candidate / officeholder form c/oh … provided by texas ethics commission ics.state.tx.us re ised...

CANDIDATE / OFFICEHOLDERCAMPAIGN FINANCE REPORT

FORM C/OHCOVER 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/OFFICEHOLDERNAME

4 CANDIDATE/OFFICEHOLDERMAILINGADDRESS

I I Change of Address

5 CANDIDATE/OFFICEHOLDERPHONE

« FIRST

AWLA 5 I

0 OFFICE USE ONLY

SUFFIX

ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE

Wa tfUU .VC 6+.

i • Tx 7-71 »iAREA COD

( 9/ )PHONE NUMBER

lo/ LMS / MRS MR )

Date Received

D fe Hand-delivered pfr Date Postmarked

Receipt # Amount $

Date Processed

6 CAMPAIGNTREASURERNAME dJ *f| o.)

NICKNAME

FIRST

LAST

Dm

l

sDate imaged

7 CAMPAIGNTREASURERADDRESS

(Residence or Business)

STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE;

tx 7-749 8 CAMPAIGN

TREASURERPHONE

AREA CODE PHONE NU BER EXTENSION

9 REPORT TYPE| | January 15

| | July 15

| | 30th day before election | j Runoff

[ | 8th day before election | [ Exceeded $500 limit

j I 15th day after campaign' ' treasurer appointment

, (Officeholder Only)

Final Report (Attach C/OH - FR)

10 PERIODCOVERED

Mont Day Year

/l9 /1jo\ionth Day Year

THROUGH

11 ELECTION ELECTION DATE

Month Day Year

5/(b / o ?I [ Primary | | Runoff

General ]] Special

ELECTION TYPE

i j OtherDescription

12 OFFICE OFFICE HELD (if any) 13 OFFICE SOUGHT (if known)

KT D BOX oc nS

GO TO PAGE 2

Forms provided by Texas Ethics Commission www.et ics.state.tx.us Re ised 9/8/2015

CANDIDATE / OFFICEHOLDERCAMPAIGN FINANCE REPORT

FORM C/OHCOVER SHEET PG 2

,4C,OHNAME Ai 0 k 15 Filer ID (Ethics Commission Filers)

16 NOTICE FROMPOLITICALCOMMITTEE(S)

| | Additional Pages

THIS BOX S FOR NOTICE OF POLITICAL CO TRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL CO MITTEES TOSUPPORT THE CANDIDATE / OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S

KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICEOF SUCH EXPENDITURES.

COMMITTEE TYPE COMMITTEE NAME

] GENERAL

I IsPECIFICCO ITTEE ADDRESS

COMMITTEE CAMPAIGN TREASURER A E

CO MITTEE CAMPAIGN TREASURER ADDRESS

17 CONTRIBUTIONTOTALS

TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THANPLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED

TOTAL POLITICAL CONTRIBUTIONS(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)

EXPENDITURETOTALS TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,

UNLESS ITEMIZED

OTAL POLITICAL EXPENDITURES

CONTRIBUTIONBALANCE TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY

OF REPORTING PERIOD

OUTSTA DI GLOA TOTALS

TOTAL PRINCIPAL A OUNT OF ALL OUTSTANDING LOANS AS OF THELAST DAY OF THE REPORTING PERIOD

0.0 0* 0. DO

* 6.7, &

O.On$ iO(?, 6

18 AFFIDAVIT

= ?:'>sybi :tC=•'w :

SHARON NOWAKNotary Public, State of Te asComm. Expires 09-16-2020

I swear, or affiTm, under penalty of perjury, that t e accompanying report is

true and cojre t and includes all information requiredJs-fcfSTepSrtedby meunder Title

Notary ID 4429489

AFFIX NOTARY STAMP / SEALABOVE

Sworn to and subscribed before me, by the saidMday of_ \| 20_

lAtexf VMD this the

to certify which, witness my hand and seal of office.

