DB COH 0712Texas Ethics Commission P.O. Box 12070 Austin, Texas 7871 1-2070 (51 2) 463-5800 (TDD 1-800-735-2989)
I I
CANDIDATE I OFFICEHOLDER
CAMPAIGN FINANCE REPORT
FORM CIOH
COVER SHEET PG I
2 Total pages filed:
The ClOH Instruction Guide explains how to complete this form.
3 CANDIDATE /
OFFICEHOLDER
NAME
1 ACCOUNT#
(~thi commm~im ~ilers)
I
MS I MRS I MR FIRST MI OFFICE USE ONLY
8
Dat IVtU ....
NICKNAME
.....
LAST
...
SUFFIX
4 CANDIDATE /
OFFICEHOLDER
MAILING
ADDRESS
ADDRESS I PO BOX; APT1 SUITE #; CITY STATE; ZIP CODE CITY SECRETARY
Date Handdel~vered or Postmarked
change of address
5 CANDIDATE/
OFFICEHOLDER
PHONE
Receipt #
AREA CODE PHONE NUMBER EXTENSION
6 CAMPAIGN
TREASURER I NAME
MS 1 MRS 1 MR FIRST MI Date Imaged
......
NICKNAME SUFFIX
1 7 CAM PAlGN 1 STREETADDRESS (NO PO BOX PLEASE); APT1 SUITE#; CITY STATE, ZIP CODE I
TREASURER
ADDRESS
(residence or business)
8 CAMPAIGN
TREASURER
PHONE
AREA CODE
(469)
PHONE NUMBER EXTENSION
9 REPORT TYPE January 15 3Oih day before election Runoff 15th day after campaign
treasurer appointment
W-m)
8th day before election Exceeded $5fXJ Fb\al report (Atlach ClOH - FR)
limit
10 PERIOD
COVERED
m ys;r m W YW
~//?II/ZO)Z. THROUGH 6 /~C/ZOIZ
11 ELECTION
12 OFFICE
GO TO PAGE 2
www.ethics.state.tx.us Revised 09/28/2011
ELECWN DATE ELECTION TYPE
m w - 1 pmw
/ / El R-. m- sm
OFFICE HELD (bany) 13 OFFICESOUGHT (bkm)
Texas Ethics Commission P.O. Box 12070 Austin, Texas 7871 1-2070 (51 2) 4635800 (TDD 1-800-735-2989)
CANDIDATE I OFFICEHOLDER REPORT: FORM CIOH
SUPPORT & TOTALS COVER SHEET PG 2
14 CIOH NAME 15 ACCOUNT # (Ethics Commission Filers)
16 NOTICE FROM
POLITICAL
COMMITTEE(S)
additional pages
COUM ITTEE TYPE
[7 GENERAL
0 SPECIFIC
COMMITTEE NAME
COMMITTEE ADDRESS
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
TOTALS
EXPENDITURE
TOTALS 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES
$
CONTRIBUTION
BALANCE
2. TOTAL POLI'TICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
OF REPORTING PERIOD
OUTSTANDING
LOAN TOTALS 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LAST DAY OF THE REPORTING PERIOD $649.37
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18 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the accompanying report
is true and correct and includes all information required to be reported by
me under T~le 15, Election Code.
/ ~inhure of Candidate or Officeholder
AFFIX NOTARY STAMP I SEAL ABOVE
Sworn to and subscribed before me, by the said pd I Iq %m 5 , this the
/& day of . 20 / , to certify which, witness my hand and seal of office.
