Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989I
CANDIDATE 1 OFFICEHOLDER FORM C/OHCAMPAIGN FINANCE REPORT COVER SHEET PG I
1 ACCOUNT # 2 Total pages filed:The C/OH Instruction Guide explains how to complete this form. (Ethics OornmissianFilers)
3 FIRST , MI
LAST SUFFIX
CANDIDATE / MS JMRS/ÿ.iÿOFFICEHOLDERNAME
• . .ÿ.'-oÿ.NICKNAME
4- CANDIDATE /OFFICEHOLDERMAILINGADDRESS
F--] change of address
ADDRESS 1 PO BOX; APT/SUITE#; CITY; STALE; ZIP CODE
!2 OFFICE
6 CANDIDATE/OFFICEHOLDERPHONE
I AREA CODE PHONE NUMBER EXTENSION6 CAMPAIGN I MS/MRS/MR FIRST MI Datelmaged
TREASURERI ÿ'ÿ6,,.._,NIAM F: ............... L. .....................
NICKNAME LAST SUFFIX
L/4g .CITY; STATE; ZIP CODE7 CAMPAIGN
TREASURERADDRESS(residenceorbusinesÿ
8 CAMPAIGNTREASURERPHONE
9 REPORT TYPE
tOPERIODCOVERED
it! ELECTION
(\,.
STREET ADDRESS (N0 PO BOX PLEASE); APTI SUITE-#;
AREA CODE PHONE NUMBER EXTENSION
[] January 15 [] 30th day before election [] Runoff [] 15th day after campaigntreasurer appointment
8ÿ (officeholder only)[---I July 15 day before electionÿI---1 Exceeded $500 [] Final report (Attach ClOH-FR)limit
Month Day year Month Day Year
ELECTION DATEMonth Day Year
¢/I / If
ELECTION TYPE
OFFICE HELD (if any) 13 OFFICESÿUGHTI ÿ.D{ifkn°wn)
OFFICE USE ONLY
Date Received
Date Hand-delivered or Postmarked
Receipt # Amount
Date Processed
GO TO PAGE 2
www.ethics.state.tx.us Revised 07/28/2014
Texas Ethics Commission R O. Box 12070 Austin, Texas 78711-2070
CANDIDATE / OFFICEHOLDER REPORT:SUPPORT & TOTALS
(512) 463-5800 (TDD 1-800-735-2989'
FORM C/OHCOVER SHEET PG 2
t4 C/OH NAME
16 NOTICE FROMPOLITICALCOMMITTEE(S)
t5 ACCOUNT.# (Ethics Commission Filets)
THIS BOX 1S FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR pOLFnCAL F.X, PENDITLIRES ]ÿADE BY POLITICAL GOM Mnq'EES TO SUPPORT THE
CANDIDATE J OFFICEHOLDFPÿ THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATErS OR OFFICEHOLDERrS KNOWLEDGE OR
CONSENT, CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFOP,ÿTION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES,
\
!7 CONTRIBUTIONTOTALS
2. TOTAL POLITICAL CONTRIBUTIONS(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
EXPENDITURETOTALS 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED $
4. TOTAL POLITICAL EXPENDITURES $
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY eBALANCE OF REPORTING PERIOD ,p
OUTSTANDING 6. TOTAL PRIN CIPAL AMOU NT OF ALL OUTSTAN DING LOANS AS OF THE $LOAN TOTALS LAST. DAY OF THE REPORTING PERIOD
"18 AFFIDAVIT
[] additional pages
COMMITTEE TYPE
[ÿ1 GENERAL
'---]SPECIFIC
r-! COM[#]ITTEE NAMEIiiiI
COMMITTEE ADDRESS
COMMiTi-EE CAMPAIGN TREASURER NAME
COIvlMITTEE CAMPAIGN TREASURER ADDRESS
TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THANPLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS iTEMIZED $
$
I swear, or affirm, under penalty of perjury, that the accompanying reportis 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 i SEAL ABOVE
Sworn to and subscribed before me, by the said
day of , 20 ____, this the
, to eeÿify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of oÿcer administering oath Title of offic.÷r administering oath
www.ethics.state.tx.us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070, Austin, Texas 78711-2070 (512) 463-5800
POLITICAL CONTRIBUTIONSOTHER THAN PLEDGES OR LOANS
(TDD i-800-735-2989
SCHEDULE A
1 Total pages ScheduleA:The Instruction Guide explains how to complete this form.
2 FILER NAME 3 ACCOUNT # (Ethics Commission Filers)
4- Date 5 Full name of contdbutor r-]out-of-statePAC(ID#: )
9 Principal occupation I Job title (See Instructions)
Date
t!.
