AD-COH 2013-01-15 Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 ACCOUNT# 2 Total pages filed:
(Ethics Commission Filers)
The C/OH Instruction Guide explains how to complete this form. Z •
3 CANDIDATE / MS/MRS/MR FIRST
MI OFFICE USE ONLY
OFFICEHOLDER
NAME Mr • Af\f2-0tA
Date Received
NICKNAME LAST
SUFFIX
kilz-01.4
4l va,.... -
4 CANDIDATE / ADDRESS/PO BOX: APT/SUITE ft; CITY STATE ZIP CODE
OFFICEHOLDER C � C��Z • /O yv 7cnA
MAILING b (. /" t
ADDRESS Date and-elivered or Postmarked
change of address ` 1 % 1 3
Rec ipt# Amount
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION
PHONE OFFICEHOLDER /714 1 lige GC15-S- Date Processed
6 CAMPAIGN MS/MRS/MR IRST MI Date Imaged
TREASURER
NAME /117 • k C
NICKNAME LAST SUFFIX
r
7 CAMPAIGN STREET ADDRESS(NO PO BOX PLEASE); APT/SUITE#; CITY- STATE ZIP CODE
TREASURER
ADDRESS ?1( etti1� �p•4 (-Ott- cbr` '( x 790
(residence or business) `U/ v' �'1 1� 1 (`
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
PHONE
TREASURER (117) 304 . G34(0
9 REPORT TYPE
January 15 I I 30th day before election I I Runoff I I 15th day after campaign
treasurer appointment
(officeholder only)
I I July 15 I I 8th day before election I 1 Exceeded $500 I I Final report(Attach C/OH-FR)
limit
10 PERIOD Month Day Year
COVERED Month Day Year
i / 1 n ots THROUGH fz. 3 __
11 ELECTION ELECTION DATE ELECTION TYPE
5 Month Day/1 ._/ a� I I P� I Runoff I I General I I Special
12 OFFICE OFFICE HELD(if any) 13 OFFICE SOUGHT (if known)
0111 couxcc L pc, 1
GO TO PAGE 2
www.ethics.state.tx.us
Revised 09/28/2011
Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
CANDIDATE / OFFICEHOLDER REPORT: FORM C/OH
SUPPORT & TOTALS COVER SHEET PG 2
14 C/OH NAME �u 15 ACCOUNT# (Ethics Commission Filers)
16 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE
POLITICAL CANDIDATE/OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDER'S KNOWLEDGE OR
COMMITTEE(S) CONSENT CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEE NAME
COMMITTEE TYPE
I GENERAL
COMMITTEE ADDRESS
I I SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF$50 OR LESS(OTHER THAN /� 0
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $ V
2. TOTAL POLITICAL CONTRIBUTIONS Q
(OTHER THAN PLEDGES, LOANS,OR GUARANTEES OF LOANS) 'P O
I EXPENDITURE •.0
TOTALS ,3. TOTAL POLITICAL EXPENDITURES OF$100 OR LESS, UNLESS ITEMIZED $ O
00
4. TOTAL POLITICAL EXPENDITURES 0
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY !O� 37
BALANCE OF REPORTING PERIOD
OUTSTANDING /�
LOAN TOTALS 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$
' ` • 0e1 LAST DAY OF THE REPORTING PERIOD �V V
18 AFFIDAVIT
• I swear,or affirm, under penalty of perjury, at t44 accompanying report
4 �`"�Y" is true and corre t and CI.es all•infer atio required to be reported by
■ �`t me under Titl:/ 5 "'e ■ Code.
CHRISTEL B PETTINOS
PAMy Commission Expires ` ,
�` May 10,2015 I,/
cap
ig turOf Candidate orOfficeholder
AFFIX NOTARY STAMP/SEAL ABOVE /� r)
Sworr�n to and subscribed before me, by the said Aa r D r. cr )Lx..v�«yam , this the
D-11` day of'd*-A , 20 1 -3 , , to certify which, witness my hand and seal of office.
�I ,/...47..t_41/ _ � t / etiR/s7L i4 r',./o .c n .sr -- C
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
' www.ethics.state.tx.us Revised 09/28/2011