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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