4
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT (512) 463-5800 (TDD 1-800-735-2989ÿ FORM C/OH COVER SHEET PG 1 The C/0H Instruction Guide explains how to complete this form. 9 ACCOUNT # (Ethics Commission Fi]ers) t,tq--cl=joo 6 CAMPAIGN FIRST MI Date Imaged T;'E200 E ....... ............ NICKNAME LAST SUFFIX 7 ZIP CODE 10 PERIOD Month Day Year Month Day Year COVERED ÿ /mÿ, / t¢ ÿ.ROUÿ. 5 / I / t 5 11 E L E C T I O N ELECTION DATE ELECTIO N TYPE Month ÿ ÿeÿ. [] P,m.ÿ [] Ruÿ ÿ Gsoera, [] S..a, 5/'ÿ /|5 12 OFFICE OFFICEHELD ([fany) 13 OFFICESOUGHT (ifknown) AREA CODE (715) MS/MRS/MR CANDIDATE/ OFFICEHOLDER PHONE 4 CANDIDATE / OFFICEHOLDER MAILING ADDRESS [] change of address CAMPAIGN TREASURER ADDRESS (msidenceorbusiness) CAMPAIGN TREASURER PHONE 9 REPORT TYPE CANDIDATE / MS/MRS/MR ,,ÿFIRST MI NAMEOFFICEHOLDER ÿ •'} ÿ ILÿIÿ J NICKNAME LAST SUFFIX ADDRESS / PO BOX; APT/SUITE#; ; STATE; ZIP CODE PHONE NUMBER EXTENSION -n q# STREETADDRESS (N0 PO BOX PLEASE); APT/SUITE #; CITY; STATE; AREA CODE PHONE NUMBER ( 715 ) £7ÿ- lÿ'l [] January 15 [] 30th day before election [] Runoff [] 15th day after campaign treasurer appointment (officeholder only) [] July 15 ÿ 8th day before election [] Exceeded $500 [] Finalreport(AttachC/OH-FR) limit 4 "O,,.ÿj 2 Total pages filed: OFFICE USE ONLY Doÿ s-- f-2,0:5- Date Hand-delivered or Postmarked Receipt # Date Processed Amount EXTENSION GO TO PAGE 2 www.ethics.state.tx,us Revised 07/28/2014

CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT … · AREA CODE PHONE NUMBER ( 715 ) £7ÿ- lÿ'l [] January 15 [] 30th day before election [] Runoff [] 15th day after campaign

  • Upload
    others

  • View
    1

  • Download
    0

Embed Size (px)

Citation preview

Page 1: CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT … · AREA CODE PHONE NUMBER ( 715 ) £7ÿ- lÿ'l [] January 15 [] 30th day before election [] Runoff [] 15th day after campaign

Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070

CANDIDATE / OFFICEHOLDERCAMPAIGN FINANCE REPORT

(512) 463-5800 (TDD 1-800-735-2989ÿ

FORM C/OHCOVER SHEET PG 1

The C/0H Instruction Guide explains how to complete this form.9 ACCOUNT #

(Ethics Commission Fi]ers)

t,tq--cl=joo6 CAMPAIGN FIRST MI Date ImagedT;'E200 E ....... ............

NICKNAME LAST SUFFIX

7 ZIP CODE

10 PERIOD Month Day Year Month Day Year

COVERED ÿ /mÿ, / t¢ ÿ.ROUÿ. 5 / I / t 5

11 E L E C T I O N ELECTION DATE ELECTIO N TYPEMonth ÿ ÿeÿ. [] P,m.ÿ [] Ruÿ ÿ Gsoera, [] S..a,

5/'ÿ /|512 OFFICE OFFICEHELD ([fany) 13 OFFICESOUGHT (ifknown)

AREA CODE

(715)MS/MRS/MR

CANDIDATE/OFFICEHOLDERPHONE

4 CANDIDATE /OFFICEHOLDERMAILINGADDRESS

[] change of address

CAMPAIGNTREASURERADDRESS(msidenceorbusiness)

CAMPAIGNTREASURERPHONE

9 REPORT TYPE

CANDIDATE / MS/MRS/MR ,,ÿFIRST MI

NAMEOFFICEHOLDER ÿ •'} ÿ ILÿIÿ J

NICKNAME LAST SUFFIX

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

PHONE NUMBER EXTENSION

-n q#

STREETADDRESS (N0 PO BOX PLEASE); APT/SUITE #; CITY; STATE;

AREA CODE PHONE NUMBER

( 715 ) £7ÿ- lÿ'l

[] January 15 [] 30th day before election [] Runoff [] 15th day after campaigntreasurer appointment(officeholder only)

