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11-17-2015 ReportSPECIFIC-PURPOSE 1 FORM sPAC CAMPAIGN 1 REPORT COVER SHEET Pty I TREASURER 1 Filer ID {Ethics Commission Eli ers) 2 Total pages�ed: The SPAC Instruction Guide explains how to complete this form. _ _ r/ "t_d. - NICKNAPAE LAST SUEFlX Q/jJ WIZ �l•� 3 COMMITTEE NAME OFFICE USE ONLY STREET ADDRESS (NO PO BOX PLEASE); APT I SUITE 9; CITY; STATE; Date Received t :i 6cn_Q 1� P l CRY; STATE; ZIP CODE ry/ 1 4 COMMITTEE ADDRESS / PO BOX; APT / SUITE lr 1 g� °� / I ADDRESS (Residence or Business) Lam/ Change of Address I y �s u1 i 'G°' A•i � eJ ° � / Date Nend- deiivered or Date Postmaraed 5 CAMPAIGN PAStMR 1618 FIRST tdl Receipt if Amount $ TREASURER Processed NAME � _ _ r/ "t_d. - NICKNAPAE LAST SUEFlX Q/jJ WIZ �l•� Date Imaged STREET ADDRESS (NO PO BOX PLEASE); APT I SUITE 9; CITY; STATE; ZIP CODE 6 CAMPAIGN TREASURER STREET ADDRESS 1 g� °� / I (Residence or Business) I y �s u1 i 'G°' A•i � eJ ° � / STREET ADDRESS OR PO BOX; APT 1 SURE S; CITY: STATE; 71P CODE 7 CAMPAIGN TREASURER L �' �)� � _ 1 MAILINGADDRESS Change of Address �( 'y el) •j 8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE / � 1 1 o- 6 9 REPORT TYPE F1 January 75 30th day before election F] Exceeded 5540 limit Dissolution (Attach PAC -DR) ❑ F-1 8th day before election IJ J0ty 15 ❑ Runcff 10th day after campaHTn treasurer termina4an 10 PERIOD • Month Day Year Month Day Year COVERED j p THROUGH 1 11 ELECTION ELECTION DATE Year ELECTION TYPE Primary Runoli Other Month Day eription J /• / O ��-------aaaa 1.PCI General Specie( • • r. Forms provided by Texas Ethics Commission www.ethics.state -IlLus Revised 9/812015 SPECIFIC—PURPOSE SPECIFIC—PURPOSE COMMITTEE To FORM SPAC PURPOSE AND TOTALS COVER SKEET PG Z 12 COMMITTEE NAME 73 Filer ID (Ethics Commission Filers) ff )D D ,,— A,- G 14 COMMITTEE CANDIDATE /OFFICEHOLDER NAME PURPOSE (Attach lists on plain paper to complete this CANDIDATE it necessary.) UPPORT (Candidate Or Measure) OFRCEHOLDER OFRCESOUGHT(candsiate) /OFFICE HELD (officehokl r) OPPOSE (Candidate or Measure) BALLOT IDENTIFICATION /8 ELECTION DATE moral Day Year 7 13 / 1 ASSIST MEASURE (Officeholder) DESCRIPTION 15 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED m� 2. TOTAL POLITICAL CONTRIBUTIONS LOANS, OR GUARANTEES OF LOANS) $ (OTHER THAN PLEDGES, 3 TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED $ EXPENDITURE TOTALS 4. TOTAL POLITICAL EXPENDITURES $ 1 3 qq. q S CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY $ BALANCE OF THE REPORTING PERIOD OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE $ LOAN TOTALS LAST DAY OF THE REPORTING PERIOD 16 AFFIDAVIT 1 swear, or affirm, under penalty of perjury, that the accompanying and includes Information required to BRENDA LOUISE DENNIS report is true and correct all NOTARY PUBLIC be reported by me under a 15, Election Code. STATE OF TEXAS My Commission Expires 11.03 -18 Signature of Campaign Treasurer AFFIX NOTARY STAMP /SEALABOVE ��J�� Sworn to d subscribed efore me, by the sei't1" -� this the F day of to certify which, wit ess my hand nd. seal of office. ti I c I -- gnature of office administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission vrnvseuuw- smta -wu� J FORM SPAC SUBTOTALS-SPAC COMER SHEET PG 3 17 COMMITTEE NAME ROOD OD 18 Filer ID (Ethics Commission Filers) 19 SCHEDULE SUBTOTALS NAMEOFSCHEDULE SUBTOTAL AMOUNT 1. SCHEDULEAI: MONETARY POLITICAL CONTRIBUTIONS $ 2. SCHEDULEA2: NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS $ 3. SCHEDULE B: PLEDGED CONTRIBUTIONS $ 4. SCHEDULE Cl: MONETARY CONTRIBUTIONS FROM CORPORATION OR LABOR ORGANIZATION $ 5' ❑ SCHEDULE C2: NON - MONETARY (IN -KIND) CONTRIBUTIONS FROM CORPORATION OR LABOR ORGANIZATION $ 6. Ll SCHEDULE D: PLEDGED CONTRIBUTIONS FROM CORPORATON OR LABOR ORGANIZATION $ 7. SCHEDULE E: LOANS $ 8. SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ 9. SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $ 10. SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $ 11. F] SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $ 12. F] SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF CfOH $ 13. SCHEDULE 1: NON - POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ 14 SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED TO FILER $ Forms provided by Texas Ethics Commission www.ethics.state.tx.Us newheu niwcu 1 u POLITICAL EXPENDITURES MADE F POLITICAL CONTRIBUTIONS scwE�uL� 7 EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expanse Loan Soficitation/Fundraeang Expense AccountingfHanlung Fees Office Overhead/Rental Expanse Transportation Ecluiprnerl& Related Expense Consulting Expense FoocL'8everage Expense Pottut9 Expense Travel In District ContdbtrlionslDonalloru Made Ely GBVAwurdsfhtemonals Expanse Printing Expense Travel Out Of District SalariesMlagesiContractLabor Other (enteracategory net listed above) CanddatefOfticehotderlPolitiral COfafffaa Legal Services CredACa`dp°pnent The Instruction Guide explains how to complete this form. Ft: 1 Total pag.eyys;; 2 FILER NAME 3 Fler ID (Ethics Commission Filers) �Scchedule, 0./t° l ty n EjAk AP l' ✓� .