3 C-OH Additional SchedulesMONETARY POLITICAL
CONTRIBUTIONS SCHEDULE Al
The Instruction Guide explains how to complete this form.
1 Total pages Schedule Al:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Full name of contributor
. . . . . . . . . . . . . . . . .
6 Contributor address;
❑ out -of -state PAC (ID #: t
. . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
7 Amount of contribution ($)
8 Principal occupation / Job title (See Instructions)
9 Employer (See Instructions)
Date
Full name of contributor
. . . . . . . . . . . . . . . . .
Contributor address;
❑ out -of -state PAC (ID #: 1
. . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor
....... .......I.......................
Contributor address;
❑ out -of -state PAC (to #: t
City; State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor
. . . . . . . . . . . . . . . . .
Contributor address;
❑ out -of -state PAC (ID #: 1
. . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF 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
NON - MONETARY (IN -KIND) POLITICAL
CONTRIBUTIONS SCHEDULE A2
The Instruction Guide explains how to complete this form.
1 Total pages Schedule A2:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED IN -KIND POLITICAL CONTRIBUTIONS
5 Date
6 Full name of contributor ❑ out -of -state PAC (ID #:
7 Contributor address; City; State; Zip Code
t
8 Amount of 9 In -kind contribution
Contribution $ description
❑ Check if travel outside of Texas. Complete Schedule T.
10 Principal occupation / Job title (FOR NON- JUDICIAL) (See Instructions)
11
Employer (FOR NON- JUDICIAL)(See Instructions)
12 Contributor's principal occupation (FOR JUDICIAL)
13
Contributor's job title (FOR JUDICIAL) (See Instructions)
14 Contributor's employer/law firm (FOR JUDICIAL)
15
Law firm of contributor's spouse (if any) (FOR JUDICIAL)
16 If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL)
Date
Full name of contributor ❑ out -of -state PAC (ID #:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
t
. . . .
Amount of In -kind contribution
Contribution $ description
Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (FOR NON - JUDICIAL) (See Instructions)
Employer (FOR NON- JUDICIAL)(See Instructions)
Contributor's principal occupation (FOR JUDICIAL)
Contributor's job title (FOR JUDICIAL) (See Instructions)
Contributor's employer /law firm (FOR JUDICIAL)
Law firm of contributor's spouse (if any) (FOR JUDICIAL)
If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL)
ATTACH ADDITIONAL COPIES OF 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
PLEDGED CONTRIBUTIONS SCHEDULE B
The Instruction Guide explains how to complete this form.
1 Total pages Schedule B:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED PLEDGES
5 Date
6 Full name of pledgor ❑ out -of -state PAC (ID #: )
8 Amount 9 In -kind contribution
of Pledge $ description
7 Pledgor address; City; State; Zip Code
❑ Check if travel outside of Texas. Complete Schedule T.
10 Principal occupation / Job title (See Instructions)
11 Employer (See Instructions)
Date
Full name of pledgor ❑ out -of -state PAC (ID #: t
Amount In -kind contribution
of Pledge $ description
Pledgor address; City; State; Zip Code
❑ Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of pledgor ❑ out -of -state PAC (ID #: t
Amount of In -kind contribution
Pledge $ description
Pledgor address; City; State; Zip Code
❑Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of pledgor ❑ out -of -state PAC (ID #: t
Amount of In -kind contribution
Pledge $ description
. . . . . . . . . . . . . . . . . . . . . . . .
Pledgor address; City; State; Zip Code
[:]Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF 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
LOANS SCHEDULE E
The Instruction Guide explains how to complete this form.
1 Total pages Schedule E:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED LOANS
$
5 Date of loan
7 Name of lender ❑ out -of -state PAC (ID #: )
. . . . . . . . . . . . . . .
8 Lender address; City; State; Zip Code
9 Loan Amount ($)
6 Is lender
10 Interest rate
a financial
Institution?
11 Maturity date
Y N
12 Principal occupation / Job title (See Instructions)
13 Employer (See Instructions)
14 Description of Collateral
15 Check if personal funds were deposited into political
account (See Instructions)
❑ none
❑
16 GUARANTOR
17 Name of guarantor
19 Amount Guaranteed ($)
INFORMATION
...... ...............................
18 Guarantor address; City; State; Zip Code
❑ not applicable
20 Principal Occupation (See Instructions)
21 Employer (See Instructions)
Date of loan
Name of lender ❑ out -of -state PAC (ID #: )
Lender address; City; State; Zip Code
Loan Amount ($)
Is lender
Interest rate
a financial
Institution?
