBEENMADEÿÿTHÿUTTHECANDÿDATEÿSÿRÿFFÿCEHÿLDERÿSKNÿWLEDGEÿR CONSENT. CANDDATES AND FCEHOLDERS ARE REQURED TO REPORT THS NFORMATON ONLY F THEY RECEVE NOTCE SUCH EXPENDTURES, COMMTTEE TYPE COMMTTEE NAME r-ÿ GENERAL --"-] SPECFC COMMTTEE ADDRESS COMMTTEE CAMPAGN NAME [] addtonal pages COMMTTEE CAMPAGN ADDRESS 17 CONTR BUTON 1, TOTAL POLTCAL CONTRBUTONS $50 OR LESS (OTHER THAN TOTALS PLEDGES, LOANS, OR GUARANTEES LOANS), UNLESS TEMZED $ ÿ.* 'ÿ t ÿ 2. TOTAL POLTCAL CONTRBUTONS - (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS),,1) EXPENDTURE TOTALS 3. TOTAL POLTCAL EXPENDTURES $100 OR LESS, UNLESS TEMZED $ J ÿ.-:" 4. TOTAL POLTCAL EXPENDTURES ÿ,,. CONTRBUTON BALANCE 5. TOTAL POLTCAL CONTRBUTONS MANTANED AS THE LAST DAYÿ. ÿ REPORTNG PEROD.ÿ?. Xÿ OUTSTANDNG 6. TOTAL PRNCPAL AMOUNT ALL OUTSTANDNG LOANS AS THE d" LOAN TOTALS LAST DAY THE REPORTNG PEROD q) f * " 18 AFFDAVT,lulJÿ : : _ KATHY ADAM8.. & ÿ MY COMMSSON EXPRE8 4ÿ,ÿ,,ÿ;< November 2, 2013 swear, or affrm, under penalty of perjury, that the accompanyng report s true and correct and ncludes all nformaton requred to be reported by me under Ttle 15, Electon Code. Uÿ Canddate or Offc4older AFFX NOTARY STAMP SEAL ABOVE Sworn to and subscrbed before me, by the sad LfLÿ day of ÿfÿ \, 20 ÿ=_ br" yfÿ Aÿ ÿ, wtch e!sÿ rnÿl ÿ ÿ'2 k ÿ, ths the, to certfy whch, " y nd and seal of offce. Sgnatul ÿ.oof offÿ admnllsterng oath L Prnted name of offcer admnsterng oath te of offcer[admnsterng oath www.ethcs.state.tx.us Revsed 09282011

Texas Ethcs Commsson P.O. Box 12070 Austn, Texas 78711-2070 (512) 463-5800 v (TDD 1-800-735-2989 POLTCAL CONTRBUTONS OTHER THAN PLEDGES OR LOANS SCHEDULE A!) The nstructon Gude explans how to complete ths form. Prncpal occul)aton Job ttle (See nstructons) 1 Total pages Schedule A: 2 FLER.ÿNAME 3 ACCOUNT # (Ethcs Commsson Flers) <, 1 -j : '. ' J 4 5 Full name of contrbutor [] out-of-state PAC(113#: ) 7 Amountof 8 n-knd contrbuton contrbuton ($) descrpton (f applcable) 6 Contrbutor address; ) Jÿ ) f 10 Employer (See nstructons),, C (f travel outsde of Texas, complete Schedule T) } Full name of contrbutor [] out-of-state PAC(D#; ) "" 7 ÿ-( ;t,'t... b,,,ÿ...,,... Contrbutorÿaddress; ) ' " M_. Prncpal occupaton Job ttle (See nstructons).j Employer (See nstructons),full name of contrbutor [] out-of-state PAC (D#:.)! ' 4.,{ t :,t ; " ' " :'.7,;; < t 7 { Contrbutor address; -! "ÿ, Prncpal occupaton Job ttle (See nstructons),' Amount of n-knd contrbuton contrbuton ($) descrpton (f applcable) 1 (f travel outsde of Texas, complete Schedule T) Amount of contrbuton ($) Employer (See nstructons) n-knd contrbuton descrpton (f applcable) (f travel outsde of Texas, complete Schedule T) Full name of contrbutor [] 0ut-of-state PAC (D#:. ) Contrbutor address; Prncpal occupaton Job ttle (See nstructons) Amount of contrbuton ($) n-knd contrbuton descrpton (f applcable) (f travel outsde of Texas, complete Schedule T) Employer (See nstructons) Full name of contrbutor [] out-of-state PAC (D#: ) Contrbutor address; Prncpal occupaton Job ttle (See nstructons) Amount of n-knd contrbuton contrbuton ($) descrpton (f applcable) (f travel outsde of Texas, complete Schedule T) Employer (See nstructons) ATTACH ADDTONAL COPES THS SCHEDULE AS NEEDED f contrbutor s out-of-state PAC, please see nstructon gude foraddtonal reportng requrements. www.ethcs.state.tx.us Revsed 09282011

