Majed, Raghib-COH 2021-04-23CANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
The C/OH Instruction Guide explains how to complete this form.
1 Filer ID (Ethics Commission Filers)
2 Total pages filed:
3 CANDIDATE/
OFFICEHOLDER
MS / MRS / MR FIRST MI
OFFICE USE ONLY
NAME
RAr�/�
y . . . . . . . .
Date Received
NICKNAME LAST SUFFIX
4 CANDIDATE/
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
MAILING OFFICEHOLDER
318
ADDRESS
❑ Change of Address
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER�}
PHONE
7
( 7�Z ) T1i6— %/ql
Date Hand -delivered or Date Postmarked
6 CAMPAIGN
MS /MRS/MR FIRST MI
Receipt #
Amount $
TREASURER
NAME
_ / ,�J
L�%lf%g1 /[�!�� �
Date Processed
NICKNAME LAST SUFFIX
Date Imaged
'
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE;
ZIP CODE
TREASURER
ADDRESS
31��
(Residence or Business)
?
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
PHONEURER
(03) gqq— S�g/
9 REPORT TYPE
January 15 D 30th day before election Runoff
15th day after campaign
treasurer appointment
(Officeholder Only)
July 15 gth day before election E] Exceeded $500 limit
El Final Report (Attach C/OH - FR)
10 PERIOD
COVERED
Month Day Year Month Day Year
/ (� / THROUGH e)(/ 2-3 / 20 2-1
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
ppp
/2olI
❑ Primary ❑ Runoff ❑ Other
Description
lwf General ❑ Special
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (if known)
GO TO PAGE 2
corms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
,. ,
� \i �s
� �< .
i �
CANDIDATE / OFFICEHOLDERS FORM C/OH
CAMPAIGN FINANCE REPORT 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
COMMITTEE(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
/ /l7
GENERAL
SPECIFIC
COMMITTEE ADDRESS
COMMITTEE CAMPAIGN TREASURER NAME
F] 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)
�9 (�
EXPENDITURE
TOTALS
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
$ ( j
'r ,
UNLESS ITEMIZED
J4 b
4. TOTAL POLITICAL EXPENDITURES
$
CONTRIBUTION
5.
BALANCE
TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
OF REPORTING PERIOD
Cz�
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.
`YP ASHLEY M. OWENS
\\�`PpkY PU
A�i
a°Oi+Notary Public, State of Texas
Comm. Expires 02-24-2023 y
°; Notary ID 130128128 Signature of Candidate or Officeholder
AFFIX NOTARY STAMP / SEALABOVE /)
Sworn �� r
1�Mdd
to knd � bscribed before me, by the said this the
day L 1
of 20 to certify which, witness my haQ and seal of office.
"i A 1,C) A A
4 VL4 Q�ft
Signature of of r administering oath Printed name o officer administering oath Title o o icer administeri fath
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
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAMEOFSCHEDULE
SUBTOTAL
AMOUNT
1.
SCHEDULE Al:
MONETARY POLITICAL CONTRIBUTIONS
$
G , C--0
2.
SCHEDULE A2:
NON -MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS
$
C &A
3.
SCHEDULE B:
PLEDGED CONTRIBUTIONS
$
4.
F]
SCHEDULE E:
LOANS
$
5•
❑
SCHEDULE F1:
POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
6.
El
SCHEDULE F2:
UNPAID INCURRED OBLIGATIONS
$
Q fP b
7.
El
SCHEDULE F3:
PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$
& 6. A
8.
SCHEDULE F4:
EXPENDITURES MADE BY CREDIT CARD
$
1/3-7.
9.
SCHEDULE G:
POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
$
2. Q
Q
10.
SCHEDULE H:
PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH
$
11.
❑
SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
6 C�
12.11SCHEDULE
K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS
RETURNED TO FILER
$
Q
forms provided by Texas Ethics Commission www. ethics. state.tx.us Revised 9/8/2015
r-orms provlaea oy Iexas Ltnlcs commission www. ethics. state.tx.us Revised 9/8/2015
'I %
CC�
ts
MONETARY POLITICAL
CONTRIBUTIONS SCHEDULE Al
The Instruction Guide explains how to complete this form.
Total pages Schedule All:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Full name of contributor
❑ out-of-state PAC (ID#: )
7 Amount of contribution ($)
. . . . . . . . . . . . . . . . .
