Texas Ethcs Commsson P.O. Box 12070 Austn,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-298g CANDaDATE / OFFCEHOLDER CAMPAGN FRNANCE REPORT FORM C/OH COVER SHEET PG t L The C/OH nstructon Gude explans how to complete ths form. 1 ACCOUNT # 2 Total pages fled: (Eth cs Commsson Rlers) 3 CANDDATE / OFFCEHOLDER NAME MS / MRS MR FRST M...... OFFCE USE ONLY Date Receved 4- CANDDATE / OFFCEHOLDER MALNG ADDRESS '--]change of address ADDRESS / PC BOX; APT/surrEÿ_g cty; SrATÿ ZP CODE Dale Hand-delvered or Poslmarked r Recept # Amount 5 CANDDATE/ OFFCEHOLDER PHONE 6 CAMPAGN NAME AREA CODE PHONE NUMBER EXTENSON (,L;J.) qjÿ-o/,ÿ MS/MRS/MR,< frst ÿ ÿ,...,,t:- /, <,/,. G M jÿ SUFFX Date Processed ;magÿ, 7 CAMPAGN ADDRESS (resdence or busness) STREETADDRESS (N0 P0 BOX please); APT/SUFE#; {*.. CTY; STATE; 8 CAMPAGN PHONE AREA CODE PHONE NUMBER (7 ÿ;) ;>ÿ.;- ÿ4/ AqENSON 1. 9 REPORT TYPE ] January 15 [] 3Oth day before electon [] July 15 [] 8th day before electon [] R.e. [] ] Exceeded $500 lmt 15th day after campagn treasurer appontment (ofÿeholder only) Rnd report (Atÿch C/OH o FR) operod' COVERED / / ÿo7 THROUGH 11 ELECTON ELECTON DAlE ELECTON TYPE r] ÿ t2 OFFCE OFFCE HELD ('d any) 7.7., 00 TO PAOÿ Z wwv.ethcs.state.tx.us Revsed 04/19/2013
Texas Ethcs Commsson RO. Box 12070. Austn,Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-298-c, CANDDATE / OFFCEHOLDER REPORT; SUPPORT & TOTALS 14 C/OH NAMEr. ÿ :/ÿ /'ÿ ;,,,,,' FORM C/OH COVER SHEET PG 2 15 ACCOUNT # (Ethcs Commsson Fgers) 16 NOTCE FROM.fHÿ;ÿXÿFÿRNDTÿCEÿFPÿTÿALCÿNÿRÿU-ÿoNSAÿCEPTEÿRPÿLÿTÿALEXPENÿTUÿEsMADEÿPÿCALCÿMMÿSÿPÿ POLTCAL CANDDATE / OFFCEH O U3 E]ÿ, THESEEXPF-ÿD77JRESMAYHAVjÿ BEEN MADE WTHOUT THE CANDDATE'S OR OFFCEHOLDfÿRÿ$1"CNOWLÿDGE OR COMMTTEE(S) CONSÿr. CANDDATES AND OFFCEHOLDERS ARE REQURED TO REPORT3HS NFORMAÿON ONLY F ÿ ÿ NOÿ OF SUCH ÿdÿ COMMTTEE TYPE COMMTTEE NAME GENERAL.,, C0MMn EEABB.ESS D SPECFC COMMTfEE CAMPAGN NAME ] addtonal pages,, COMMTTEE CAMPAGN ADDRESS 17 CONTRBUTON 1. TOTAL POLTCAL CONTRBUTONS OF $50 OR LESS (OTHER THAN TOTALS PLEDGES, LOANS. OR GUARANTEES OF LOANS). UNLESS TEMZED $ 2. TOTAL POLTCAL CONTRBUTONS $ ÿ/.ÿ ÿsÿ (OTHER THAN PLEDGES. LOANS, OR GUARANTEES OF LOANS) ;ÿ ÿ, "" ÿ..ÿnd'-zure " OR LESS. UNLESS TEMZED $ ÿ/, ÿ ÿo TOTALS 3. TOTAL POLTCAL EXPENDTURES OF $1O0.j. - 4. TOTAL POLTCAL EXPENDTURES $ ÿ,,ÿ ÿ ÿ?.-//ÿ CONTRBUTON 5. TOTAL POLTCAL CONTRBUTONS MANTANED AS OF THE LAST DAY $ BALANCE OF REPORTNG PEROD OUTSTANDNG 8. TOTAL PRNCPAL AMOUNT OF ALL OUTSTANDNG LOANS AS OF THE LOAN TOTAL8 LAST DAY OF THE REPORTNG PEROD t8 AFFDAVT swear, or affrm, under penalty of perjury, that the accompanyng report s true and correct and ngludes all nformaton requred to be reported by me ÿ Eÿ.ÿf Sgnature of Canddate or Offceholder AFFX NOTARY,.ÿTh, MP / ÿp.alabove ÿ 0 Sworn to and,ubscrbedd before me, by the sÿd ÿ" ÿ!ÿ " '., ths the..ÿ, \ÿml ÿÿ",ÿ dÿlÿ. ÿj "/ÿ.20pn ÿnaÿmsÿÿÿr ad mÿ 'nÿsÿ ÿ ÿ t0 certfy whch, wtne.s my hand and seal f ft]oe" ÿÿ ÿoaÿ1... www.ethcs.state.tx.us ÿ Revsed 04/lgl2013
