CANDIDATE I OFF!CEHOLDER FORM C/OH CAMPAIGN …...04-28-17 P01:21 IN CANDIDATE I OFF!CEHOLDER...

7
04-28-17 P01:21 IN CAND I DATE I OFF!CEHOLDER CAMPAI GN F!NANCE REPORT ! 1 The C/OH Instruction Guide explains how to complete this form. I 3 CANDIDATE l OFFI C EHOLDE.=l NAME 4 CAI'\ C :OATE I OFFI C t:HOLDE R MAIL :0J G ADDRESS D Chang e or Add ress 5 CA N DIDATE/ OFFI :::t: HOLDER PH01 -J E 6 CAMPAIGN TRE .C..S URER NAME 7 TRE,l\SURER ADC P ESS or Busi ness ) 8 CA!\; ., -\IGf\C TRE, : . .:>UF:::O:P. PHC . .: ::: 9 REP " RT TYPE 10 PER r'.) D CO Ve RED MS ' I LAST ' hDCc ESS , APT I SUITE;: CITY; STATE. ZIP CO'JE 140" }),.._ 7S"Ot'Q-- PRe:. COD!" PHONE (qo3> ) 8!5 MS /MRS I MR FIRST ),, t--{r A t:I':'<NAME LA Sl SUFF!'< I I STP.EEl ACDRESS PO BOX PLE/,5Ei: AP' I :;UITE #; CITY; :'1'.\TE lc.tOb D. IX I .\fiE/'. COCE PHONE D January 15 0 3GI:1 day belor" r.leclion D Ru no li 0 July 15 'Jil( St:; day bolare e\ec!IOn 0 ExcP..:d c- C: S5'JO i imit I Mor.tn Day 'tca1 r,,\ontil I s ;)J 17 4 THR OUG H FORM C/OH COVER SHEET PG 1 l 2 Total o2.ges tiled: Crt=. USE ONLY Date Rcccivc:J O;;t e Ha r.n·r;- l:•:e(C'd or Date Postmarked I Amount S Date Proccs: r.d ZIP C:J C:= 75og;). D 0 Do X 15:i1 co'} 211er campaign trc.:surer appointment Only) Fin<'l Rae crt (Atta ch CIOH • FA) Yac\1 ,, 11 ELE CT ION I [;!.[E TYPe D 0 ,....., ',1c Year P11r .1 Rt ;-, c_j -J :!: I .Jl{. cp c 01 Do:. _ '' "' " OS 0' ;)1)17 12 OFFi r. E OFFICE HELD (if ooy) I Forms pr ·;ded by Texas Ethics Commissio: : viWW.<=lnics state.tx.us Revised 9/8/2015

Transcript of CANDIDATE I OFF!CEHOLDER FORM C/OH CAMPAIGN …...04-28-17 P01:21 IN CANDIDATE I OFF!CEHOLDER...

Page 1: CANDIDATE I OFF!CEHOLDER FORM C/OH CAMPAIGN …...04-28-17 P01:21 IN CANDIDATE I OFF!CEHOLDER CAMPAIGN F!NANCE REPORT ! 1 The C/OH Instruction Guide explains how to complete this form.

04-28-17 P01:21 IN

CANDIDATE I OFF!CEHOLDER CAMPAIGN F!NANCE REPORT

! 1 The C/OH Instruction Guide explains how to complete this form . I

3 CAN D IDATE l OFFIC EHOLDE.=l NAME

4 CAI'\ C :OATE I OFFIC t:HOLDE R MAIL:0JG ADDRESS

D Chang e or Add ress

5 CANDIDATE/ OFFI :::t:HOLDER PH01 -J E

6 CAMPAIGN TRE .C..SURER NAME

7 CAI'v~ "" !I.IGN TRE,l\SURER ADC P ESS

(Residen~" or Business)

8 CA!\ ; ., -\IGf\C TRE,: . .:>UF:::O:P. PHC . .: :::

9 REP " RT TYPE

10 PER r'.)D COVe RED

• MS ' '~AS I ~.1R

~ICK)!AME LAST ~UFF '