6 Contributor address;
. . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
8 Principal occupation / Job title (See Instructions)
9 Employ (See Instructions)
Date
Full name of contributor
❑ out-of-state PA/#: (ID )
Amount of contribution ($)
Contributor address;
City; Statde
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor
❑ OW-Of/-ae PAC (ID#: )
Amount of contribution ($)
t
i
Contributor address;
/y; State; Zip Code
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor !f
out-of-state PAC (ID#: )
Amount of contribution ($)
. . . . . . . ..
. . . . . . .
Contributor address;/
City; State; Zip Code
f
V
7
Principal occupation / Job title (See )hstructions)
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.
r-orms provlaea oy Iexas Ltnlcs commission www. ethics. state.tx.us Revised 9/8/2015
NON -MONETARY (IN-KIND) POLITICAL ,,r,��,
CONTRIBUTIONS ^� 6,,4, 1, �VSCHEDULE A2
�w
The Instruction Guide explains how to complete this form.
1 Total pages Schedule A2:
2 FILER NAME
Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED IN-KIND POLITICAL CONTRIBUTION
$
5 Date
6 Full name of contributor ❑ out-of-state PAC (ID#: i
. . . . . . . . . . ... . . . . . . .
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 JUDIC L)
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
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
PLEDGED CONTRIBUTIONS d 6nk1'4'b SCHEDULE 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-ot-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 mployer (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 ❑ 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)
Date
Full name of pledgor ❑ out-of-state PAC (ID#: I
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 V 0 '-'" A -�
7 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 ($)
6 Is lender
a financial
10 Interest rate
Institution?
Y N
11 Maturity date
12 Principal occupation / Job title (See Instructions)
13 Employ r (See Instructions)
14 Description of Collateral
15 Che k if personal funds were deposited into political
acc unt (See Instructions)
El none
16 GUARANTOR
17 Name of guarantor
19 Amount Guaranteed ($)
INFORMATION
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18 Guarantor address; City; St e; Zip Code
❑ not applicable
20 Principal Occupation (See Instructions)
21 Employer (See Instructions)
Date of loan
Name of lender ( )
❑ out -of tate 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.
t-orms provided by texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS N6 SCHEDULE F1
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayntent/Reimbursement Solicitation/Fundraisin Ex
Accounting/Banking Fees g pense
Office Overhead/Rental Expense Transportation Equipment 8 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 Labo
Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this for
1 Total pages Schedule F1:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
8
(a) Category (See Categories listed at the top of this schedule)
(b) escription
PURPOSE
❑ Check if travel outside of Texas. Complete Schedule T.
OF
EXPENDITURE
❑ Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip 7e
Category (See Categories listed at the top ofthis sc edule)
Description
PURPOSE
ElCheck if travel outside of Texas. Complete Schedule T.
OF
EXPENDITURE
ElCheck 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 ($)
Payee address; City State; Zip Code
Category (See Categories li ed at the top of this schedule)
Description
PU R POSE
❑ Check if travel outside of Texas. Complete Schedule T.
OF
E]
EXPENDITURE
Checkif Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder narne Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
PURCHASE OF INVESTMENTS MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F3
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F3:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Name of person from whom investment is purchased
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Address of person from whom investment is purchased; ity; State; Zip Code
7 Description of investment
8 Amount of investment ($)
Date
ed
Name of person from whom investment/iipurch"ased;
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom investmeCity; 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
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
Accounting/Banking
Event Expense Loan Repayment/Reimbursement Solicitation/FundraisingExpense
Fees p
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)
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 ($)
8
Payee address; City; State; Zip Code
9
TYPE OF
EXPENDITURE
F]Political ❑ Non P itical
10
(a)
Category (See Categories listed at the top of this sched e)
(b) Description
PURPOSE
[:]Check if travel outside of Texas. Complete Schedule T.
OF
EXPENDITURE
❑Check if Austin, TX, officeholder living expense
11
Complete ONLY if direct
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Arnount ($)
Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE
❑ Political ❑ Non -Political
Category (s Categories listed at the top of this schedule)
Description
❑ Check if travel Texas.
PURPOSE
outside of 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
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
$
20U 76
5 Date`111(1202,(
/, J /2A Z (
6 Payee name t/�J ! /� /0
7 Amount ($)
g Payee address; City; State; Zip Code
Zoo - W
271 l_�_"r7 50eee, G'J4Yffia)14
9 TYPE OF
EXPENDITURE
Political ❑ Non Political
10
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSEOF
❑ Check if travel outside of Texas. Complete Schedule T.