Texas Ethcs Commsson P.O. Box 12070 Austn, Texas 78711-2070 (512)463-5800 Lq'DD 1-800-735-2989 POLTCAL CONTRBUTONS OTHER THAN PLEDGES OR LOANS 2 FLER NAME Tÿe nstructon Gude explans how to complete ths form. r ' 3 SCHEDULE A,,,,, To'tal pages ScheduleA: / ACCOUNT # (Ethcs Commsson Flers) $ Date 9 Date Amount of 8 n-knd conbrÿbuten 5 Full name ol= contrbutor r"j out-of-state pac(dÿ.. } 7 contrbuton (ÿ;) ] descrpton (f applcable) 2 : :,// Do,,ÿ:& ; jÿ. o, 6 Contrlbutorÿddrÿs; Cty; Slate; Zp Cod 9ÿ 6 k"'+:7) 7?: j..,.7.,.;, ÿ2 7;'<ÿ#:' PHncpal oÿ:upaton Job ttle (See nstructons) ',,," 10 Employer (See nstructons) Date Full name of contrbutor [] out-of-state pacd/ÿ:.., ".. L:.ÿ...ÿ. Contrbutor address; Cty; ÿt@; Zp Code C. u / f" ÿ:! : q,. / /<-7;:?. Prncpal occupaton / Job ttle (See nstructons) [ Employer (See lnstÿ'uctons) Full name of contdbut0r r7 aut-of-stalepac(ll:ÿ-...... ":... 'J... : "odg "ÿ... Contrbutor address" Cty; State; Zp C P,,, Prncpal occupaton / Job ttle (See nstructons) Amount of 1 contrbuton ($) Employer (See nstructons) [ / ÿ ÿ'ÿ :0:ÿ! (f travel outsde of Texas. complete Schedule T),' j' ', Amount of n-knd Contrbuton conÿ'buton.($) descrpton (f applcable), (f travel outsde 9[ Texas. romp ate Schedule T) :.,.: :9o " l n-knd contrbuton descrpton (t= applcable) (f travel outsde of Texas, ÿ0mple)e 8ÿhedule T) contrbuton ($) 1 descrpton (t= eppl=ble) Date Full name of contrbutor [] oubof-statepaclleÿ=, ) Amount of n-knd contrbuton <..>.,,...oo.,o.so,o0o,o occupaton / Job ÿ nstructons) --- 1 Employer (See nstructons) n-knd contrÿbutlon Date Full name of ÿ:mtrbutor [] out-of-slatepac(l[ÿcontrbuton (S) descrpton (f applcable). ) Amountof F " Cont'dt)ut'oracdress: " Ct:y;" 8dte "zp bad;... 1 ( f travel outsde 0fÿ Prncpal oÿcupatlon t-job ttle (See nstructons) Employer (See nstructons) ATTACH ADDTONAL COPES OF THS SCHEDULE AS NEEDED f contrbutor s out-of.state PAG, please see nstructon gude foraddtonal reportng requrements. wÿw.ethcs.state.tx-us Revsed 0411912013
Texas Ethcs Commsson p.o. Box 12070 Austn, Texas 78711-2070 (512) 463-5800 O'DD 1-800-735-298E POLTCAL EXPENDTURES SCHEDULE F 1 Total pages Schedule F: " Z FLER NAME 4,, :,, EXPENDTURE CATEGORES FOR BOX 8(a) Advertsng Expense Gft/Awards/Memorals Expense Salares/VVages/Contract Labor Accountng/Bankng Legal Servces SolcRatonlFundrasng Expense Consultng Expense Food/Beverage Expense Travel n Dstrct Event Expense Pollng Expense Travel Oat Of Dstrct Fees Prntng Expense Offce OverheadlRental Expense Date. " / $ Pÿyee name The nstructon Gude explans how to complete ths form. Loan Repayment/Rembursement Transportaton Equpment & Related Expense ContrbutonslDonatons Made By Canddate/Offceholder/Poltcal Commttee OTHER (enter a category not lsted above) 3 ACCOUNT # (Ethcs' Commsson Flers) ' 6 Amount ($) 7 payee address;' Cty; State; Zp Code', z,.l, j/7/q3 (a) Gate,pry See ÿategodes lsted at the top ofths schedule} Oo) Descrpton (ftraveloutsdeoftexas, completeschedulet) /t EXPENDTURE 9 Complete ONLY f drect expendture to beneft C/OH Canddate Offceholder name Offce sought Oÿc,=. held yee nafte Amount ($) Payee address: ÿ Cty: State: Zp Code T J,.;, y';;,, ' Category (See Categores lsted at the top of ths schedule] Descrpton (ftravel oulsdeoftexas, complete Sched,!-T) EXPENDTURE Co=plote ONLY f <troÿt expendture to beneft C/OH %/,o Amount ($) 7 OF EbNDTURE[ Complete ONLY f drect expendture to beneft C/OH Date f" ÿ ÿ?"