Maturity date
Y N
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Description of Collateral
Check if personal funds were deposited into political
account (See Instructions)
❑ none
❑
GUARANTOR
Name of guarantor
Amount Guaranteed ($)
INFORMATION
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Guarantor address; City; State; Zip Code
❑ not applicable
Principal Occupation (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If lender 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 EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F1
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/FundraisingExpense
Accounting /Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards /Memorials Expense Printing Expense Travel Out Of District
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 Fl:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑ Check if travel outside ofTexas . Complete Schedule T.
OF
❑ Check If Austin, TX, officeholder living expense
EXPENDITURE
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
❑ Check if travel outside of Texas. Complete Schedule T.
PURPOSE
OF
❑ Check if Austin, TX, officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
❑ Check If travel outside of Texas
PURPOSE
OF
.CompleteScheduleT.
❑ Check if Austin, TX, officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8!2015
UNPAID INCURRED OBLIGATIONS SCHEDULE F2
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate /Officeholder/PoliticalCommittee Legal Services SalariesNJages/ContractLabor Other (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F2:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS
$
5 Date
6 Payee name
7 Amount ($)
8 Payee address; City; State; Zip Code
9 TYPE OF
Political Non - Political
EXPENDITURE
10
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑ Check if travel outside of Texas. Complete Schedule T.
OF
❑Check if Austin, TX, officeholder living expense
EXPENDITURE
11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE
Political Non Political
Category (See Categories listed at the top of this schedule)
Description
❑ Check if travel outside of Texas. Complete Schedule T.
PURPOSE
OF
❑ Check if Austin, TX, officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
PURCHASE OF INVESTMENTS MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F3
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F3:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Name of person from whom investment is purchased
. . . . . . . . . . . . . . . . . . .
6 Address of person from whom investment is purchased; City; State; Zip Code
7 Description of investment
8 Amount of investment ($)
Date
Name of person from whom investment is purchased
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom investment is purchased; City; State; Zip Code
Description of investment
Amount of investment ($)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
EXPENDITURES MA ®E, BY CREDIT CARD
SCHEDULE F4
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment& Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate /Officeholder/Political Committee Legal Services Salaries Wages /Contract Labor Other (entera category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F4:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TO A CREDIT CARD
$
5 Date
6 Payee name
7 Amount ($)
8 Payee address; City; State; Zip Code
9 TYPE OF
EXPENDITURE
❑ Political ❑ Non - Political
10
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
[::]Check if travel outside of Texas. Complete Schedule T.
OF
EXPENDITURE
❑Check if Austin, TX, officeholder living expense
11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE
El Political 1-1 Non-Political
Category (See Categories listed at the top of this schedule)
Description
❑ Check if travel outside of Texas. Complete Schedule T.
PURPOSE
OF
❑Check if Austin, TX, officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
POLITICAL EXPENDITURES
MADE FROM PERSONAL FUNDS SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate /Ofriceholder/PoliticalCommittee Legal Services SalariesM/ages/ContractLabor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
❑Reimbursement from
political contributions
intended
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑
OF
Check if travel outside of Texas. Complete Schedule T.
EXPENDITURE
❑ Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
E:1 Reimbursement from
political contributions
Intended
Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑
OF
EXPENDITURE
Check if travel outside of Texas. Complete Schedule T.
❑ Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
❑Reimbursement from
political contributions
Intended
Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑
OF
Check if travel outside of Texas. Complete Schedule T.
EXPENDITURE
❑ Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
PAYMENT MADE FROM POLITICAL
CONTRIBUTIONS TO A BUSINESS OF C /OH SCHEDULE FI
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment& Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate /Officeholder/PoliticalCommittee Legal Services SalariesNdages/ContractLabor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Business name
6 Amount ($)
7 Business address; City; State; Zip Code
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑ Check if travel outside of Texas. Complete Schedule T.
OF
❑ Check if Austin, TX, officeholder living expense
EXPENDITURE
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
Date
Business name
Amount ($)
Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
❑ Check if travel outside of Texas. Complete Schedule T.
OF
EXPENDITURE
Check If Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
Date
Business name
Amount ($)
Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
❑ Check It travel outside of Texas. Complete Schedule T.
PURPOSE
OF
❑ Check if Austin, TX, officeholder living expense
EXPENDITURE
Complete ONLY If direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
NON - POLITICAL EXPENDITURES
MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE B
The Instruction Guide explains how to complete this form.