EXPENDITURE
i !�'
❑Check if Austin, TX, officeholder living expense
11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date1'
q'L2 iL0 [
Payee name PFA/
Amount ($)
Payee address; City; State; Zip Code
2 8�
2, v X -4
TYPE OF
EXPENDITURE
Z' 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
EXPENDITURE
��
❑Check if Austin, TX, officeholder living expense
I�"fU/ D � ,
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 R 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)
18 �7'I /-jjG /�
4 Date
5 Payee name
'0 q / /112,6 zlw/-
6 Amount ($)
7 Payee address; City; State; Zip Code
l6
2 S � � shy `, JAA 4M, In o 2
`Sl
❑Reimbursementfrom
political contributions
intended
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑ Check if travel outside of Texas. Complete Schedule T.
OF
EXPENDITURE
-pUe2 '46 kigm
❑ Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
oql 4041
Payee name
Amount ($)
Payee address; City; State; Zip Code
ei 1ur
Reimbursement from
2000 /?oya.i� L N ba&a _" / IC 722
political contributions
intended
Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
1A.57s�(„
4
❑ Check if travel outside of Texas. Complete Schedule T.
EXPENDITURE
O'er
❑ 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
�/z zaz
� p4V
Amount ($)
Payee address; City; State; Zip Code
z36-
Reimbursement from
❑ political contributions
20� � / Inye,
v\ , j✓ l 3-2
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
`//�'
j°v(�i�'
❑ 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
IN-KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES (VO �WVAd
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 ❑ Sc edule D ❑ Schedule F1
❑Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ S edule 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 C ❑ Schedule D ❑ Schedule F1
[]Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule ❑ 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 Ic onference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledgor / Pay
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
rorms proviaea oy texas Lthics commission www.ethics.state.tx.us Revised 9/8/2015
INTEREST, CREDITS, GAINS, REFUNDS, AND&"I'eqzyld
CONTRIBUTIONS RETURNED TO FILER /kja 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; ty; 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 re ived; City; State; Zip Code
Amount ($)
Purpose for which amount is received Check if political contribution returned to filer
Date
Name of person from whom amount is eceived
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amo nt is received; City; State; Zip Code
Amount ($)
Purpose for which amount is receed F-1 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 ($)
Purpose for which amount is received F--] Check if political contribution returned to filer
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
corms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
NON-POLITICAL EXPENDITURES
�o
MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE
The Instruction Guide explains how to complete this form.
1 Total pages Schedule I:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
8
PURPOSE
(a)Category (See instructions for examples of acceptable
scription (See instructions regarding type of information
(7quired.)
OF
categories.)
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
PURPOSE
Category (See instructions for examples of accepts a
Description (See instructions regarding type of information
OF
categories.)
required.)
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; Stat ; Zip Code
PURPOSE
Category (See instructions for exa pies of acceptable
Description (See instructions regarding type of information
OF
categories.)
required.)
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
PURPOSE
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
OF
categories.)
required.)
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
�ut j 1 - Niwivau by 1exas Ethics Commission www.ethIcs.state.tx.us Revised 9/8/2015
PAYMENT MADE FROM POLITICAL wp C"4'1AqA"'f
CONTRIBUTIONS TO A BUSINESS OF C/OH SCHEDULE H
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees
Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Business name
6 Amount ($)
7 Business address; City; State; Zip Code
8
(a) Category (See Categories listed at the top of this schedule)
(b) Descriptio
PURPOSE
❑
OF
Ch f travel outside of Texas. Complete Schedule T.
EXPENDITURE
❑ Ch k if Austin, TX, officeholder living expense
9 Complete ONLY if direct Candidate / Officeholder name Off ic sought Office held
expenditure to benefit C/OH
Date
Business name
Amount ($)
Business address; City; State; Zip Cod
Category (See Categories listed at the top of this sch ule)
Description
PURPOSE
❑ Check if travel outside of Texas. Complete Schedule T.
OF
❑ Check if Austin, TX, officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Business name
Amount ($)
Business address;City State; Zip Code
Category (See Categories fisted at the top of this schedule)
Description
PURPOSE
ElCheckif travel outside of Texas. Complete Schedule T.
OF
EXPENDITURE
❑ Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / chiceholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
corms provided by Texas Ethics Commission www. ethics. state.tx.us Revised 9/8/2015