CANDIDATE / CAMPAIGN FINANCE REPORT COVER SHEET PG 1 The C/OH Instruction Guide explains how to complete this form. 1 Filer ID (Ethics Commission Eilers) 2 Total pages filed: ÿ,,,--"ÿ 3 CANDIDATE/ NAME MS / MRS / MR f/!ÿ 4, NICKNAME FIRST /-.ÿ' LAST SUFFIX FICE USE ONLY Date Received /ÿ 4 CANDIDATE/ MAILING ADDRESS ADDRESS / PC BOX; APT / SUITE #; CH'Y; STATE; ZIP CODE [] Change of Address 5 CANDIDATE/ PHONE 6 CAMPAIGN NAME AREA CODE PHONE NUMBER EXTENSION <ÿ.ÿ1ÿ,#/ÿ.- "ÿg2_. MS / MRS / MR FIRST #.," J_. _ MI...ÿ.ÿ..... dÿ/pc... NIGh,NAME LAST SUFFIX Date Hand-delivered or Date Postmarked Receipt # Anlount Date Processed Date Imaged 7 CAMPAIGN ADDRESS (Residence or Business) 8 CAMPAIGN PHONE STREET ADDRESS (NO PC BOX PLEASE); APT / SUITE #; CITY; C,lÿ,,,4 AREA CODE 'D)' PHONE NUMBER 7 %v0 EXTENSION STATE; ZIP CODE 9 REPORT TYPE ] January 15 [] 30th day before election [] July 15 [] 8th day before election ],,,,ÿfi'lo f f._ÿ<,ÿ ÿ(d.m [] Exceeded 500 Iinlit [] 15th day aftel campaign treasurer appointment (Officeholder Only) Final Report (Attach C/OH - FR) 10 PERIOD Month Day Year Month Day Year COVERED ÿ"/ /J ÿ/szi/ THROUGH 6" ÿ/2j ÿ/ÿ 11 ELECTION ELECTION DATE 12 FICE Menth Day Year S! 740/i FICE HELD (if any) ] Primary ] General 0v0n ÿ/eÿ)'0!!, Gÿ 5ÿvu, ÿi ELECTION TYPE ] Special DescripIio3c,, "/ÿ!/g.w 13 FICE SOUGHT (if known) GO TO PAGE 2 Forms provided by Texas Ethics Comrnission www.ethics.state.tx.us Revised 9/8/2015
CANDIDATE / CAMPAIGN FINANCE REPORT COVER SHEET PG 2 14 16 NOTICE FROM POLITICAL COMMITTEE(S),/ÿ,/;L,ÿiÿ 15 FilerlD (Ethics Commission Fliers) THIS BOX IS FOR NOTICE POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL S MADE BY POLITICAL COMMITTEES TO SUPPORT THE CANDIDATE /. THESE S MAY HAVE BEEN MADE WITHOUT THE OANDIDATErS OR 'S KNOWLEDGE OR CONSENT, CANDIDATES AND S ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE SUCH S. CO Mÿ4ÿE TYPE j GENERAL [ÿ] SPECIFIC COMMITTEE NAME COMMITTEE ADDRESS / [] Additional Pages COMMITTEE CAMPAIGN ADDRESS 17 CONTRIBUTION TOTALS TOTAL POLITICAL CONTRIBUTIONS 50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS), UNLESS ITEMIZED 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES LOANS) TOTALS 3. TOTAL POLITICAL S 100 OR LESS, ÿ /ÿ"ÿ UNLESS ITEMIZED CJ... 4. TOTAL POLITIOAL S ÿ1ÿ1 ÿÿ' CONTRIBUTION,ÿ '! V2ÿ' ÿ'ÿ.ÿ,ÿ" BALANCE 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS THE LAST DAY ÿ R".ÿ' REPORTING PERIOD OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT ALL OUTSTANDING LOANS AS THE LOAN TOTALS LAST DAY THE REPORTING PERIOD ÿ U 18 AFFIDAVIT :ÿ'i"-i'ÿi;z',: "DANIEL ANDREW RAMIREZ I,ofe o,,oxos My Commission Expires fÿ,tÿ June.og, =ol 8 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. Signature of Candidate or Officeholder AFFIX NOTARY STAMP / SEALABOVE Sworntoand.ÿ..s bsc bed u r, before me, Fÿ'ÿ/"ÿ'ÿ' bythesaid,ÿ( "/'ÿ/ ÿ ' ")ÿ'tÿ ) ÿjÿ "... th,s the _do_... day of..d/.t..ÿi/, 20 /fÿ2,to certify which, witness my hand and seal of office. Signature of officer administering ÿ.ath f..., Printed name of officer administering oath Title of officÿr administering oath Forms provided by Texas Ethics Cornmission www.ethics.state.tx.us Revised 9/8/2015