hDCc ESS , FOE~::: APT I SUITE;: CITY; STATE. ZIP CO'JE

140" u~uee~ }),.._ B~/"\-r}{ 7S"Ot'Q--

PRe:. COD!" PHONE NU~te::; EXTE~SIC:-1

(qo3> ) 8!5 6"~' MS /MRS I MR FIRST ),,

t--{r o;~~ph. A t:I':'<NAME LA Sl SUFF!'<

I Ar~("D~

I STP.EEl ACDRESS i~IO PO BOX PLE/,5Ei: AP' I :;UITE #; CITY; :'1'.\TE

lc.tOb \tJorJtf~l D. e,'c~~ IX I

.\fiE/'. COCE PHONE NUI.:~ER

D January 15 0 3GI:1 day belor" r.leclion D Runo li

0 July 15 'Jil( St:; day bolare e\ec!IOn 0 ExcP..:d c- C: S5'JO iimit

I

Mor.tn Day 'tca1 r,,\ontil

I s ;)J 17 4 THR OUG H

FORM C/OH COVER SHEET PG 1

l

2 Total o2.ges tiled:

Crt=. ~E USE ONLY

Date Rcccivc:J

O;;t e Har.n·r;- l:•:e(C'd or Date Postmarked

I Amount S

Date Proccs: r.d

ZIP C:JC:=

75og;).

D

0

Do

X

15:i1 co'} 211er campaign trc.:surer appointment (O:I~r: -o-h '21det Only)

Fin<'l Rae crt (Attach CIOH • FA)

Yac\1 ,, 11 ELECTION

I ELECTIC.~ [;!.[E ELECT!C~ TYPe

D 0 ,.....,

',1c c· Year P11r ~ .1 ~ Rt ;-, c_j -J :!: I

.Jl{. cp c 01

Do:._ ''"' "

OS 0' ;)1)17 ~ Gt:I~CI,l:

12 OFFi r.E OFFICE HELD (if ooy)

I

Forms pre· ·;ded by Texas Ethics Commissio: : viWW.<=lnics state.tx.us Revised 9/8/2015

Page 2: CANDIDATE I OFF!CEHOLDER FORM C/OH CAMPAIGN …...04-28-17 P01:21 IN CANDIDATE I OFF!CEHOLDER CAMPAIGN F!NANCE REPORT ! 1 The C/OH Instruction Guide explains how to complete this form.

04-28-17 P01:21 IN

CANDIDATE I OFFjCEHOLDE~;t CAMPAIGN FcNANCE REPORT

FORM C/OH GOVEn f.-;;HEET PG 2

16 NO 1 ICE FRO;v; PO~ r-ICAL COMMITTEE(S)

0 Additional Page s

17 CONTRIBUTION TOTALS

EXPENDITL.;R~

TOTALS

CONTRIBUTION BALANCE

OUTSTANDING LOAN TOTALS

18 AFFIDAVIT

,:: Filer !C. (::O'if·,ic; Commission Filers) '----- ----1 ,:OTICE OF POLiiiCAL CO.'<o'li9~TIONS ACCEPT:D 0'1 POLITIC.~L 2!!Pc:!~F.TH~S MADE !3'! FLi_!'iiCAL COMMITTEES TO

~L?."JOA1 n::: : .tlD;JATE / .J.-F!C.=~:~.;Lc:=:: T 1'E$E 5XPENDITURES .:iA}· H.1.VE HIEEN i•ACi: ~'1/rt'.:~:- rHF.. ~!... ""W!7'E1S OR OFFICEHOLDER'S

KNOWLEDGE 0!0 CONSENT. CANDIDATES AND OFriCorlOLDERS AR~ F.ECUI!'!!"D TO REcCR'i T~ic !NrO~IMTION C!<LY iF THEY RECEIVE NOTICE

OF SUCH EXPE!~01 fUAES.

COW!.ITTEE TYPE COMMITTEE !>Ar.:E

, __ /SPECIFIC

1 .

2.

J

.,.

5

'

COMtd iTTEE CAft1 PA:.3 1\! .i RE.:.:. suREF\ ASORFSS

TOTl1L :·~i)LIT ICAL :-::c i.,l·: s !C LF--i:::Ji .:.:; or- ss D (")P ~ :::E: .s ro-o1::R TH/. 1

PLEC:GE'S, LOANS , CR (iUA::':f.i•!TC::':S ClF I 0:1i'S). I~I ·' LE~S ,-'EH I'ZED

TOH.I. i·1 0LITICAL C;Ci\ITRiSIJT;O!JS IOTHO:;~ THAN PLEDGES L::i\1 S OR <, u M;I'.~'i'l' E S ::J F L(;,c,;:,; ;

