SPECIFIC-PURPOSE COMMITTEE CAMPAIGN FINANCE REPORT FORM SPAC COVER SHEET PG 1 The SPAC Instruction Guide explains how to complete this form. 3 COMMITTEE NAME 1 Filer ID 2 Total pages filed: 8 FICE USE ONLY Received ELECTRONICALLY FILED 0/27/2017 COMMITTEE ADDRESS ADDRESS / PO BO; APT / SUITE #; 2221 Justin Road, Ste 119-233 CITY; STATE; ZIP CODE Hand-delivered or Postmarked Change of Address Flower Mound, T 75028 Receipt # Amount Processed Imaged 5 CAMPAIGN TREASURER NAME MS / MRS / MR Mr. FIRST Alexander Larkin MI NICKNAME Alex LAST Buck SUFFI 6 CAMPAIGN TREASURER STREET ADDRESS STREET ADDRESS (NO PO BO PLEASE); 100 Moccasin Trail #16 APT / SUITE #; CITY; STATE; ZIP CODE (Residence or Business) Lewisville, T 75077 7 CAMPAIGN STREET OR PO BO; APT / SUITE #; CITY; STATE; ZIP CODE TREASURER MAILING 2221 Justin Road Ste. 119-233 ADDRESS Change of Address Flower Mound, T 75028 8 CAMPAIGN TREASURER PHONE AREA CODE (21) 908-590 PHONE NUMBER ETENSION 9 REPORT January 15 TYPE 10 PERIOD COVERED July 15 30th day before election 8th day before election Runoff Month Day Year Month Day Year 03/28/2017 THROUGH 0/26/2017 Exceeded 500 Limit Dissolution (Attach PAC-DR) 10th day after campaign treasurer termination 11 ELECTION ELECTION DATE Month Day Year 05/06/2017 Primary General ELECTION TYPE Runoff Special Other GO TO PAGE 2
SPECIFIC-PURPOSE COMMITTEE REPORT: PURPOSE AND TOTALS FORM SPAC COVER SHEET PG 2 12 COMMITTEE NAME 13 Filer ID 1 COMMITTEE PURPOSE CANDIDATE / FICEHOLDER NAME (Attach lists on plain paper to complete this report if necessary.) Candidate Officeholder FICE SOUGHT (candidate) / FICE HELD (officeholder) SUPPORT (Candidate or Measure) OPPOSE (Candidate or Measure) BALLOT IDENTIFICATION / # ELECTION DATE Month Day Year ASSIST (Officeholder) Measure DESCRIPTION Lewisville Independent School District Bond Election 15 CONTRIBUTION TOTALS 1. TOTAL POLITICAL CONTRIBUTIONS 50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS), UNLESS ITEMIZED 0.00 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS) 21,800.00 TOTALS 3. TOTAL POLITICAL S 100 OR LESS, UNLESS ITEMIZED 0.00. TOTAL POLITICAL S 1,691.55 CONTRIBUTION BALANCE 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS THE LAST DAY THE REPORTING PERIOD 7,108.5 OUTSTANDING LOAN TOTALS 6. TOTAL PRINCIPAL AMOUNT ALL OUTSTANDING LOANS AS THE LAST DAY THE REPORTING PERIOD 0.00 16 AFFIDAVIT AFFI NOTARY STAMP / SEAL ABOVE 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. Mr. Alexander Larkin Buck Signature of Campaign Treasurer Sworn to and subscribed before me, by the said, this the day of, 20, to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
SUBTOTALS - SPAC FORM SPAC COVER SHEET PG 3 3 of 8 17 COMMITTEE NAME 18 Filer ID 19 SCHEDULE SUBTOTALS NAME SCHEDULE SUBTOTAL AMOUNT 1. SCHEDULE A1: MONETARY POLITICAL CONTRIBUTIONS 1,050.00 2. SCHEDULE A2: NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS 3. SCHEDULE B: PLEDGED CONTRIBUTIONS. SCHEDULE C1: MONETARY CONTRIBUTIONS FROM CORPORATION OR LABOR ORGANIZATION 7,750.00 5. SCHEDULE C2: NON-MONETARY (IN-KIND) CONTRIBUTIONS FROM CORPORATION OR LABOR ORGANIZATION 6. SCHEDULE D: PLEDGED CONTRIBUTIONS FROM CORPORATION OR LABOR ORGANIZATION 7. SCHEDULE E: LOANS 8. SCHEDULE F1: POLITICAL S FROM POLITICAL CONTRIBUTIONS 1,691.55 9. SCHEDULE F2: UNPAID INCURRED OBLIGATIONS 10. SCHEDULE F3: PURCHASE INVESTMENTS FROM POLITICAL CONTRIBUTIONS 11. SCHEDULE F: S MADE BY CREDIT CARD 12. SCHEDULE H: PAYMENT FROM POLITICAL CONTRIBUTIONS TO A BUSINESS C/OH 13. SCHEDULE I: NON-POLITICAL S FROM POLITICAL CONTRIBUTIONS 1. SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED TO FILER
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A1 2 FILER NAME 5 Beogher, Ray Von 6 1 Total pages Schedule A1: Sch: 1/2 Rpt: /8 3 Filer ID 7 Amount of Contribution () 1,000.00 Lewisville, T 75077-735 8 9 Deloach, Holly Amount of Contribution () 250.00 Lewisville, T 75056-5620 Dollack, Bobby Amount of Contribution () 1,000.00 Lewisivlle, T 75077 Hassett, Kristin Amount of Contribution () 100.00 Flower Mound, T 75022 0/06/2017 Kobdish, Charles Amount of Contribution () 200.00 Dallas, T 75230-1811
