Majed, Raghib-COH 2021-04-12CANDIDATE / 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.
3 CANDIDATE/
MS / MRS / MR FIRST
MI
OFFICEHOLDEROFFICE
USE ONLY
NAME
AAGt ltB. . . . . _ lnov65 . . . . .
. . . . . . . . .
Date Received
NICKNAME LAST
. . .
SUFFIX
4 CANDIDATE/
ADDRESS / PO BOX; APT / SUITE #; CITY;
STATE; ZIP CODE
OFFICEHOLDER
MAILING
j
ADDRESS
❑ Change of Address
5 CANDIDATE/
AREA CODE PHONE NUMBER
EXTENSION
OFFICEHOLDER
PHONE
(�
%� 2) 7z,6� /�g/
Date Hand -delivered or Date Postmarked
6 CAMPAIGN
MS / MRS / MR FIRST
MI
Receipt #
Amount $
TREASURER
s'nAir1j
NAME
0-499, Q/v. . ,t�i%/��/�
Date Processed
NICKNAME LAST
SUFFIX
Date Imaged
7 CAMPAIGN
STREET/,ADDDRESSS BOX PLEASE); APT / SUITE #;
CITY; STATE; ZIP CODE
TREASUR
ADDRESSER
)(NNO/PO
3`76 Gu�le? U/fc.,)
c Pe&1 7X /
(Residence or Business)
8 CAMPAIGN
AREA CODE PHONE NUMBER
EXTENSION
PHO
PHONE
2— ���— 11 47(
9 REPORT TYPE
❑ January 15 30th day before electionRunoff
15th day after campaign
treasurer appointment
(Officeholder Only)
July 15 ❑ 8th day before election
❑ Exceeded $500 limit Final Report (Attach C/OH - FR)
10 PERIOD
Month Day Year
Month Day Year
COVERED
03/ /.r /.24 / THROUGH 47 /0/ 12,0 1—/
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
❑ Primary
Runoff ❑ Other
Description
v -S/ 01, / 2-62- %
❑ General ❑
Special
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (if known)
GO TO PAGE 2
Forms provided by Texas Ethics Commission www. ethics. state.tx.us Revised 9/8/2015
CANDIDATE /OFFICEHOLDER 60011 d7
CAMPAIGN FINANCE REPORT No �a�l �j��Q ORM C/OH
COVER SHEET PG 2
14 C/OH NAME
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 HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDER'S
COMM ITTEE(S)
KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENDITURES.
COMMITTEE TYPE
COMMITTEE NAME
❑ GENERAL
SPECIFIC
COMMITTEE ADDRESS
COMMITTEE CAMPAIGN TREASURER NAME
❑ Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
TOTALS
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
$
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
$ v
CONTRIBUTION
BALANCE
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
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.
Signature of Candidate or Officeholder
AFFIX NOTARY STAMP/ SEALABOVE
nd subscribed before me, by the said e this the
Sworn t41)rik
day of.202-1 to certify which, witness my hand an . eal of office.
OFR a._. & A)U�i 0��Cr-41r(d
Signature of of ' r administering oath Printed name of officer administering oath Titl 90officer administerin ath
Forms provided by Texas Ethics Commission www. ethics. state.tx.us Revised 9/8/2015
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 n�GN�-3 InIq1co;
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAMEOFSCHEDULE
SUBTOTAL
AMOUNT
1
❑
SCHEDULE Al: MONETARY POLITICAL CONTRIBUTIONS
$
C, _ &0
2.
SCHEDULE A2: NON -MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS
$
0 - CSO
3•
SCHEDULE B: PLEDGED CONTRIBUTIONS
$
O
4.
SCHEDULE E: LOANS
$
5.
SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
6.
SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
$
7.
SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$
8.
❑
SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD
$
6�
9.
F1
SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
$
Pt . 61
10.
El
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: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS
RETURNED TO FILER
$
0,
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
MONETARY POLITICAL
No Po�cFl� G�v9��7iI�t�O N
CONTRIBUTIONS SCHEDULE Al
The Instruction Guide explains how to complete this form.
1 Total pages Schedule At:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Full name of contributor
. . . . . . . . . . . . . . . . .
6 Contributor address;
❑ out-of-state PAC (ID#: )
. . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
7 Amount of contribution ($)
8 Principal occupation / Job title (See Instructions)
9 Employer (See Instructions)
Date
Full name of contributor
. . . . . . . . . . . . . . . . .
