CANIATE/ FICEHOLER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 1 The C/OH Instruction Guide explains how to complete this form. 1 Filer I (Ethics Commission Filers) 2 Total pages filed: 3 CANIATE / MS / MRS / MR FIRST Ml FICEHOLER NAME. ~ V 0(}() -. S,.. NICKNAME LAST SL FIX FICE USE ONLY ELl:>ASO ~n;e- (\) 0-.:\..p { c..._ car IMUNITY COLLEGE,_,, 4 CANIATE/ ARESS / PO BOX; APT / SUITE #; CITY; STATE ; ZI COE FICEHOLER MAILING APR 2 8 2017 ARESS Change of Address Li ~:l. UT)R[o. Id (/2, ') ( a.so \K" h ~d<y 5 CANIATE/ AREA COE PHONE NUMBER EXTENSION RECEIVE FICEHOLER PHONE PR =~1omT sopptee (Sos) ;}JQ-L{s'I 6 CAMPAIGN MS / MRS / MR FIRST L~ RMI Receipt# NAME......... ate Processed NICKNAME LAST SUFFIX ate Imaged l\jo...,~ 7 CAMPAIGN STREET ARESS (NO PO BOX PLE~); APT / SUITE #; CITY; STATE ; ZIP COE ARESS (Residence or Business) J /1 & UJ ~f~fvvnr' 1 fj '-So /)c 7 JO;~g 8 CAMPAIGN AREA COE PHONE NUMBER EXTENSION (915') '3SS- Jl..f-:J I PHONE I Amount 9 REPORT TYPE 30th day before election January 15 Runoff Ju1y1s ~ 8th day before election Exceeded 500 limit 15th day after campaign treasurer appointment (Officeholder Only) Final Report (Attach C/OH - FR) 10 PERIO Month ay Year Month ay Year COVERE t-/ /Jb / ~1, THROUGH 4/;)g / ;;)0J 7 11 ELECTION ELECTION ATE ELECTION TYPE 5/0 Month ay Year Primary /dbl~ General Runoff Other escription Special 12 FICE FICE HEL (if any) 13 FICE SOUGHT (if known) GO TO PAGE 2
CANIATE/ FICEHOLER CAMPAIGN FINANCE REPORT FORM C/OH COVER SHEET PG 2 16 NOTICE FROM POLITICAL COMMITTEE(S).SO,,,~No.._-e10... 15 Filer I (Ethics Commission Filers) THIS BOX IS FOR NOTICE POLITICAL CONTRIBUTIONS ACCEPTE OR POLITICAL EXPENITURES MAE BY POLITICAL COMMITTEES TO SUPPORT THE CANIATE / FICEHOLER, THESE EXPENITURES MAY HAVE BEEN MAE WITHOUT THE CANIATE'S OR FICEHOLER'S KNOWLEGE OR CONSENT. CANIATES AN FICEHOLERS ARE REQUIRE TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE SUCH EXPENITURES. COMMITTEE TYPE COMM ITTEE NAME OGENERAL OsPEC1F1c COMMITTEE ARESS COMMITTEE CAMPAIGN NAME Additional Pages COMMITTEE CAMPAIGN ARESS 17 CONTRIBUTION TOTALS 1. TOTAL POLITICAL CONTRIBUTIONS 50 OR LESS (OTHER THAN PLEGES, LOANS, OR GUARANTEES LOANS}, UNLESS ITEMIZE 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEGES, LOANS, OR GUARANTEES LOANS) L/ 00; oo EXPENITURE TOTALS 3. TOTAL POLITICAL EXPENITURES 100 OR LESS, UNLESS ITEMIZE 4. TOTAL POLITICAL EXPENITURES CONTRIBUTION BALANCE 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINE AS THE LAST AY REPORTING PERIO OUTSTANING LOAN TOTALS 6. TOTAL PRINCIPAL AMOUNT ALL OUTSTANING LOANS AS THE LAST AY THE REPORTING PERIO 18 AFFIAVIT PAMELA L PAYNE Notary I #10447812 My Commission Expires Jan 21, 2021 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 under Title 15, Election Code. AFFIX NOTARY STAMP / SEALABOVE Sworn to and subscribed before me, by the said B'Yl.n..i'..e. s{)rt, C!c_ Al tt. i la7j<._., P~ ';/ Pa~ Pt>._l'Y)e,la... L. Pa_t-,n--e. day of Apn' /, 2 0 I 7, to certify which, witness my hand and seal o~office., this the Signature of officer administering oath Printed name of officer administering oath Title of officer administe ring oath