[] July 15 ÿ 8th day before election [] Exceeded $500 [] Finalreport(AttachC/OH-FR)limit

4 "O,,.ÿj

2 Total pages filed:

OFFICE USE ONLY

Doÿ s-- f-2,0:5-

Date Hand-delivered or Postmarked

Receipt #

Date Processed

Amount

EXTENSION

GO TO PAGE 2

www.ethics.state.tx,us Revised 07/28/2014

Page 2: CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT … · AREA CODE PHONE NUMBER ( 715 ) £7ÿ- lÿ'l [] January 15 [] 30th day before election [] Runoff [] 15th day after campaign

Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070

CANDIDATE / OFFICEHOLDER REPORT:SUPPORT & TOTALS

(512) 463-5800 (TDD 1-800-735-2989

FORM C/OHCOVER SHEET PG 2

C/OH NAME .ÿ -- , -- • = 15 ACCOUNT# (Ethics Commission Fliers)

16 NOTICE FROM THÿsBÿFÿRNÿCEÿFPÿLÿTÿALÿNTRÿBÿTÿNSAÿcÿEPTIEDÿRPÿLÿCALEÿPENDÿTURESMADEBYPÿLÿTIÿALcÿMMÿTÿ15ESTÿSUPPÿRTÿ-ÿE

POLITICAL CANDIDATE / OFFICEHOLDER, THESEÿ(ÿENDÿTURÿSMAYÿAVEÿEÿADEwÿTHÿUÿTHECANÿDATEÿSÿRÿFFÿCEHÿLÿERÿSKNÿWLEÿEÿR

C O M M I TT E E ( S ) CONSENT. CANOIDA'i]SS AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMA'I1ON ONLY IF "II-IEY RECEIVE NOTICE OF SUCH EXPENDITURES.

COMMITTEE NAMECOMMITTEE TYPE

Iÿ] GENERAL

rÿ} SPECIFIC

17TOTALsCONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THANd, #,fÿ" Iÿ€)PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED q) -ID=

2. TOTAL POLmcAL coNTriBuTioNs$ ÿ500(oTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS>

EXPENDITURETOTALS 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED $ ÿ)

4. TOTAL POLITICAL EXPEN DlTU RES , ÿ Iÿ11ÿ1 "!'1

BALANcECONTRIBUTION 5. TOTALoF REPORTINGPOLITICALpERIoDCONTRIBUTIONS MAINTAINED AS OF THE LAST DAY $ ÿ 11 ÿ1__Lÿ'= iÿo

OUTSTANDINGLOAN TOTALS 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDINGLAsT DAY OF THE REPORTING PERIOD LOANS AS OF THE $ ÿ)

18 AFFIDAVIT

] additional pages

COMMITTEE ADDRESS

COMMITTEE CAMPAIGN TREASURER NAME

COMMITTEE CAMPAIGN TREASURER ADDRESS

%1111111 II,,,'),%;,ÿ.;.,."ÿ:',,. KATE C. NORDLANDER ÿ i,,ÿo.... '" ÿ ÿ Nofory Public, State of TexasI... ".ÿ.

-€ÿ My commission Expires ÿ II ÿ;,ÿoÿ,*ÿ May 22, 2016 )

I swear, or affirm, under penalty of perjury, that the accompanying reportis true and correct and includes all information required to be reported byme under Title 15, Election Code.

Siglÿaÿ re fÿ;ndidate or Officeh o1ÿ..ÿ ÿ''ÿ-

AFFIX NOTARY STAMP / SEALABOVE

Swoiÿ,}L9" and subscribed beforejllÿA=jme, by the|ÿsaid ÿlÿlÿlÿ ÿ. ÿ,ÿ ÿ ,this the

day of , r, tlr/ÿvJ , 20 ÿ , to certify which, witness my hand and seal of office.

Signature of officer administering oath

www.ethics.state.tx.us

Printed name of officer administering oathno ,?4

tle of officer adm in iTlering! oath

Revised 07/28/2014

Page 3: CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT … · AREA CODE PHONE NUMBER ( 715 ) £7ÿ- lÿ'l [] January 15 [] 30th day before election [] Runoff [] 15th day after campaign

Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070

POLITICAL CONTRIBUTIONSOTHER THAN PLEDGES OR LOANS

(512) 463-5800 (TDD 1-800-73ÿ-298ÿ

SCHEDULE A

4 Date

4ÿin

The Instruction Guide explains how to complete this form.

