Jun, John-COH 2018-04-27CANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT
COVER SHEET PG 1
1 Filer ID (Ethics Commission Filers)
2 Total pages filed:
The C/OH Instruction Guide
explains how to complete this form.
17
3 CANDIDATE/
MS / MRS / MR FIRST
MI
OFFICE USE ONLY
OFFICEHOLDER
NAME
Mr. Young -Chu
Date Received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NICKNAME LAST
SUFFIX
John Jun
4 CANDIDATE/
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
OFFICEHMAILING OLDER
Coppell,
TX 75019
ADDRESS
04/27/18 Cj�
F—]Change of Address
(/
5 CANDIDATE/
AREA CODE PHONE NUMBER
EXTENSION
Date Hand -delivered or Date Postmarked
OFFICEHOLDER
PHONE
6 CAMPAIGN
MS / MRS / MR FIRST
MI
Receipt #
Amount $
TREASURER
Mr. David
Jungho
Date Processed
NAME
. . . . .
NICKNAME LAST
SUFFIX
Park
Date Imaged
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #;
CITY; STATE;
ZIP CODE
105 Cross Timber Tr.
Coppell TX
75019
ADDRESSER
(Residence or Business)
8 CAMPAIGN
AREA CODE PHONE NUMBER
EXTENSION
TREASURER
( 214 404-3646
PHONE
9 REPORT TYPE
January 15 ❑ 30th day before election
❑ Runoff
15th day after campaign
treasurer appointment
(Officeholder Only)
❑ July 15 X❑ 8th day before election
❑ Exceeded $500 limit
❑ Final Report (Attach C/OH - FR)
10 PERIOD
Month Day Year
Month
Day Year
COVERED
04 / 27 /2018
05/
05 / 2018
THROUGH
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
❑ Primary ❑
Runoff ❑ Other
Description
05/ 05/ 2018
® General ❑
Special
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (if known)
Coppell City Council Place 6
GO TO PAGE 2
Forms provided by Texas Ethics Commission www. ethics. state. tx.us Revised 9/8/2015
CANDIDATE
/ OFFICEHOLDER FORM C/OH
CAMPAIG14
FINANCE REPORT COVER SHEET PG 2
14 C/OH NAME John
Jun
15 Filer ID (Ethics Commission Filers)
16 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICAL
SUPPORT THE CANDIDATE / OFFICEHOLDER. THESE EXPENDITURES MAY IIAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDER'S
COMMITTEE(S)
KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS AIIE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCII EXPENDITURES.
COMMITTEE TYPE
COMMITTEE NAME
7 GENERAL
COMMITTEE ADDRESS
❑ SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
❑ Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
TOTALS
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
$ 200.00
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS
$ $1,200.00
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
TOTALSEXPENDITURE
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
$ 64.84
UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES
$ $426.22
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$ $2,877.62
OF REPORTING PERIOD
OUTSTANDING
LOAN TOTALS
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$
LAST DAY OF THE REPORTING PERIOD
18 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the accompanying report is
true and correct and includes all information rPnllired to be reported by me
JEONGSEO PARK under Title 15, Election Code.
Notary
Public, State of Texas
••c
4�9 •....• Comm.
Expires 04-04-20221-4r
`�
%
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
SUBTOTALS
- C/OH FORM C/OH
COVER SHEET PG 3
19
FILER NAME
John Jun
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAME OF SCHEDULE
SUBTOTAL
AMOUNT
1.
X SCHEDULEAI:
MONETARY POLITICAL CONTRIBUTIONS
$ 1,400.00
2.
El SCHEDULE A2:
NON -MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS
$
3.
SCHEDULE B:
PLEDGED CONTRIBUTIONS
$
4.
SCHEDULE E:
LOANS
$
5.
SCHEDULE Fl:
POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$ 361.38
6.
SCHEDULE F2:
UNPAID INCURRED OBLIGATIONS
$
7.
SCHEDULE F3:
PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$
8.
SCHEDULE F4:
EXPENDITURES MADE BY CREDIT CARD
$
9.