QUtr 6l < SHcuTrYyftJp Jg Nb v MSignature of officer administering oath Dr-in+cH -n+i«

CPrinted name of officer administering oath Title of officer administering oath

orms provided by Texas Ethics Commission www.ethics .state, t .us Revised 9/8/2015

MONETARY POLITICAL CONTRIBUTIONS schedule A1

The Instruction Gui e 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 n n t-nf-st tB pao (id#: )

6 Contributor address; City; State; Zip Code

7 Amount of contribution ($)

08 Principal occupation / Job t tle (See Instructions) 9 Employer (See Instructions)

Date F ll name of contributor H out-of-state PAC HD#: )

Contributor address; City; State; Zip Code

Amount of contribution ($)

Principal occupation / Job title (See instructions) Employer (See Instructions)

Date Full name of contributor FI out-of-state PAG (ID#: 1



(/Principal occupation Job title (See Instructions) Employer (See Instructions)

Date Full name of contributor n o t-of-state PAG (ID#: )



Principal occupation / Job title (See Instructions) Employer (See Instructions)

ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.

Forms provided by Texas Ethics Commission www.et ics.state.tx.us Revised 9/8/2015

SUBTOTALS - C/OH form c/ohCOVER SHEET PG 3

19 FILER NAME . .

AsI h V/vift 20 Filer ID (Ethics Commission Filers)

C7 21 SCHEDULE SUBTOTALSNAME OF SCHEDULE

SUBTOTALAMOUNT

1. Q SCHEDULEA1: MO ETARY POLITICAL CONTRIBUTIONS $

2 Q SCHEDULE A2: NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS $

3. Q SCHEDULE B: PLEDGED CONTRIBUTIONS $

4. SCHEDULE E: LOANS $ 15 o. 0 o

5. ] SCHEDULE FI: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $

6. Q SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $

7 Q SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $

8 Q SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD * 58. %9 Q SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS $ I57

10. ] SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $

11. Q SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $

12 I 1 SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONSI I RETURNED TO FILER

$


NON-MONETARY (IN-KIND) POLITICALCONTRIBUTIONS SCHEDULE A2

The Instruction Guide explains how to complete this form.1 Total pages Schedule A2:

2 FILER NAME ftshl 3 Filer ID (Ethics Commission Filers)

4 TOTAL OF UNITEMIZED IN-KIND POLITICAL CONTRIBUTIONS

5 Date 6 Full name of contributor out-of-state RAC (ID#:_ 8 Amount ofContribution

7 Contributor address; City; State; Zip Code

9 In-kind contributiondescription

I I Check if travel outside of Texas. Complete Schedule T.

10 Principal occupation / Job title (FOR NON-JUDICIAL) (See Instructions) 11 Employer (FOR ON-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 O out-of-state PAC (ID#:_

Contributor address; C t ; State; Zip Code

Amount ofContribution $

In-kind contributiondescription

| | Check if travel outside of Texas. Complete Schedule T.

Principal occupation / Job title (FOR NON-JUDICIAL) (See Instructions) Employer (FOR ON-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 NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.

Forms provided by Texas Ethics Co m ssion www.ethics.state.tx.us Revised 9/8/2015

PLEDGED CONTRIBUTIONS SCHEDULE B

The Instruction Guide explains how to complete this form.1 Total pages Schedule B:

2 FILER NAME

AsVilfNi D. \)m4 TOTAL OF UNITEMIZED PLEDGES

3 Filer ID (Ethics Commission Filers)

5 Date

66 Full name of pledgor out-of-state PAC (ID#:

7 Pledgor address; City; State; Zip Code

8 Amountof Pledge

9 In-kind contributiondescription

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 I-] out-of-state PAC (ID#: ) Amount In-kihd contribution

Pledgor address; City; State; Zip Code

of Pledge $ description

1 I Check if tra el outside of Texas. Complete Schedule T.


Date Full name of pledgor 1 1 out-of-state PAC (ID#: Amount of In-kind contributionPledge $ description


1 1 Check if travel outside of Texas. Co plete Schedule T.