SUBTOTALS - C/OH 19 FILER NAME /ÿ /ÿ* - J'/iÿ' 4 COVER SHEET PG 3 20 Filer ID (Ethics Commission Fliers) 21 SCHEDULE SUBTOTALS NAME SCHEDULE SUBTOTAL AMOUNT 1. [] SCHEDULEA1 : MONETARY POLITICAL CONTRIBUTIONS 2. ÿ] SCHEDULE A2: NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS 3. [ÿ SCHEDULE B: PLEDGED CONTRIBUTIONS 4. [ÿ SCHEDULEE: LOANS 5. ÿ_j SCHEDULE FI: POLITICAL S MADE FROM POLITICAL CONTRIBUTIONS 6. [ÿ SCHEDULE F2: UNPAID INCURRED OBLIGATIONS 7. Lÿ SCHEDULE F3: PURCHASE INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS 8. ÿ1 SCHEDULE F4: S MADE BY CREDIT CARD 9. ÿ] SCHEDULE G: POLITICAL S MADE FROM PERSONAL FUNDS 10. Lÿ SCHEDULE t4: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS C/OH 11. [ÿ SCHEDULE I: NON-POLITICAL S MADE FROM POLITICAL CONTRIBUTIONS 12. [ÿ SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED TO FILER Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/201
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A1 The Instruction Guide explains how to complete this form. FILER NAMEs: 1 Total pages Schedule AI: 3 Filer ID (Ethics Commission Filers) 4 Date 5 Full name of contributor Fq out-of-state PAC (ID#:_ ) 7 Amount of contribution () oi, ' 0 6 Contributor address; -, "I 9 8 Employer (See Instructions) Date Full name of contributor [] out-of-state PAC (ID#: Amount of contribution () Contributor address; Ernployer (See Instructions) Date Full name of contributor [] out-of-state PAC (ID#: Amount of contribution () Contributor address; Employer (See Instructions) Date Full name of contributor [] out-of-state PAC (ID#: Amount of contribution () Contributor address; Employer (See Instructions) ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED 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 S MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F1 Advertising Expense Accounting/Banking Consulting Expense Contributions/Donations Made By Candidate/Officeholder/Political Committee Credit Card Payment I Total pages Sclledule FI: I 4 Date,ÿ ] ÿ 5/2/id %t40 6 Amount (,) CATEGORIES FOR BOX 8(a) Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services Loan RepaymendReirnbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Corltract Labor The Instruction Guide explains how to complete this form. Solicitation/Fu ndraisieg Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) 2 FILER NAMEÿ'ÿ"ÿ" ÿ _ÿ/ÿ; itÿ,ÿ /fyyf ÿ./3 Filer,D (Ethics Co rn r nissi on File r s) 7 Payee address; (a) Category (SeeCategorieslistedatthetopofthisschedule) (b) Description [ÿ] Check if Austin, TX, officeholder living expense " ÿ'ÿ//ÿÿ ÿ'ÿhyÿ" [ÿ Check if travel outside of Texas. Cornplete Schedule T. ' 9 Cornplete ONLY if direct Candidate / Officeholder name Office sought Office held D ate Payee name Amount () Payee address; l,j ) vv,,, d P,,,t f Category (See Categories listed at the lop of this schedule) Description ite ] Check if travel outside ol Texas. Complete Schedule T. [ÿ Cheek if Austin, TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held Date f / Amount () Payee name h-7<..-) Payee address; j Category (See Categories listed at the top of th s sehadu e) Description '77'7Y4 [ÿ] Check il travel outside of Texas. Complete Schedule ]ÿ [ÿ Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held ATTACH ADDITIONAL COPIES THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015