I Signature of officer administering oath Printed name of officer administering oath Tae of officer administering oath
I I
www.ethics.state.tx.us Revised 091281201 1
Texas Ethics Commission P.O. Box 12070 Austin, Texas 7871 1-2070 (51 2) 463-5800 (TDD 1-800-7352989)
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POLITICAL CONTRIBUTIONS
OTHER THAN PLEDGES OR LOANS SCHEDULE A
1 Total pages Schedule A: The Instruction Guide explains how to complete this form. 1
2 FILER NAME 3 ACCOUNT # (Ethics Commission Filers)
5 Full name of contributor 0 out-of-state PAC(IW ) I E%'lc C~CCI AS
.................................. 1 5 /z 0)~ 0 lz I 6 Contributor address; City; State; Zip Code
703 NEW HA PS~IR~ NLJ @/509
7 Amount of 1 8 In-kind contribution
contribution ($) I description (if applicable)
I Date I Full name of contributor out-of-staePAC(IW ) Amount of I ln-kind contribution I
M ASHI~GQN, PC. zoo37
ChARLES Ho ~&?oo/C contribution ($) description (if applicable)
........ ........................ I
Contributor address; City; State; Zip Code $7'5.0" I
I
(If travel outside of Texas, complete Schedule T)
9 Principal occupation I Job title (See Instructions)
IRv)AJC, 75062
.......... .....................
Contributor address; City; State; Zip code
10 Employer (See lnstrucions)
I
(If travel outsid of Texas, complete Schedule T)
I
Date
Principal occupation I Job title (See Instructions)
I
(If travel outside of Texas, complete Schedule T)
....................
contributor address; City; State; Zip code
Employer (See Instructions)
Full name of contributor out-of-statePACOW )
Principal occupation I Job title (See Instructions)
I
Amwnt of I In-kind contribution
contribution ($) description (if applicable) I
Employer (See Instructions)
Date
Amount of I In-kind contribution
contribution ($) description (if applicable) I
Date
(If travel outside of Texas, complete Schedule T)
Full name of contributor [7 out-of-state PAC(IW i
Full name of contributor [7 o~-ol-stale~~~(l~
Principal occupation I Job title (See Instructions)
..............
contributor address; City; State, 'zip Code
Employer (See Instructions)
Amount of 1 In-kind contribution
contribution ($) description (if applicable) I
AlTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide foradditional reporting requirements.
(If travel ouhde Af Texas, complete Schedule T)
www.ethics.state.tx.us Revised 091281201 1
Principal occupation I Job title (See Instructions) Employer (See Instructions)
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (51 2) 4635800 (TDD 1-800-735-2989)
1
POLITICAL EXPENDITURES
MADE FROM PERSONAL FUNDS SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense GiWAwardslMernorials Expense SalariesMlageslContract Labor Loan RepaymenVReimbursement
AccountinglBanking Legal Services SolicitationlFundraising Expense Transportation Equipment 8 Related Expense
Consulting Expense FoodlBeverage Expense Travel In District Contributions/Donation~ Made By
Event Expense Polling Expense Travel Out Of District CandidatelOfficeholderlPolitical Committee
Fees Printing Expense Office OverheadlRental Expense OTHER (enter a category not listed above)
4 Date 5 Payeename 1 5-7-z017-~0PilL3TAR Gfl ZEm
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G:
6 Amount ($)
Reimbutxement from
political contributions
11 Date I payeename ,,
2 FILER NAME
7 Payee address; City; State; Zip Code
629 KRONP 317
8 PURPOSE
OF
EXPENDITURE
I Payee address; City; State; Zip Code
3 ACCOUNT # (Ethics Commission Filers)
I PURPOSE I Category (See categories listed at the top df this schedule) I Description (If travel outside of Texas, complete Schedule T)
I
(a) Category (See categories Ilsted at the top of this schedule)
I OF
EXPENDITURE 1 Apv&tr)~)~G E~PCNSE I /VEN~PAPEZ
@) fhscnption (If travel wtslde of Texas, complete Schedule T)
1 rq qdZn Payee name
&re ,?-aarz I Ffice60~~ a DJ
I ~&unt ($1 I Payee address; City: State; Zlp Code
I WR- I Category (See categories listed at the top of this schedule) I Description (If travel outside of Texas, complete Schedule T)
a ,sz - lcl
Reimbwsment from
pol~t~cal contributions El ..
intended
I Date ( Payee name
1661 S. LdciF*P/v\AAuE.
h0 A c.iu, LA 94304
Reimbursement from
Amount (8)
I PURPOSE ( Category (See categories listed at the top of this schedule) I Description (If travel anside of Texas, complete Schedule T)
Payee address; City; State; Zip Code
OF I EXPENDITURE 1
AlTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED I
Revised 091281201 1