At
Principal occupation / Job title (See Instructions)
6 Contributor address; City; State; Zip Code
Furl name of contributor
Contributor address; City; State; Zip Code
[] out-of-state PAC(ID#:..
10 Emptoyer (See Instructions)
) Amount of 1contribution ($) I
III
7 Amountof t 8 in-kind contributioncontribution ($) I description (if applicable)
!1]
(If travel outside of Texas, complete Schedule T)
in-kind contributiondescription (if applicable)
(If travel outside of Texas, complete Schedule T)Employer (See Instructions)
Date
Principal occupation I Job title (See Instructions)
Full name of contributor [] out-of-state PAC (IEÿ
Contributor address; City; State; Zip Code
) Amount of } In-kind contributioncontribution ($) ] description (if applicable)
III
(If travel outside of Texas, complete ,Schedule T)
Employer (See Instructions)
Date
Principal occupation / Job title (See Instructions)
Full name of contributor [] out-of-state PAC(ID#:
Contributor address; City; Sÿate; Zip Code
Amount ofcontribution ($)
In-kind contributiondescription (if applicable)
(if travel outside of Texas, complete Schedule T)Employer (See Instructions)
Date
Principal occupation / Job title (See Instructions)
Full name of contributor [] 0ut-ef-statePAO(IDik.
Contributor address; City; ÿate; Zip Code
Amount of Icontribution ($) I
I]l
('If travel outside of Texas, complete Schedule T)
Employer (See Instructions)
In-kind contributiondescription (if applicable)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDIf contributor is out-of-state PAO, please see instruction guide foradditional reporting requirements.
www,ethics.state.tx.us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800
POLITICAL EXPENDITURES
(TDD 1-800-735-2989'
SCHEDULE F
Advertising ExpenseAccounting/BankingConsulting ExpenseEvent ExpenseFees
"i Total pages Schedule F:
4- Date
EXPENDITURE CATEGORIES FOR BOX 8(a)Gift/Awards/Memorials Expense Salaries!Wages/Contract LaborLegal Services Selicitation!Fundraising ExpenseFood/Beverage Expense Travel In DistrictPolling Expense Travel Out Of DistrictPrinting Expense Office Overhead!Rental Expense
The Instruction Guide explains how to complete this form.
5 Payee name
7 Payee address; City; State; Zip Code
Loan Repayment/Reim bursem ant
Transportation Equipment & Related ExpenseContributions/Donations Made By
Candidate/Offioeholder/P olitical CommitteeOTHER (enter a category not listed above)
3 ACCOUNT # (Ethics Commission Filers)
8 PURPOSE I {a) Category (See cetegaries listed at the top of this schedule) I (b} Description (]ftravel outside of Texas, complete Schedule T)
OFtl I [] ChecktfAustth, T×, o#]ceholder living e×penee
9 Complete ONLY if direct Candidate I Officeholder name Office sought Office heldexpenditure to benefit C./OH
Date
Amount ($)
PUP.POSEOF
F-J(PENDITU RE
Payee name , ÿ,ÿ
Payee address; City; State Zip Code
Complete ONLY if directexpenditure to benefit CtOH
Category (See categories listed at the top of this schedule)
Candidate ] Officeholder name
Description (If travel outside of Texas, complete Schedule T)
r-] Check ifAustth, TX, o#3ceholder living expense
Office sought" Oÿce held
Date
Amount ($) Payee address; City; State; Zip Code
Category (See categories listed at the top of this schedule)PUP.POSE
JOF|'f" ' 'ÿ"ÿ" : "ÿ "lÿOÿ)ÿ. [] Check ifAustin, "IX, ofÿceholder living expense
i
EÿPENDITURE
C0mplete Oh]LY if direct Candidate I Officeholder name Office sought Oÿce heldexpenditure to benefit CIOH
Date Payee name
Amount (S) Payee address; City; State; Zip Code
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
PURPOSEOF
vE,,.PENDITURE
Complete ONLY if directexpenditure to benefit C/OH
Candidate / Oÿceholder name
Description (If travel outside of Texas, complete Schedule T)
[] Check ifAu slJn, l-X, oÿceholder living expense
Office sought Office held
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 07/28t2014