To·:- ·:JLITIC/.L ~-->·.~cl,[, 1 _;I:.~;~~ CF ~;i'lO () \ !_ ·=: ~.:2,

UN; :".' ; !TEMI ZE D

TOT -.:. :)OLIT IGA L CC :'.' ·:·r.!r:; "i iOrJ S ':V AI.'.JI!./I! f: C.~[' ·)r: 1 ~-t=-: ~. r .ST) \': OF ,-;f'F<J RTI NG PE,0,;();J

TOT\c ?I~ INCIPI.L ,,_;,;ounr : ;:: ·, l!. our sr ,\:. :<~w> Lc •1\N s ,<·: .::: ,c ·-,-.f.:: L;.E : .:J:t OF TI< E i1<~p,,: :-:· ·: :--L.:-.;L;['

c' ,._;

! ;.:.N:·ar, o: ~i: n . n. u: 1 ~: o r ::·.;,:: ii ~' c:: . ;u ry. ;hai <he: <tCSJmpanying report is

·:r~ l 8 J.11U ccn,·.~ - i :nw i: : : !~_; ;:: :; :: .:1: . li lh ;-, ~ -~ ·;ic ;l ; E ;~~ Liil.::c. ~o be reported by me

AFFIX NOTARY STAMP I SEAL ABOVE

Sworn to and suoscribe::l before m::. :~y the said

.: :.1

fAen-v,~ (Y)G

Revised 9/8/2015

Page 3: CANDIDATE I OFF!CEHOLDER FORM C/OH CAMPAIGN …...04-28-17 P01:21 IN CANDIDATE I OFF!CEHOLDER CAMPAIGN F!NANCE REPORT ! 1 The C/OH Instruction Guide explains how to complete this form.

04-28-17 P01:21 IN

SUBTOTALS - C/OH FORM C/OH COVE~\I SHEET PG 3

19 ?.<J File• IIJ (Ethb; C;;:nmission Filers)

21 SCHEDULE SU3TO<-ALS NAME OF SCHEDULE

1 . D SCHEDULE A 1: MONETP, R ~' POLITICAL CONT~:: ! 6 ~ !T!Oi\!S

2 . D scH~DULE A2: NON-MOc'ETARY (IN-KI ''>JD) Po~_!T'CF.L coNTRi f' UTiON S

3 . D SCHEDULE B: PLEDGED CONTRIBUTIONS

4. D SChEDULE E: LOANS

s. 0 sci-lt::DULE t= ,: POLITIG,\~. EXPENDITURES i'vi!\C.:: FRGivl PC.L1 r IC,\L CONT·~;su-r ;c.'ls

s. 0 scHEDULE F2: UNPAID :c.: ~: :JRRED OBL1G/-1TIC~~ s

7. D scHEDULE F3: PURCH"SE OF INVESTrVIENl :; i·h DE FRCL-1 F' .::; !.IT! C,\L. c u NTRISUTIONS

e . D scHED ULE F-'. EXPENDiTUREs MADE E:: ': c ;=:t:c,, ·:- cARD

~--------------------------------------------- -----------------------------------9.

10.

11 .

12.

D D D D

SCHEDULE G POLITIC:\L e XPENDITUR E' S H '\ 0 0. FP.o ~·- PEF: ~'O lt\L FUf\!!:: .s

SCHEDULE K INTE R EE·-- CF\EDITE. G J.iN S :·: F.: r~ ·Ji JC;;~ .\ i'<r) "" r-, , ! T~I F.··: i..J"T:C, ~ S

RETURNED T O FILER

SUBTOTAL AMOUNT

$ :;Jso·~

$

$

·' I

:;; 53 . t>L\ $ 1 .i) I

$ ~Lt~ ::> 53.oy s

~

s

------- ------------------------------------~ Forms provided by Texas Ethir.s Commissio:' \'N.c'.\'.?lh:c;:; Sl2.t 8 .TY.L:S Revised 9/8/2015

Page 4: CANDIDATE I OFF!CEHOLDER FORM C/OH CAMPAIGN …...04-28-17 P01:21 IN CANDIDATE I OFF!CEHOLDER CAMPAIGN F!NANCE REPORT ! 1 The C/OH Instruction Guide explains how to complete this form.