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A1 2 FILER NAME 5 Rivera, Randi 6 1 Total pages Schedule A1: Sch: 2/2 Rpt: 5/8 3 Filer ID 7 Amount of Contribution () 750.00 Highland Village, T 75077 8 9 0/11/2017 Smith, Jody Amount of Contribution () 10,000.00 Flower Mound, T 75022-0000 Steward, Ron Amount of Contribution () 750.00 Highland Village, T 75077
MONETARY CONTRIBUTIONS FROM CORPORATION OR LABOR ORGANIZATION SCHEDULE C1 1 Total pages Schedule C1: Sch: 1/1 Rpt: 6/8 2 FILER NAME 3 Filer ID 5 Corporation / Labor Organization name 7 0/18/2017 Flower Mound Hospital Partners, LLC Amount of contribution () 5,000.00 6 Arlington, T 76011 Corporation / Labor Organization name Green Meadows Design & Landscaping, Inc. Amount of contribution () 500.00 Lewisville, T 75056 Corporation / Labor Organization name Hilton Garden Inn-Lewisville Amount of contribution () 250.00 0/06/2017 Lewisville, T 75067 Corporation / Labor Organization name Nelson Bros. Ready Mix, Ltd. Amount of contribution () 1,000.00 0/06/2017 Lewisville, T 75057 Corporation / Labor Organization name The Flower Mound Chamber of Commerce Amount of contribution () 1,000.00 Flower Mound, T 75028-78 V1.0.1321
POLITICAL S FROM POLITICAL CONTRIBUTIONS SCHEDULE F1 Advertising Expense Accounting/Banking Consulting Expense Contributions/ Donations Made By - Candidate/Officeholder/Political Committee Credit Card Payment Loan Repayment/Reimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor 1 Total pages Schedule F1: 2 FILER NAME 3 6 Sch: 1/2 Rpt: 7/8 03/30/2017 Amount () 8,250.00 CATEGORIES FOR BO 8(a) Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services 5 Payee name Mayes Media Group 7 Payee address; City; State; Zip Code 312 Creekwood Drive Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel in District Travel Out of District OTHER (enter a category not listed above) Filer ID Sunnyvale, T 75182 8 PURPOSE (a) Category (See Categories listed at the top of this schedule) (b) Consulting Expense Check if Austin, T, officeholder living expense Organization meetings and strategy 9 Complete ONLY if direct Candidate/Officeholder name Office sought 03/30/2017 Payee name Mayes Media Group Amount () 2,033.50 Payee address; City; 312 Creekwood Drive State; Zip Code Sunnyvale, T 75182 PURPOSE (a) Category (See Categories listed at the top of this schedule) Printing Expense (b) Check if Austin, T, officeholder living expense Printing of Push Cards Complete ONLY if direct Candidate/Officeholder name Office sought 03/30/2017 Payee name Mayes Media Group Amount () 1,00.00 Payee address; City; 312 Creekwood Drive State; Zip Code Sunnyvale, T 75182 PURPOSE (a) Category (See Categories listed at the top of this schedule) Design Expense (b) Check if Austin, T, officeholder living expense Design of Logo and print materials Complete ONLY if direct Candidate/Officeholder name Office sought
POLITICAL S FROM POLITICAL CONTRIBUTIONS SCHEDULE F1 Advertising Expense Accounting/Banking Consulting Expense Contributions/ Donations Made By - Candidate/Officeholder/Political Committee Credit Card Payment Loan Repayment/Reimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor 1 Total pages Schedule F1: 2 FILER NAME 3 6 Sch: 2/2 Rpt: 8/8 03/30/2017 Amount () 2,993.25 CATEGORIES FOR BO 8(a) Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services 5 Payee name Mayes Media Group 7 Payee address; City; State; Zip Code 312 Creekwood Drive Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel in District Travel Out of District OTHER (enter a category not listed above) Filer ID Sunnyvale, T 75182 8 PURPOSE (a) Category (See Categories listed at the top of this schedule) (b) Advertising Expense Check if Austin, T, officeholder living expense Web Hosting 9 Complete ONLY if direct Candidate/Officeholder name Office sought 0/18/2017 Payee name Paypal Amount () 1.80 Payee address; City; 2211 North First Street State; Zip Code San Jose, CA 95131 PURPOSE (a) Category Fees (See Categories listed at the top of this schedule) (b) Check if Austin, T, officeholder living expense Credit Card Fees Complete ONLY if direct Candidate/Officeholder name Office sought