SUBTOTALS - C/OH FORM C /OH COVER SHEET PG 3 19 FILER NAME 2 0 File r I (Ethics Commission Filers) 21 SCHEULE SUBTOTALS SUBTOTAL NAME SCHEULE AMOUNT 1. [Qf SCHEULE A 1: MONETARY POLITICAL CONTRIBUTIONS 'Joo-oo 2. SCHEULE A2: NON-MONETARY (IN-KIN) POLIT ICAL CONTRIBUTIONS 3. 4. 5. 6. 7. 8. 9. 10. 11. SCHEULE B : PLEGE CONTRIBUTIONS SCHEULE E: LOANS SCHEULE F1: POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS SCHEULE F2: UNPAI INCURRE OBLIGATIONS SCHEULE F3: PURCHASE INVESTMENTS MAE FROM POLITICAL CONTRIBUTIONS SCHEULE F4: EXPENITURES MAE BY CREIT CAR SCHEULE G: POLITICAL EXPENITURES MAE FROM PERSONAL FUNS SCHEULE H : PAYMENT MAE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS C /OH SCHEULE I: NON-POLIT ICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS 12. SCHEULE K: INTEREST, CREITS, GAINS, REFUNS, AN CONTRIBUTIONS RETURNE TO FILER
MONETARY POLITICAL CONTRIBUTIONS SCHEULE A1 The Instruction Guide explains how to complete this form. 1 Total pages Schedule A 1: 2 3 Filer I (Ethics Commission Filers) 4 ate 5 Full name of contributor 0 out-of-state PAC (I# : ~ 7 Amount of contribution () L/-~-17 /I 6 Contributor address; C ity; Sta te ; Zip Code /75' 60 8 Principal occupation I Job title (See Instructions) 9 ate Full name of contributor 0 out-o f-state PAC (I#: ~ A.NJV,;> _-~el~>tu~~ A mount of contribution () Contributor address; C ity; State; Zip Code :/ /)SOO Principal occupation I Job title (See Instructions) ate Full name of contributor 0 out-of-state PAC (I#: ~ Amount of contribution () Contributor address; C ity; State ; Zip Code /Cb, 00 Princ ipal occupation I Job title (See Instructions) ate Full name of contributor 0 out-of- state PAC (I#: ~ Amount of contribution () Contributor address; City; State; Zip Code Principal occupation I Job t itle (See Instructions) 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
POLITICAL EXPENITURES MAE FROM POLITICAL CONTRIBUTIONS SCHEULE F1 EXPENITURE CATEGORIES FOR BOX S(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 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 The Instruction Guide explains how to complete this form. 1 Total pages Schedule F1: 21ER NAME 13 Filer I (Ethics Commission Filers) -:Jt,, l't ~3 '.ss 4 rq, 5 \JOnl\P ~N\i ~ 't>1nc... No..~-f'Jc.. '-.I p(57~az\ s of\-- ~.o.j}h: ~ 7 Payee address; City; State; Zip Code ~Yb~ L:r>,P ~lvj l P~:>o Tx;,9q3 >< 8 (a)"category (See Categories listed at the top of this schedule) (b) escription PURPOSE EXPENITURE ~Ovm~ "il'\ s\~~n5 Check if travel outside of Texas. Complete Schedule T. 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; Z ip Code Category (See Categories listed at the top of this schedule) escription PURPOSE Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense EXPENITURE Complete ONLY if direct Candidate I 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 PURPOSE Check if travel outside of Texas. Compk,te Schedule T. Check if Austin, TX, officeholder living expense EXPENITURE Complete ONLY if direct Candidate / Officeholder name Office sought Office held ATTACH AITIONAL COPIES THIS SCHEULE AS NEEE