Date Full name of pledgor 1 1 out-of-state PAC (ID#: f Amount of In-kind contribution


Pledge $ description

1 Check if travel outside of Texas. Complete Schedule T.


ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide for additional re orting 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 for .1 Total pages Schedule E:

2 FILER NAME A \ / , TN\ \ /

)) \1gy\v\3 Filer ID (Ethics Commission Filers)

1 1

4 TOTAL OF UNITEMIZED LOANS $ ISO.005 Date of loan

aim In7 Name of lender I FT o t-of-state PAC HD#: I

n Vi i9 Loan Amount ($)

IQD Db» "

6 Is lendera financialInstitution?

v £)8 Lender address; City; State; Zip Code

TOl M rble ov i-, TX 1 -74 4-

10 Interest rate

11 Maturity date

12 Principal occupation / Job title (See instructions)

MoXanVur13 Employer (See instructions)

|U( KJ -14 Description of Coliaterai

]H none

15 Check if persona! funds were deposited into politicaiaccount (See Instructions)

16 GUARANTORINFORMATION

I I not applicable

17 Name of guarantor 19 Amount Guaranteed ($)

18 Guarantor address; City; State; Zip Code

20 Principal Occupation (See Instructions) 21 Employer (See Instructions)

Date of loan ame of lender |~| ™ it-of-statn pac (id#: 1 Loan Amount ($)

Is lendera financialInstitution?

Y N

Lender address; City; State; Zip CodeInterest rate

Maturity date


Description of Collateral

I I none

Check if personal funds were deposited into politicalaccount (See Instructions)

GUARANTORINFORMATION

I I not applicable

ame of guarantor Amount Guaranteed ($)

Gu rantor address; Cit ; State; Zip Code

Principal Occupation (See Instructions) Employer (See Instructions)

ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDIf lender is out-of-state PAC, please see instruction guide for additional reporting requirements.

POLITICAL EXPENDITURES MADEFROM POLITICAL CONTRIBUTIONS schedule F1

EXPENDITURE CATEGORIES FOR BOX 8(a)

Advertising Expense EventExpense LoanRepayment/Reimbursement Solicitation/Fundraising E penseAccounting/Banking Fees Office O erhead/Rental Expense Transportation Equipments Related ExpenseConsulting Expense Food/Beverage Expense Polling Expense Travel In DistrictContributions/Donations Made By Gift/Awards/Memoriats Expense Printing Expense Travel Out Of DistrictCandidate/Officeholder/Political Committee Legal Services Saiaries/Wages/Contract Labor Other (enter a category not listed above)

Credit Card PaymentThe instruction Guide explains how to complete this for .

1 Total pages Schedule F1: 2 FILER NAME jA I \ T'S* I 3 Filer ID (Ethics Commission Filers)

/ hk j u /tfm 4 Date, I I

b/Ti In5 Payee name (

6 Amount ($) / 7 Payee address; Cit ; State; Zip Code

8 PURPOSE

OFEXPENDITURE

(a) Category (See Categories listed at the top of this schedule) (b) Description

1 1 Check if travel outside of Texas. Complete Schedule T.

1 1 Check if Austin, TX, officeholder living expense

9 Complete ONLY if direct Candidate/Officeholder name Office sought Office heldexpenditure to benefit C/OH

Date Payee name

Amount ($) Payee address; City; State; Zip Code

PURPOSEOF

EXPENDITURE

Category (See Categories listed at the top of this schedule) Description


1 1 Chec if Austin, TX, officeholder living expense

Complete ONLY if direct Candidate / Officeholder name Office sought Office heldexpenditure to benefit C/OH

Date Payee name


PURPOSEOF

EXPENDITURE

Category (See Categories listed at the top ot this schedule) Description

1 1 Check iftravel outside of Texas. Complete Sche ule T.

i 1 Chec if Austin, TX, office older living expense

Complete O LY if direct Candidate / Officeholder name Office sought Office heldexpenditure to benefit C/OH

ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED

Forms provide by Texas Ethics Commission www.ethics.state.tx.us Re ised 9/8/2015

PURCHASE OF INVESTMENTS MADESCHEDULE F3FROM POLITICAL CONTRIBUTIONS

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; C ty; State; Zip Code

7 Description of investment

8 Amount of investment ($)

Date Name of person from whom investment s purchased

Address of person from whom investment is purchased; City; State; Zip Code

Description of investment

Amount of in estment ($)