® 4 Date �b��F�s 5 Payee name oEr-/ 6 Amount (S) 7 Payee address; City; Slate; Zip Code A404 n.R ' 'w'q $ (a) Category (See Categories fisted at the top of this schedu ) (b) Description ❑ Contp'P_te Schedu:-T. PURPOSE OF ( �/t LR '5' Opp 0 Cheat B travel eulside ofTexzs_ ❑ Check if Austin, TX, officeholder Irving expense EXPENDITURE 9 Complete ONLY if direct Candidate I Officeholder name Office sought Office held expenditure to benefit CIOH .. Date Payee name Amount ($) Payee address; City; State; Zip Code Category (See Categories listed at the top of this schedule) Description ❑ Check it I--, outsda of Texas. c—ptow Schad -T. PURPOSE OF EXPENDITURE c G�� `eJ Check l Austin, TX, officeholder living expense p 1, IF Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C /OH Date Payee name 0 ° _:�® P 5- 11�a�' 5 P )� Amount ($) Payee address; City; State; Zip Code bd 06 Category (See Categories listed at the top of this schedule) Description ❑ Cheold tra.N wtsde otTexas. Corn,!aw Sch°- duleT. PURPOSE _ j Q�` `1 A G ❑ Check it Austin, TX, officeholder living expense OF EXPENDITURE Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit GIOH ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED .�.__ _._._ ....... Revised 9/812015 Forms provided by Texas Ethics Commission POLITICAL EXPENDITURES Candidate / Officeholder name FROM POLITICAL CONTRIBUTIONS SCHEDULE F1 EXPENDITURE CATEGORIES FOR BOX 9(a) Date Advertising Expense Event Expense t ozrt Fees OfficeOVaheadffterdaiF So tlarYFunraaisiiv Expense Trar*pwtar -n Enu$ment BRea!ed Expense tE Faad av— dgeEV— PoErarg Expense Cor��> p 8y Gift%w dwfAernarials Expense Preginglspense CanddaIsX)IficetKM- 1pdWmW Comaeltee LegalSewices Travel In District Travel Out Otfkshict Coiw(emat arategary tmtVAed above) CredlGaditpere The instruction Guide explains how to complete this form. Amount (5) I Total pages Schedule Ft: 2 FILER NAME 3 Fier ID (Ethics Commission Filers) L t 4 Date �,� —;,� j r 5 Payee name�� B Amount (S) 7 Payee address; City: State; Zp Code OSE PUflOPF ({��, D'� 1 ` i v () ❑ Check it AUSan. Tx. atrx;hdder Grhtg expense EXPENDITURE 8 (a) Category (see Categories fisted at the top oliirissched -m) (b) Description ❑CirghaauoiTgeas.Carra ?eSC:e & feT PUROPOSE b�/ .� �� 1 d=: � G� ( I ❑ Ghe, if Auslin. T)L oifcelia!def Gong expeme EXPENDITURE 9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C10H ` Date Payee name W - a � o 'l + A (- F— Amount (5) Payee address; City, State; Zip Code Category (see Categories listed at the tap at lh:s schedule) Description ❑CheckifU xloees5dootTexas_Comp�-te SdmdeaT- OSE PUflOPF ({��, D'� 1 ` i v () ❑ Check it AUSan. Tx. atrx;hdder Grhtg expense EXPENDITURE Complete ONLY it direct Candidate / officeholder name Office sought Office hold expenditure to benefit C/OH Date Payee name Amount (S) Payee address; City: Stag Zip Code Category lseeCategodesbAedatfne top offut;shedute) Description ❑ Cdreeki11r8retct.s+de otTexas.COCnl�a sdsc�.diT_ PURPOSE ❑ Check if AcsGrr. Tx, ottcehalder living expense OF EXPENDrURE Complete ONLY N direct Candidate / Officeholder name expenditure to benefit C /OH Office sought ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED = orms provided byTexasBhtcsUOrnmissaon Office held Revised 9/8/2015 POLITICAL COMMITTEE AFFIDAVIT OF DISSOLUTION FORM Thelinstruction Gulde-expitains howtocompletethisform. Complete only if "ReportTyW' on page 1 is marked "Dissolution" -- 1 COMMITTEEENNAME 2 Filer ID (Ethics Commission Filers) n J p / 3 Affidavit of Dissolution I, the undersigned campaign treasurer, do not expect the occurrence of any further reportable activity by this political committee for this or any other campaign or election for which reporting under the Election Code is required. I declare that all of the information required to be reported by me has been reported. I understand that designating a report as a dissolution report terminates the appointment of campaign trea- surer. I further understand that a political committee may not make or authorize political expenditures or accept political contributions without having an appointment of campaign treasurer on file. f� �4 Signature of Campaign Treasurer DO NOT SIGN UNLESS POLITICAL COMMITTEE IS TO BE DISSOLVED AFFIX NOTARY STAMP /SEALABOVE - 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 Forms provided by Texas Ethics Commission wmw.ethics.state.N.us Revised 9/8/2015