1 Total pages Schedule I:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
8
(a)Category (See instructions for examples of acceptable
(b) Description (See Instructions regarding type of information
PURPOSE
categories.)
required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See instructions for examples of acceptable
Description (See Instructions regarding type of Information
PURPOSE
categories.)
required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
PURPOSE
Category (See Instructions for examples of acceptable
Description (See Instructions regarding type of Information
OF
categories.)
required.)
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See instructions for examples of acceptable
Description (See Instructions regarding type of information
PURPOSE
categories.)
required.)
OF
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER SCHEDULE K
The Instruction Guide explains how to complete this form.
1 Total pages Schedule K:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Name of person from whom amount is received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Address of person from whom amount is received; City; State; Zip Code
a Amount ($)
7 Purpose for which amount is received F—] Check if political contribution returned to filer
Date
Name of person from whom amount is received
Address of person from whom amount is received; City; State; Zip Code
Amount ($)
Purpose for which amount is received Check if political contribution returned to filer
Date
Name of person from whom amount is received
. . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Amount ($)
Purpose for which amount is received Check if political contribution returned to filer
Date
Name of person from whom amount is received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Amount ($)
Purpose for which amount is received F-] Check if political contribution returned to filer
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
IN -KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES
FOR TRAVEL OUTSIDE OF TEXAS SCHEDULE T
The Instruction Guide explains how to complete this form. 1 Total pages Schedule T:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Name of Contributor / Corporation or Labor Organization / Pledger / Payee
5 Contribution / Expenditure reported on:
❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1
❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COH -LIC ❑ Schedule B -SS
6 Dates of travel
7 Name of person(s) traveling
8 Departure city or name of departure location
9 Destination city or name of destination location
10 Means of transportation T11
Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledger / Payee
Contribution / Expenditure reported on:
❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1
[_1 Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COWLIC ❑ Schedule B -SS
Dates of travel
Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation
TPUrpose of travel (including name of conference, seminar, or other event)
Name of Contributor/ Corporation or Labor Organization / Pledger / Payee
Contribution / Expenditure reported on:
❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1
❑Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COWLIC ❑ Schedule B -SS
Dates of travel
Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation
Purpose of travel (including name of conference, seminar, or other event)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
CANDIDATE/ OFFICEHOLDER REPORT:
DESIGNATION OF FINAL REPORT FORM C /OH - FR
The Instruction Guide explains how to complete this form.
-- Complete only if "Report Type" on page 1 is marked "Final Report" --
7 C /OH NAME
2 Filer ID (Ethics Commission Filers)
3 SIGNATURE
I do not expect any further political contributions or political expenditures in connection with my candidacy. I understand that designat-
ing a report as a final report terminates my campaign treasurer appointment. I also understand that I may not accept any campaign
contributions or make any campaign expenditures without a campaign treasurer appointment on file.
Signature of Candidate / Officeholder
4 FILER WHO IS NOT AN OFFICEHOLDER
•• Complete A& B below only if you are not an officeholder. ••
A. CAMPAIGN FUNDS
Check only one:
F__1 I do not have unexpended contributions or unexpended interest or income earned from political contributions.
0 I have unexpended contributions or unexpended interest or income earned from political contributions. I understand that I
may not convert unexpended political contributions or unexpended interest or income earned on political contributions to
personal use. I also understand that I must file an annual report of unexpended contributions and that I may not retain
unexpended contributions or unexpended interest or income earned on political contributions longer than six years after filing
this final report. Further, I understand that I must dispose of unexpended political contributions and unexpended interest or
income earned on political contributions in accordance with the requirements of Election Code, § 254.204.
B. ASSETS
Check only one:
I do not retain assets purchased with political contributions or interest or other income from political contributions.
I do retain assets purchased with political contributions or interest or other income from political contributions. I understand
that I may not convert assets purchased with political contributions or interest or other income from political contributions to
personal use. I also understand that I must dispose of assets purchased with political contributions in accordance with the
requirements of Election Code, § 254.204.
Signature of Candidate
5 OFFICEHOLDER
•• Complete this section only if you are an officeholder ••
0 I am aware that I remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer on
file. I am also aware that I will be required to file reports of unexpended contributions if, after filing the last required report as an
officeholder, I retain political contributions, interest or other income from political contributions, or assets purchased with politi-
cal contributions or interest or other income from political contributions.
Signature of Officeholder
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015