Forms provided by Texas Ethics Commission www. et h i cs .state .tx. us Re ised 9/8/2015

EXPENDITURES MADE BY CREDIT CARD SCHEDULE F4


Advertising ExpenseAccountin /BankingConsulting ExpenseContributions/Donations Made By

Candidate/Officeholder/Political Committee

Event ExpenseFeesFood/Beverage ExpenseGift/Awards/Memorials ExpenseLegal Services

Loan Repaymeni/ReimbursementOffice Overhead/Rental ExpensePolling ExpensePrinting ExpenseSalaries/Wages/Contract Labor

Solicitation/Fundraising ExpenseTransportation Equipments Related ExpenseTravel In DistrictTravel Out Of DistrictOther (enter a category not listed above)

The Instruction Guide explains how to complete this form.

1 Total pages Schedule F : 2 FILER NAME 1 i \//- Shltv, l/ft h

3 Filer ID (Ethics Commission Filers)

4 TOTAL OF UNITEMIZED EXPE DITURES CHARGED TO ACREDIT CARD $

5 Date 6 Payee name

H rv K7 A ount ($) 8 Payee address; City; State; Zip Code

tint fK

K.4, Tx 9 TYPE OF

EXPENDITURE | | Political Non-Political

10

PURPOSEOF

EXPENDITURE

(a) Categor (See C tegories listed at the top of this schedule) (b) Description

1 | Check if travel outside ot Texas. Complete Schedule T.

1 1 Check if Austin, TX, officeholder living ex ense

11 Complete ON Y if direct Candidate / Officeholder name Office sought Office heldexpenditure to benefit C/OH

Date Payee name


TYPE OFEXPENDITURE | | Political O Non-Political

PURPOSEOF

EXPENDITURE

Category (See Categories listed at the top of this schedule) Description

| [ Check if travel outside of Texas. Complete ScheduieT.

| [check if Austin, TX, officeholder li ing expense

Complete ONLY if direct Candidate / Officeholder na e Office soughtexpenditure to benefit C/OH

ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED¦

Forms provided by Texas Ethics Com ission www.ethics.state.tx.us Re ised 9/8/2015

POLITICAL EXPENDITURESMADE FROM PERSONAL FUNDS schedule G


Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising ExpenseAccounting/Banking Fees Office Overhead/Rental Expense Transportation Equipments Related xpenseConsulting Expense Food/Beverage Expense Polling Expense Travel In DistrictContributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of DistrictCandidate/Officeholder/Political Com ittee Legal Ser ices Salaries/Wages/Contract Labor Other (enter a category not listed above)

Credit Card PaymentThe Instruction Guide explains how to complete this form.

1 Total pages Schedule G: 2 FILER NAME A . * /

H Ufcfc3 Filer ID (Ethics Commission Filers)

4 Date

U / 617

5 Payee name

6 A ount ($)

1 | Reimbursementfrom1 1 political contributions

intended

7 Payee address; City; State; Zip Code

>0 Tn + Dr.

K„-k, tx i-i n8

PURPOSEOF

EXPENDITURE

(a) Category (See Categories listed at the top of this schedule)

l/ ptnsc

(b) Description

1 1 C eck if travel outside of Texas. Complete Sc edule T.

1 1 Check if Austin, TX, officeholder li ing expense

9 Complete ONLY if direct Candidate / Officeholder name Office sought Office heldexpenditure to benefit C/OH

Date

/t / tollPayee name

6:1! t, isoAmount ($)

JSfXooI I Reimbursementfrom1 1 political contributions

intended

Payee address; City; State; Zip Code

0<>3 t FaI/s cL

Hi. Tx -7 1

PURPOSEOF

EXPE DITURE

Categor (See Categories listed at the top of this schedule) (b) Description


1 1 Check if Austin, TX, officeholder living expense

Complete ONLY if direct Candidate / Officeholder name Office sought Office heldexpenditure to benefit C/OH