Contributor address;
❑ out-of-state PAC (ID#: )
. . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor
. . . . . . . . . . . . . . . . .
Contributor address;
❑ out-of-state PAC (ID#: )
. . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor
. . . . . . . . . . . . . . . . .
Contributor address;
❑ out-of-state PAC (ID#: )
. . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
Amount of contribution ($)
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 -V6 Con6w6U67-,U SCHEDULE A2
The Instruction Guide explains how to complete this form.
1 Total pages Schedule A2.-
2:2
2FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED IN-KIND POLITICAL CONTRIBUTIONS
5 Date
6 Full name of contributor E-1 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.
i-orms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
PLEDGED CONTRIBUTIONS ryO ew, '��04 e4U9& CHEDULE 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#: )
$ 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 ofled or out-of-state PAC ID#:
p g ❑ ( )
Amount of In-kind contribution
a
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 /-Y� (civ/ 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#: I
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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#: I
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 ('OY7 /,nIJAC H E D U L E 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 F1:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
❑ Check if travel outside of Texas. Complete Schedule T.
PURPOSE
OF
❑ Check if Austin, TX, officeholder living expense
EXPENDITURE
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
❑
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
Payee name
Amount ($)
Payee 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
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 'ala 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 ($)
8 Payee address; City; State; Zip Code
9 TYPE OF
EXPENDITURE
1-1 Political ❑ Non Political
10
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑ Check if travel outside of Texas. Complete Scheduler.
OF
EXPENDITURE
❑Check if Austin, TX, officeholder living expense
11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE
❑ 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
I-orms provided uy iexas Ethics commission www. ethics. state.tx.us Revised 9/8/2015
PURCHASE OF INVESTMENTS MADE
FROM POLITICAL CONTRIBUTIONS i� ' 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)
RAC l)
4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TO ACREDIT CARD
$
5 Date
6 Payee name
31/S Lot/j�'/
�'!� S; f; /raj tiv�
7 Amount ($)
8 Payee address; City; State; Zip Code
'240 lJaf�Lf CNN tYa. Bim- �`-/od , Xus(7h / 7_X
9 TYPE OF
EXPENDITURE
Political ❑ Non -Political
10
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
`
❑ Check if travel outside of Texas. Complete Schedule T.
EXPENDITURE
❑Check if Austin, TX, officeholder living expense
11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
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
rorms provlaea 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
Accounting/Banking
Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Fees
Consulting Expense
Office Overhead/Rental Expense Transportation Equipment & Related 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
RA 2-6
3 Filer ID (Ethics Commission Filers)
a Al IVMC-6
4 Date
5
Payee name 31tIZA cleep S / �-AS
6 Amount ($)
7
Payee address; City;; State; Zip Code
10,00 wa67 � Cenjecz
Sella, r /'1llcOYJ /
❑Reimbursement from
political contributions
intended
8
(a)
Category (See Categories listed at the top of this schedule)
(b) D2scription
PURPOSE
❑ Check if travel outside of Texas. Complete Schedule T.
OF
�y �y
EXPENDITURE
y"� `^ -�'u
❑ Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct
Candidate / Officeholder name
Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
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 ($)
Payee address; City; State; Zip Code
❑Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑
OF
Check if travel outside of Texas. Complete Schedule T.
EXPENDITURE
❑ Check if Austin, TX, officeholder living expense
Complete ONLY if direct
Candidate / Officeholder name
Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www. ethics. state.tx.us Revised 9/8/2015
PAYMENT MADE FROM POLITICAL
I
CONTRIBUTIONS TO A BUSINESS OF C/OH DULE H
U�
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees
Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Business name
6 Amount ($)
7 Business address; City; State; Zip Code
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑
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
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
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
L,
to A"
NON-POLITICAL EXPENDITURES NIA iLol
��b
MADE FROM POLITICAL CONTRIBUTIONS (_- SCHEDULE 1
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
PURPOSE
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
OF
categories.)
required.)
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
PURPOSE
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
OF
categories.)
required.)
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
PURPOSE
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
OF
categories.)
required.)
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 NlA
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 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 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 t✓%A Gbv Jn 10
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
S 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
9 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 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)
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 HSchedule 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