-ÿ Canddate oÿ=hoÿj=r core Pÿee name. cty; ÿ,ÿ; Szp Code Ca ÿgoÿy (See categores lsted at the top oftlÿs schedule) Canddate / Offceholder name Payee name Offce held,,,,, Desodÿoton (f travel outsde of Texas. complete Schedule'r} Dorc. Vÿ ÿc!ÿyÿ oÿ.o hed Offce sought,,/ Amount (S) payee address: Cty: State: 71p Code ' PuRPosE ' OF Y'ÿ=ND-U RE Complete ÿ f drect pendture to beneft C/OH www.ethcs.state.tx.us outsdeof Texas.complete ScheduleT) Category (See categodes'llsted at the top of ÿhs schedule) Of travel Canddate/.Offceholder name Offÿa sought ATTACH ADDTONAL COPES OF THS SCHEDULE AS NEEDED 0 ff'=,e held,,,, Revsed 04!1g/201ÿ
Texas Ethcs Commsson P.O. Box 12070 Austn, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) CANDDATE / OFFCEHOLDER REPORT: DESGNATON OF FNAL REPORT FORM C/OH - FR The nstructon Gude explans how to complete ths form. *, Complete only f "Report Type" on page t s marked "Fnal Report" --,,,,,, 1 C/OH NAME 2 ACCOUNT# (Ethcs Commsson Flers) 3 SGNATURE do not expect any further poltcal contrbutons or poltcal expendtures n connecton wth my canddacy. understand that desgnatng a report as a fnal report termnates my campagn treasurer appontment. also understand that may not accept any campagn contrbutons or make any campagn expendtures wthout a campagn treasurer appontment on fle. Offceholder 4 FLER WHO S NOT AN OFFCEHOLDER.- Complete A & B below only f you are not an offceholder. -- A. CAMPAGN FUNDS Ch'ÿpfÿ only one: r ÿj do not have unexpended contrbutons or unexpended nterest or ncome earned from poltcal contrbutons. r-7 have unexpended contrbutons or unexpended nterest or ncome eamed from poltcal contrbutons. understand that may not convert unexpended poltcal contrbutons or unexpended nterest or ncome earned on poltcal contrbutons to personal use. also understand that must fle an annual report of unexpended contrbutons and that may not retan unexpended contdbutons or unexpended nterest or ncome earned on poltcal contrbutons longer than sx years after flng ths fnal report. Further, understand that must dspose of unexpended poltcal contrbutons and unexpended nterest or ncome earned on poltcal contrbutons n accordance wth the requrements of Electon Code, 254.204. B. ASSETS Chÿck C only one: do not retan assets purchased wth poltcal contrbutons or nterest or other ncome from poltcal contrbutons. r-7 do retan assets purchased wth poltcal contrbutons or nterest or other ncome from poltcal contrbutons. understand that may not convert assets purchased wth poltcal contrbutons or nterest or other ncome from poltcal contrbutons to personal use. also understand that must dspose of assets purchased wth poltcal contrbutons n accordance wth the requrements of Electon Code, 254.204. 5 OFFCEHOLDER *- Complete ths secton only f you are an offceholder = 1ÿ ÿm aware that reman subject to flng requrements applcable to an offceholder who does not have a campagn treasurer on fle. m also aware that wll be requred to fle reports of unexpended contrbutons f, after flng the last requred report as an offceholder, retan poltcal contrbutons, nterest or other ncome from poltcal contrbutons, or assets purchased wth poltcal contrbutons or nterest or other ncome from poltcal contrbutons. /ÿ... ÿtj... www.ethcs, state.tx.us Revsed 04/19/2013