Date Payee name

Amount ($)

I | Reimbursementfrom1 1 political contributions

intended

Payee address; City; State; Zip Code

PURPOSEOF

EXPE DITURE

Category (See Categories listed at the top of this schedule) (b) Description

1 i Check if travel outside of Texas. Complete Schedule T.

f 1 Check if Austin, TX, officeholder living expense

Co plete ONLY if direct Candidate / Office older name Office soug t Office eldexpenditure to benefit C/OH



PAYMENT MADE FROM POLITICALCONTRIBUTIONS TO A BUSINESS OF C/OH


Advertising ExpenseAccounting/BankingConsulting ExpenseContributions/Donations Made ByCandidate/Officeholder/Political Committee Legal Services

Credit Card Payment

Event ExpenseFeesFood/Beverage ExpenseGift/Awards/Memorials E pense

Loan Repayment/ReimbursementOffice O erhead/Rental ExpensePolling ExpensePrinting ExpenseSalariesA/Vages/Contract Labor

Solicitation/Fundraising ExpenseTransportation Equipments Related ExpenseTravel In DistrictTravel Out Of DistrictOther (enter a category not listed above)


1 Total pages Schedule H: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)

4 Data 5 Business name

6 Amount ($) 7 Business address; City; State; Zip Code

(a) Category (See Categories listed at the top of this schedule)

PURPOSEOF

EXPENDITURE

(t>) Description

I I Check if travel outside of Texas. Complete Schedule T.

I i Check if Austin, TX, officeholder living expense

9 Complete ONLY if direct Candidate / Officeholder nameexpenditure to benefit C/OH

Off ce sought Office held

Date Business name

A ount ($) Business address; City; State; Zip Code

Category (See Categories listed at the top of this schedule)

PURPOSEOF

EXPENDITURE

Description

I I Chec if travel outside of Texas. Complete Schedule T.

I I Check if Austin, TX, officeholder li ing expense

Complete ONLY if direct Candidate / Officeholder nameexpenditure to benefit C/OH

Office sought Office held

Date Business name

Amount ($) Business address; City; State; Zip Code

Category (See Categories listed at the top of this schedule)

PURPOSEOF

EXPENDITURE

DescriptionI I Check if travel outside of Texas. Complete ScheduleT.

Check if Austin, TX, officeholder living ex ense

Complete ONLY if direct Candidate / Officeholder nameexpenditure to benefit C/OH

Office sought Office held

ATTACH ADDmONAL COPIES OF THIS SCHEDULEAS NEEDED

Forms provided by Texas Et ics Commission www.ethios.state.tx.us Revised 9/8/2015

NON-POLITICAL EXPENDITURESMADE FROM POLITICAL CONTRIBUTIONS schedule 1


1 Total pages Schedule I: " !sVi!evD-\Jtf 3 Filer ID (Ethics Commission Filers)

4 Date - 5 Payee na e

6 Amount ($)

a>7 Payee address; City; State; Zip Code

8 *PURPOSE

OFEXPENDITURE

(a) Category (See instructions for examples of acceptablecategories.)

(b) Description (See instructions regarding type of infor ationrequired.)

Date Payee name


PURPOSEOF

EXPE DITURE

Category (See instructions for examples of acceptablecategories.)

Description (See instructions regarding type of informationrequired.)

Date Payee name


PURPOSEOF

EXPENDITURE



Date Payee name


PURPOSEOF

EXPENDITURE




Forms provided by Texas Ethics Com ission www.ethios.state.tx.us Revised 9/8/2015

INTEREST, CREDITS, GAINS, REFUNDS, ANDCONTRIBUTIONS RETURNED TO FILER SCHEDULEK

The Instruction Guide explains how to complete this form.1 Total pages Schedule K:

2 FILER NAME

' i j. Ml3 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 A ount {$)

Address of person from whom amount is received; City; State; Zip Code

Purpose for which amount is recei ed Check if political contribution returned to filer

Date Name of person fro whom amount is receive A ount ($)


Purpose for which amount is received Check if political contribution returned to filer