04-28-17 POl:22 IN

"~,-~, ·'':::DULE A1 '-""'-··'··-

---~---=~=====:::j

2 2 :=.Jer ID (EU·.;c>: Commission Filers)

4 Date -, ;' :.'1cun; c: ::c:>: : :buUon ($)

8 Principal occCJ;:>ation I Job title (S3e l11streJctions)

- . Date Full narn:J of contr1clit(1r

.Lip Cr:::'

Principal occupa!i-::'1 I Job tit!e (SPs In ct·uctions)

Date Ful l n<lm£- of contri--ut:x

Conrribu~or acJdra:: :-:

Principal occu p2tio n I J ob li t i-:o (S 2e lnst: u :.:tions)

Date c c·,"·(IT· ·~:t• t= :; !:Dii;

ContriD'.!tor addre~·- :,

Principal occup<:tion I Job till~ (S ee 11···''· e~ :::t ions)

Forms provided by Te:t.1S E:thics .:omm1ssic:: Revised 9/8/2015

Page 5: CANDIDATE I OFF!CEHOLDER FORM C/OH CAMPAIGN …...04-28-17 P01:21 IN CANDIDATE I OFF!CEHOLDER CAMPAIGN F!NANCE REPORT ! 1 The C/OH Instruction Guide explains how to complete this form.

Adverti~ing Exr:e·· '~(~ Acccunt:r:r.'• )ankin£.· Consultinr] E <pensP Contcibutior. >IDonz.·J::r. . .~ ·:-~·,.

Candidate/Officeho:d ,-:r i~.:.~ !. L~;3.1 Cc.-r: ,..,; t:te,; Credit Card Pe~-ment

.. .:tv.··~

9 Complete ONLY i ::' "' '" 1

l==ex=p=e=nd=it=cr=e=to=b=-s_,-. _e·;_,: _c_:c_r_i ~.:::J ~er _Bt ~~ Date

r---------~-Amount ($) ~-'' }'C'-'

Pl.!F;POS::: OF

EXPEI\'DITUC';'=C

Complete ONLY ii rJ 1:act expenditu re to b :n2i i< :> OH

Oat<;

1--- - - - ---1--AmoUI',t ($) ,0 ::•;3e J ::!c! -

?UF:!"OSE O F

E X PE o,! OITU".;E

Complete ONLY i f ,,,,2ct expenditure to b '"" i i i GICH

tl

Forms provided byTe·: s c:t~ .. :;s C: nr:-,1 .7 ~ - ,:

-----

--· DD!T' L...J

04-28-17 P01:22 IN

·~. : 1 ~:: · ~:11 ' F'"~ :c E;..:rense , . "·" ,,,, . .. ,,ont .l. Related Expense ·::.l t. :.' :

• • 1 ·. ' 1 ; ~· ' ; :: ,, ,-: 1 :~:v not listed above)

,; ' te ;

' ., ' .~o11mission Filers)

7)ol5 T

D

[U

,'Jjf, :Cfiicc held

T

Oiiice held

Revtsed 9/8/2015

Page 6: CANDIDATE I OFF!CEHOLDER FORM C/OH CAMPAIGN …...04-28-17 P01:21 IN CANDIDATE I OFF!CEHOLDER CAMPAIGN F!NANCE REPORT ! 1 The C/OH Instruction Guide explains how to complete this form.

EXPENDITURES MADE 8\''. C;j:~ED~T (~ABD

Advertis•ng Expc r.Sl; Account. r.g/Ban : ~lr'g

Consuning Expense Contributions/Donations ~J1ade By

Candidate/Officf:!ho!c!C'! r/Politlca! C::mmitcr:n

-=·v t E.xoe:.se ' .

,-nod:'Bevara~e E:.. ""-r sr. G•ft·Awa.rds/Men~.Jrial:. c:::<p":":.)' ~

·QRI Servicr·s

T~e lnstiJcl -,,. ' ._., ·:r c

_,~.::. - :-H..":2·:·nar.~/~;.: ;• ~ "· . ..:;.~:11Co1!

Gi:ic..:; (;v~ :Jd1~\.:H ~ul r.:... l·c·:·~.::

Pcl!•n·:·l E>:.::urse p,-r:ltin~·, tXfJB:'lS€-

.:;:::,.:tr:'"'~'ll.' ~-;~·~s/C:-.;r'~~~t -~~~(."..:

~ r pk ,. t i-:. f ~1.

1 Total pTchedule F4 _ 2 FILEi=:r~Jo~ A'(...,.......~+..(~

4 TOTAL OF UNITEMIZED EXPEr,JD!TURES CH.~r.::. :~EC TC / \Cf-lcDlT C.C>.RD

7 Amount ($)

9

10

\7li .~ TYPE OF

EXPENDITURE.

PURPOSE OF

EXPENDITURE

(a) C :gv

.......... )' .. •f.• 'c•

"o P , ~a!

