DB COH 0713 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:
The C/OH Instruction Guide explains how to complete this form. (Ethics Commission Filers)
3 CANDIDATE / MS/MRS/MR FIRST MI OFFICE USE ONLY
OFFICEHOLDER
NAME MfC -2:>It- lfJ RI
ECEINED NICKNAME LAST T SUFFIX
2 N 5 � tN
OCT 29 2013
4 CANDIDATE / ADDRESS/PO BOX, APT/SUITE#, CITY; STATE; ZIP CODE
OFFICEHOLDER
MAILING .2 2. g No L(, y w o a `L 2 City Secretary
Date Hance rid 0eNrked
ADDRESS
n change of address C o e2i2 i✓ - C_, 7x 7 5-a/ 9 Receipt# Amount
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER /, Date Processed
PHONE (2-1 7/1 — / SS 7
6 CAMPAIGN MS/MRS/MR FIRST MI Date Imaged
TREASURER M`le /O/0)-4 N
NAME '
NICKNAME LAST SUFFIX
/
7 CAMPAIGN STREET ADDRESS(NO PO BOX PLEASE); APT/SUITE#; CITY; STATE; ZIP CODE
TREASURER
ADDRESS ,l
(residence or business) 7 Eve, C M m� N T L. T � 75-0-1 l 9
fill... .../
6:wipe-U.,
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER ( /9`
PHONE 7OO %/ 76� _ c806
9 REPORT TYPE wJanuary 15 n 30th day before election n Runoff n 15th day after campaign
l�+l treasurer appointment
(officeholder only)
n July 15 I 1 8th day before election I J Exceeded $500 n Final report(Attach C/OH-FR)
limit
10 PERIOD Month Day Year Month Day Year
COVERED 7/ 1 /Z 012 THROUGH '7_/3 I /Z O 1a
11 ELECTION ELECTION DATE ELECTION TYPE
Month Day Year
Primary Runoff I I General n Special
/ /
12 OFFICE OFFICE HELD(if any) 13 OFFICE SOUGHT (if known)
GO TO PAGE 2
www.ethics.state.tx.us Revised 04/19/2013
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 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 OFFICEHOLDERS 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
pi additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF$50 OR LESS(OTHER THAN Q@
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS,OR GUARANTEES OF LOANS)
EXPENDITURE
TOTALS 3. TOTAL POLITICAL EXPENDITURES OF$100 OR LESS, UNLESS ITEMIZED $
4. TOTAL POLITICAL EXPENDITURES $ /
BALANCE
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY $ 7 :� �0
OF REPORTING PERIOD D
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS $ 9 . 37 LAST DAY OF THE REPORTING PERIOD 6 y
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 Title 15, Election Code.
��. ` _,�,
ignature of Candidate or Officeholder
AFFIX NOTARY STAMP/SEAL ABOVE
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
www.ethics.state.tx.us Revised 04/19/2013