Texas Ethcs Commsson P.O. Box 12070 Austn, Texas 78711-2070 (512)463-5800 ( 0-735-2989 POLTCAL EXPENDTURES SCHEDULE F EXPENDTURE CATEGORES FOR BOX 8(a) Advertsng Expense GftAwardsMemorals Expense SalaresWagesContract Labor Loan RepaymentRembursement AccountngBankng Legal Servces SolctatonFundrasng Expense Transportaton Equpment & Related Expense Consultng Expense FoodBeverage Expense Travel n Dstrct ContrbutonsDonatons Made By Event Expense Pollng Expense Travel Out Of Dstrct CanddateOffceholderPoltcal Commttee Fees Prntng Expense Offce OverheadRental Expense OTHER (enter a category not lsted above) The nstructon Gude explans how to complete ths form. 1 Total pages Schedule F: 2 FLER NAME 3 ACCOUNT # (Ethcs Commsson Flers) 4 5 6 7' 8 (a) (}3) Descrpton (f travel outsde of Texas, complete Schedule T) " ".' t EXPENDTURE t ' ÿ' ( \J ÿ: ÿ' -::; <: '," - ÿ ÿ : 9 Canddate'Offceholder name Offce sought Offce held payee name "] ) ÿ k4 ' } ' EXPENDTURE j., Canddate Offceholder na'me } Descrpton (f travel outsde of Texas, complete Schedule T) Offce sought Offce held,,:,.,' ' t :, ÿ" EXPENDTURE ÿ ÿ \ ÿ-" ' " ' -'L. Canddate Offceholder name Descrpton (f travel outsde of Texas, complete Schedule T) Offce sought Offce held EXPENDTURE Descrpton (f travel outsde of Texas, complete Schedule T) Canddate Offceholder name Offce sought Offce held ATTACH ADDTONAL COPES THS SCHEDULE AS NEEDED www, ethcs.state,tx.us Revsed 09282011

Texas Ethcs Commsson RO. Box 12070 Austn, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989 POLTCAL EXPENDTURES MADE FROM PERSONAL FUNDS SCHEDULE G Advertsng Expense AccountngBankng Consultng Expense Event Expense Fees EXPENDTURE CATEGORES FOR BOX 8(a) GftAwardsMemorals Expense SalaresWagesContract Labor Loan RepaymentRembursement Legal Servces SolctatonFundrasng Expense Transportaton Equpment & Related Expense FoodBeverage Expense Travel n Dstrct ContrbutonsDonatons Made By Pollng Expense Travel Out Of Dstrct CanddateOffceholderPoltcal Commttee Prntng Expense Offce OverheadRental Expense OTHER (enter a category not lsted above) The nstructon Gude explans how to complete ths form. 1 Total pages Schedule G: 2 FBER NAME l;' t ".j " 3 ACCOUNT # (Ethcs Commsson Flers) 6 7 f.j,,-,. 7{,-" ) :"... ÿ "j' ; {, EXPENDTURE (a) (b) Descrpton (f travel outsde of Texas, complete Schedule T) Descrpton (f travel outsde of Texas, complete Schedule T) EXPENDTURE Descrpton (f travel outsde of Texas, complete Schedule T) EXPENDTURE PU RPOSE Descrpton (f travel outsde of Texas, complete Schedule T) EXPENDTURE ATTACH ADDTONAL COPES THS SCHEDULE AS NEEDED www.ethcs.state.tx,us Revsed 09282011