5 Full name of contributor 17out-of-statePAC(ID#" ) 7 Amountof

Aÿÿÿ1,ÿ ÿ.ÿ .ÿ. ' contribution ($)1ÿ "6' Coniributoradd'ressi " "Cityl State; Zi;Code ...........ÿ"..,,vviÿ'tÿ"}Iÿ

1 Total pages ScheduleA: j

3 ACCOUNT # (Ethics Commission Fliers)

I 8 In-kind contribution

I description (if applicable)

II

9 Principal occu

I'ÿ 1ÿ "1 7 ÿ) 1 7--..-" (If travel outside of Texas, complete Schedule T)

ation / Job title/(See Instructions) 10 Employer (See Instructions)

Date

Principal occu

Full name of contributor [] out-of-state PAC(ID#: )

..........Contributor address; City; State; Zip

)ation / Job title (See Instructions)

Amount of Icontribution ($) [

$1o0.ÿo III

(If travel outside of Texas, complete Schedule T)Employer (See Instructions)

In-kind contributiondescription (if applicable)

Date Full name of contributor [] out-of-statePAC(ID#:. )

d |ÿ'% ..... " ..... ;" " (3"ty;" Statei "Zip Code ........../

I%ÿ{,n, ÿ 77011Principal occupation / Job title (See Instructions)

Amount of Icontribution ($) I

II

(If travel outside of Texas, complete Schedule T)

Employer (See Instructions)

In-kind contributiondescription (if applicable)

Date Full name of contributor [] out-of-state PAC (113#: .)

• ...................Contributor address; City; State; Zip Code

Principal occupation / Job title (See Instructions)

Amount of Jcontribution ($) I

Ioo.'" 'II

(If travel outside of Texas, complete schedule T)Employer (See Instructions)

In-kind contributiondescription (if applicable)

Date Full name of contributor [] 0ut-of-state PAC(ID#:. )

Contributor address; City; State; Zip Code

Principal occupation / Job title (See Instructions)

Amount of Icontribution ($) I

III

(If travel outside of Texas, complete Schedule T)Employer (See Instructions)

In-kind contributiondescription (if applicable)

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

www. ethics, state,tx, u s Revised 07/28/2014

Page 4: CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT … · AREA CODE PHONE NUMBER ( 715 ) £7ÿ- lÿ'l [] January 15 [] 30th day before election [] Runoff [] 15th day after campaign

Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989

POLITICAL EXPENDITURES SCHEDULE F

Advertising ExpenseAccounting/BankingConsulting ExpenseEvent ExpenseFees

EXPENDITURE CATEGORIES FOR BOX 8(a)Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement

Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related ExpenseFood/Beverage Expense Travel In District Contributions/Donations Made ByPolling Expense Travel Out Of District Candidate/Officeholder/Political CommitteePrinting Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)

The Instruction Guide explains how to complete this form.

I Total pages Schedule F:

4 Date| |

H'LIS|\S6 Amount ($)

2 FILER NAME I , =

Payeeÿn aÿeÿ 3ÿ,ÿ, ÿt ÿ ÿ

7 Payee address; City; State; Zip Code

-3\3

9 ConÿleteONLYif direct

8 PURPOSEOF

EXPENDITURE

3 ACCOUNT # (Ethics Commission Filers)

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

Candidate / Officeh'ÿ'lder name

expenditure to benefit C/OH

(b) Description (If travel outside of Texas, complete Schedule T)

] Check ifAustin, TX, officeholder living expense

Office sought Office held

=;1;5. vo

PURPOSEOF

EXPENDITURE

Complete ONLY if directexpenditure to benefit C/OH

Paÿe=ÿe nameÿ

• qo .)nn nPayee address;

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

Candidate / Officeholder name

Description (Iftravel outsideofTexas, completeScheduleT)

[ÿ Check ifAustin, TX, officeholder living expense

Office sought Office held

Dat¶

Amount ($)

PURPOSEOF

EXPENDITURE

Complete ONLY if directexpenditure to benefit C/OH

Payee address; City; State; Zip Code

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

Candidate / Officeholdÿe ÿ'

Description (If travel outside of Texas, complete Schedule T)

]Check ifAustin, TX, officeholder living expense

Office sought Office held

Amount ($)

PURPOSEOF

EXPENDITURE

Complete ONLY if directexpenditure to benefit C/OH

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

Payee name

Payee addres S te; Zip-r7 2.

Description (If travel outside of Texas, complete Schedule T)

] Check ifAustin, TX, officeholder living expense

Office sought Office held

ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED

www.et hics. state.tx, us Revised 07/28/2014