·';a!t.=. c ( b )

0" .el ;e <"

04-28-17 P01:22 IN

SCdEDULE F4

~ o~ icirat, :-;:1/P unc1 nising Expense T:3r:t.pc:-:.a.t:rm :~;.L::pm9nt & Related Expense

Trave! Cut C;; ;·_: snict Glncr (~;r-~e:' •~ r:'l·,cnorv not listed above)

3 Fiier ID (Ei:•tc3 Commission Filers)

held 11 Complete ON~ 1i direct expenditure to beneli \ C/01-1

Date L/ I';);)-J )7 r--

:ro~pL. P~s-t~ eJSD §)T All!L 3 ~uy

8 APtf4 s~~ + ~~ Amou nt ($)

TYPE OF EXPENDITURE

PURPOSE OF

EXPENDITUR:=

Complete ON'=Y if direGt expenditure t~ benefit C/CH

C'""" ica

Ca.tego~y (See Cntegones li:-.11!~1 nr 1111--: rnr r,; t 'I~ :;--'•f.:c:c~ll~'

Forms provided by Texas Ethi cs Ccm mission

1eld

Revised 9/8/2015

Page 7: CANDIDATE I OFF!CEHOLDER FORM C/OH CAMPAIGN …...04-28-17 P01:21 IN CANDIDATE I OFF!CEHOLDER CAMPAIGN F!NANCE REPORT ! 1 The C/OH Instruction Guide explains how to complete this form.

POLITICAL E:X.PE.I\E:WfURES MADE FROM PERSONAL FUNDS

Advertising ::xpenF~ Accour.ting i3ankinu Consulting E:<pense Contribution s/DonaliO ~l :, r, ·;~~ .:.Je f j;, Candidate/Officeholder/PaJ : tic~.l Con1rnittce

Credit Card P<yment

i ··.. • r xpens:-·

-=r ~,.. cveraqe E···T i'l;J"·

--:~t. ~ •. rd:.;/f\1cm ~~~-.~f.,· ~.,_

:_.:=:n:ll Servir:es

!...c-1.n R.:.1~.:..•n .. 'R;: -r· 'l•o. -n. ......... • -~ 0'1-:-· ,, .. J Re~~:;. i,~ '­

n,, !..-']f.>" ... '(' ~:Jr:nt .. w l:):p. ·;u S:=.L::i! ''"" -.. '\".!;y· :>•Ccritr__,d L;;b•JI

1 Totalpagr ScheduleG:[ 2 FILER NA~~-~ ~'('~J~

4 4t/14/t7 __ '' P~, ~-· Of-f(~ ~ 6 Amount ($) 7 Pa:,ee 2Cc!r:·:·:~ Cit, '::::1:w: •_;· J~

~:;:~~.:;;;:. 1~1 tJ. VJt&p<~ Ro--l!j1X Is

intended

PURPOSE OF

EXPEN:JITUF:C:

Date

Amouo>i ($)

ReuT.bursem:;nr '~:..::.., political contributions lnter.09d

PURPOSE OF

EXPENDITURE

Complete ONLY 1i ::l;rnct expendit.Jre to b2ne''' C/OH

Date

- · Amount ($)

D Relir.t..ursem.:::nt Jro.11 polit:cal contnbul•:.ns inter.ded

jc ,;;·

J C"ro'

·::.c:'

- _I ~: ..

_] c ,,,,'

·-~ ;$[_) • Ill.

Pa:tee na:11c•

(I.} J>:!SC~ . IC'.

-,

04-28-17 P01:22 IN

>:::·· •''HEDULE G .. _);.,.,.

S::~is i13 l :l ~ :1'F• r . ..::r: ,,~;:n i) Expense ; ':.t·l !;pv r .o • ::: ~ "::q• .. q: .-n ~~nt & Related Expen&e

• I :'"!V ~) IIn C r:··;t or' r r:.: .. Ja r CL\ ( JI t...~ . t· Gt .:·1 ,,; r (cmc~ r .:-r c::~-:~~ ''' y no~ listed above)

8 Filer I;) ( f: t:1;cs Commission Filers)

Office held

,. ~:' .... ·~~~ T

'\' 1 • ':'· ;nse

Olf1ce held

PURPOSE OF

EXPENDITURE

_j ( . ,:, d.~ t CY<13 Co ""':.. ·-tr• -.,

__ ] cr.-:\ . ,).,.rr T: .. (I'll .. ·halc!CI I

OificehorcJe, l:ltnc: Office held

-

Forms provi ded by Te::as Eth1cs Commiss ion Revised 9/8/2015