SCHEDULE G:
POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
$
10.
SCHEDULE H:
PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH
$
11.
SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
12
❑SCHEDULE K:
RETURNED TO
INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS
FILER
$
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
The Instruction Guide explains how to complete this form.
1 Total pages Schedule At:
1
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
John Jun
4 Date
5 Full name of contributor ❑ out-of-state PAC (I D#:
7 Amount of contribution ($)
Helena Kim
04/25/2018
......................................
6 Contributor address; City; State; Zip Code
2301 Creekside Circle, Irving, TX 75063
$500.00
8 Principal occupation / Job title (See Instructions)
g Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC (ID#:
Amount of contribution ($)
04/25/2018
HH Kwon Inc.
......................................
Contributor address; City; State; Zip Code
2625 Old Denton Rd. Suite 413 Carrollton, TX 75007
$500.00
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC (ID#:
Amount of contribution ($)
04/25/2018
HK & EW Investment Inc.
......................................
Contributor address; City; State; Zip Code
2625 Old Denton Rd. #700, Carrollton, TX 75007
$200.00
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC (ID#:
Amount of contribution ($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
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
8 Amount of g 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
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
1 Total pages Schedule B:
The Instruction Guide explains how to complete this form.
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#:
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 F-1out-of-statePAC (ID#:
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#:
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/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 (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
1
John Jun
4 Date
5 Payee name
04/16/2018
Joyce Hwang
6 Amount ($)
7 Payee address; City; State; Zip Code
$125.00
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
Home Depot -sign post reimbursement
❑ Check if travel outside of Texas. Complete Schedule T.
❑
OF
Check if Austin, TX, officeholder living expense
EXPENDITURE
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
04/16/2018
Pho Xpress
Amount ($)
Payee address; City; State; Zip Code
$100.14
310 E. Round Grove Rd. #100, Lewisville, TX 75067
Category (See Categories listed at the top of this schedule)
Description
❑ Check if travel outside of Texas. Complete Schedule T.
PURPOSE
OF
EXPENDITURE
Food/Beverages Expense
❑ Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
04/18/2018
Rice Chicken Restaurant
Amount ($)
Payee address; City; State; Zip Code
$136.24
2540 Old Denton Rd. #136, Carrollton, TX 75006
Category (See Categories listed at the top of this schedule)
Description
❑ Check iftraveloutside ofTexas.Complete Schedule T.
PURPOSE
OF
Food/Beverage Expense
❑ 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/Political Committee Legal Services Salaries/Wages/Contract Labor 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 MADE 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 (enter a 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 TOACREDIT CARD
$
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
PURPOSE
❑ Check if travel outside of Texas. Complete Schedule T.
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/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 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
❑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
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
❑Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑ Check if travel outside of Texas. Complete Schedule T.
OF
EXPENDITURE
❑ Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www. ethics. state. tx.us Revised 9/8/2015
PAYMENT MADE FROM POLITICAL
CONTRIBUTIONS TO A BUSINESS OF C/OH SCHEDULE H
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Business name
6 Amount ($)
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
❑
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
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
❑
PURPOSE
Check if travel outside of Texas. Complete Schedule T.
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
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
8 Amount ($)
7 Purpose for which amount is received ❑ Check if political contribution returned to filer
Date
Name of person from whom amount is received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Amount ($)
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 ($)
Purpose for which amount is received ❑ Check if political contribution returned to filer
Date
Name of person from whom amount is received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Amount ($)
Purpose for which amount is received ❑ Check if political contribution returned to filer
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/ Pledgor / 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-UC ❑ Schedule B -SS
6 Dates of travel
7 Name of person(s) traveling
8 Departure city or name of departure location
g Destination city or name of destination location
10 Means of transportation
11 Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledgor / 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 COH-UC ❑ 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)
Name of Contributor / Corporation or Labor Organization / Pledgor / 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 COH-UC ❑ 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" --
1 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:
0 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:
0 I do not retain assets purchased with political contributions or interest or other income from political contributions.
0 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