Date Name of person from whom amount is received Amount ($)


Purpose for which amount is received Check if political contribution returned to filer

attach additional copies of this scheduleas needed

Forms provided by Texas Ethics Commission www.ethios.state.tx.us Revised 9/8/2015

IN-KIND CONTRIBUTIONS OR POLITICAL EXPENDITURESFOR TRAVEL OUTSIDE OF TEXAS SCHEDULE T

The Instruction Guide explains how to complete this form. 1 Total pages Schedule T:

2 FILER NAME V

r ev /an n 3 Filer ID (Ethics Commission Filers)

4 Name of Contributor Corporatio'n or bjibor Organization / Pledgor / Payee

5 Contribution / Expenditure reported on:

n Schedule A2 Q Schedule B Q Schedule B(J) D Schedule C2 D Schedule D D Schedule Ft

t Schedule F2 d Schedule F4 C Schedule G [ Schedule H 0 Schedule COH-UC IZ3 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:

D Schedule A2 D Schedule B Schedule B(J) D Schedule C2 D Schedule D Schedule Ft

d Schedule F2 d Schedule F4 d Schedules d Schedule H Schedule COH-UC I 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:

d Schedule A2 d Schedule B d Schedule B(J) Schedule C2 Schedule D d Schedule F1

d Schedule F2 d Schedule F4 d Schedules d 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 SCHEDULEAS NEEDEDForms provided by Texas Ethics Commission www.et ios.state.tx.us Re ised 9/8/2015

CANDIDATE / OFFICEHOLDER REPORT:DESIGNATIO OF FINAL REPORT form C/OH - FR

The Instruction Guide explains howto complete this form.Complete only if "Report Type" on page 1 is marked "Final Report" ••

1 C OH NAME k ,tenmD. i o2 Filer ID (Ethics Commission Filers)

3 SIGNATURE

I do not expect any further political contributions or political expenditures in connect on'ing a report as a final report terminates my campaign treasurer appointment. I also uijcontributions or make any campaign expenditures without a campaign treasurer appo/i

ith my candidacy. I understdF d thaT esignat-lerstand that I may_not ccept any c mpaigntment on file

bf (Janaidate / Officeholder

4 FILER WHO IS NOT AN OFFICEHOLDERComplete A & B below only if you are not an officeholder.

A. CAMPAIGN FUNDS

Check only one:

I I I do not have unexpended contributions or unexpended interest or income earned from political contributions.

I I I have unexpended contributions or unexpended interest or income earned from political contributions, i understand that imay not convert unexpended political contributions or unexpended interest or income earned on political contributions topersonal use. I also understand that I must file an annual report of unexpended contributions and that I may not retainunexpended contributions or unexpended interest or income earned on political contributions longer than six years after filingthis final report. Further, I understand that I must dispose of unexpended political contributions and unexpended interest orincome earned on political contributions in accordance with the requirements of Election Code, § 254.204.

B. ASSETS

Check only one:

I I i do not retain assets purchased with political contributions or interest or other income from political contributions.

I I I do retain assets purchased with political contributions or interest or other inspme from political contributions. I understandthat I may not convert assets purchased with political contributions or interastpr other income from p lWcalcomftbutions topersonal use. I also understand that I must dispose of assets purchased \fitl7 politiqpl conb utiljQSin accordanceiwith therequirements of Election Code, § 254.204

i

ire tW Can idate

OFFICEHOLDERComgl te this section only if you are an officeholder

I am aware that I remain subject to filing requirements applicable to an officeholdefVvho does not have a campaign treasurer onfile. I am also aware that I will be required to file reports of unexpended contribuiiojfis if, after filing thaJast requ pdTSptJr as anofficeholder, I retain political contributions, interest or other income from political qontributions, o ssets pujj nased with p liti¬cal contributions or interest or other income from political contributions.

Signature of Officeholder

Forms provided by Texas Ethics Co mission www.ethics.state.tx.us Revised 9/8/2015

candidate / officeholder form c/oh … provided by texas ethics commission ics.state.tx.us re ised...

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