10-26-2015 ReportCANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN
FINANCE REPORT
COVER SHEET PG I
1 Filer ID (Ethics
Commission Filers)
2 Total pages filed:
The C10H Instruction Guide
explains how to complete this form.
'
3 CANDIDATE /
MS I MRS / MR FIRST
MI OFFICE USE ONLY
OFFICEHOLDER
NAME
, , Date Received
, , , , , ,
'
NICKNAME LAST
ADDRESS I PO BOX; APT I SUITE #; CrrY; STATE;
,./
SUFFIX
1 pj T
ZIP CODE
4 CANDIDATE /
OFFICEHOLDER
MAILING
ADDRESS
❑ Change of Address
AREA CODE PHONE NUMBER EXTENSION
- pale Hand - delivered or pate Postmarked
S CANDIDATE/
OFFICEHOLDER
PHONE
l 1
MI Receipt # Amount $
6 CAMPAIGN
TREASURER
FIRST
-
, . Date Processed
NAME
• ' ' ' LAST
NICKNAME
SUFFIX
Dale Imaged'
D A 1
STREET ADDRESS (NO PO BOX PLEASE); APT I SUITE #; CITY;
STATE; ZJP CODE
7 CAMPAIGN
TREASURER
ADDRESS
(Residence or Business)
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
C 4o 6 6(1 ", 77
PHONE
❑ January 15 ❑ 30th day before election ❑
Runoff ❑ 15th day after campaign
treasurer appointment
9 REPORT TYPE
(Officeholder Only)
❑ July 15 eth day before election ❑
Exceeded $500 limit ❑ Final Report (Attach CIOH - FR)
10 PERIOD
COVERED
Month Day Year
Month Day Year
•
) 0 / V
1h / / ) THROUGH
ELECTION DATE
ELECTION TYPE
11 ELECTION
Month Day Year Primary ❑ Runoff
Other
Description
General ❑ Special
0
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (iiknown)
GO TO PAGE 2
Forms provided by Texas Ethics Commission
www.ethics.state.tx.us Revised 02/2712015
CANDIDATE / OFFICEHOLDER FORM CiOH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C /OH NAME 15 Filer ID (Ethics Commission Filers)
16 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICAL SUPPORT THE CANDIDATE /OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDERS
COMMITTEE(S) KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENDITURES.
COMMITTEE TYPE COMMITTEE NAME
GENERAL
COMMITTEE ADDRESS
O SPECIFIC
M Additional Pages
17 CONTRIBUTION
TOTALS
EXPENDITURE
TOTALS
CONTRIBUTION
BALANCE
OUTSTANDING
LOAN TOTALS
18 AFFIDAVIT
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED & -0
2. TOTAL POLITICAL CONTRIBUTIONS p
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) 4 > ' , o U
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, $
UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY $
OF REPORTING PERIOD
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE $
LAST DAY OF THE REPORTING PERIOD
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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 Co ,
Signature of Candidate or Officeholder
AFFIX NOTARY STAMP / SEALABOVE p�
Sworn to a d subscribed before me, by the said ` this the
aao Mocer 0 1 to certify which, witness my hand and seal of office.
ti
Ak VA
Signstering oat h Printed name of officer administering oath Title of officer administering oath
Rnvicori n9 /97/7015
Forms provided by Texas Ethics Commission WWW' U L1 l;J.blAtc. LA. uo
Forms provided by Texas Ethics Commission
www.ethics.state,tx.Us Revised 02/2712015
FORM CIOH
SUBTOTALS ® COH COVER SHEET PG G 3 3
20 Filer ID (Ethics Commission Filers)
19
FILER NAME
SUBTOTAL
21
SCHEDULE SUBTOTALS
AMOUNT
NAME OF SCHEDULE
1.
SCHEDULEAi: MONETARYPOLITICALCONTRIBUTIONS
p
$ (� mo
2.
F] SCHEDULEA2: NON- MONETARY(IN -KIND) POLITICAL CONTRIBUTIONS
$
3.
F] SCHEDULE B: PLEDGED CONTRIBUTIONS
$
4,
F] SCHEDULE E: LOANS
$
5.
SCHEDULE F1: POLITICAL EXPENDITURES FROM POLITICAL CONTRIBUTIONS
$
6.
SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
$
$
7. F1 SCHEDULE F3: PURCHASE OF INVESTMENTS FROM POLITICAL CONTRIBUTIONS
B.
SCHEDULE G: POLITICAL EXPENDITURES FROM PERSONAL FUNDS
$
$
9.
SCHEDULE H: PAYMENT FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C /OH
$
10. F1 SCHEDULE I: NON - POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
11.
SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS
$
RETURNEDTO FILER
Forms provided by Texas Ethics Commission
www.ethics.state,tx.Us Revised 02/2712015
MONETARY 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)
66
f
4 Date 6 Full name of contributor E] out -of -state PAC (ID#:
7 Amount of contribution ($)
. . . . . .
6 Contributor address; City; State; Zip Code
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31) b "V, e &,%i�l mot
f
8 Principal occupation / Job title (See Instructions)
9 Employer (See Instructions)
Date
Full name nMa/me of contributory El out-of-state PAC (ID #: )
Amount of contribution ($)
p
t
Contributor address; City; State; Zip Code
�f
`) �t r
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
j �tF 5 � vv ^)
' U*
Date
Full name of contributor ❑ out -of -state PAC (ID#:• )
Amount of contribution ($)
� 77
Contributor address; City; State; Zip Code
_ ((,
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Full name of contributor [] out -of -state PAC (ID# )
Amount of contribution ($)
Date
Contributor address; City; State; Zip Code
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.
PPvicPrI n2/27/2015
Forms provided by Texas Ethics Commission WWW.tA1 llub'bta to. LA.u.
POLITICAL EXPENDITURES
FROM POLITICAL CONTRIBUTIONS SCHEDULE F1
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting /Banking Fees Office Overhead/Rental Expanse Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contdbutlons/Donations Made By Gift/AWards/Memadals Expense Printing Expense Travel Out Of District
Candidate /Otficeholder/PoliticalCommittee Legal Services SalariesrWages/ContractLabor Other (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule Fi:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
lb-6 j
< �$
6 Amount ($)
7 Payee address; City; State; Zip Code
g
(a) Category (See categories listed at the top of this schedule)
(b) Description
PURPOSE
❑ Check if travel outside of Texas, complete Schedule T
OF
❑ Check If Austin, TX, officeholder living expense
EXPENDITURE
fA
9 Complete ONLY If direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C /OH
Payee} name
jDate
6
Amount ($)
Payee address; City; State; Zip Code
�A tA '111� 1-16V
Category (See categories fisted at the top of this schedule)
Description
❑ Check if travel outside of Texas, complete Schedule T
PURPOSE
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
Payee name
Amount ($)
Payee 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
❑ Check if Austin, TX, officeholder Irving 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.stateJx,us Revised 02/2712015