l, ,.,,.:•, i rol · candidate / officeholder form c/ oh campaign finance report cover sheet pg 2...
TRANSCRIPT
CANDIDATE / OFFICEHOLDER FORM C/ OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 Filer ID ( Ethics Commission Filers) 2 Total pages filed:The C/ OH Instruction Guide explains how to complete this form.
3 CANDIDATE/ MS! MRS/ MR FIRST MI
OFFICEHOLDERMit e Lic,( eff- A
OFFICE USE ONLY
NAMEc, l, ,.,,.:•, 1,,,,, a
NICKNAME LAST SUFFIXi 117,Date Filed / 0
Rol4 CANDIDATE/ ADDRESS ! PO BOX; APT/ SUITE#: CITY; , S ATE; ZIP CODE
OFFICEHOLDER1 q (9 ac Rix) Ril tr Dr, Ve-
MAILINGRebecca HuertaADDRESS
C t.r toN, S Ch r a si--i ) ry 7 (5, y/ 0 City Secretary1 i Change of Address
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER Date Hand- delivered or Date Postmarked
PHONE 361 ) Li q 3 - 9 i '736 CAMPAIGN • MS/ MRS I MR FIRST Receipt # Amount$
TREASURER nisrS' S IA ti LiNAME Date Processed
NICKNAME LAST SUFFIX
6 e Riese Date Imaged
7 CAMPAIGN STREET ADDRESS ( NO PO BOX PLEASE): APT/ SUITE ti• CITY: STATE: ZIP CODE
TREASURER
ADDRESS 1 Lki'a(? Rt4 Pluzi Clout ) & ric. 45 CArisk , -7- KResidence or Business)
7 a/ /
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
9 REPORT TYPEAJanuary 15 r 1 30th day before election 1- 1 Runoff I 1 15th day after campaign
treasurer appointment
Officeholder Only)
I I July 15 I I 8th day before election Exceeded$ 500 limit Final Report( Attach C/ OH- FR)
I10 PERIOD Month Day Year Month Day Year
COVERED
ra i I I / 1 g THROUGH 12 / 3/ - ') g
11 ELECTION ELECTION DATE ELECTION TYPE
Month Clay Year 1 I PrimaryI1 Runoff Other
Description
General I I Special
12 OFFICE OFFICE HELD ( if aryl 13 OFFICE SOUGHT ( if known)
Co‘ Af1 C1 1\IVR.Mbr
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics. state. tx. us SCANNED Revised 9/ 8/ 2015
CANDIDATE / OFFICEHOLDERFORM C/ OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
Eu14 C,/OH NAME
15 Filer ID ( Ethics Commission FelIqs)
tr e-ti11-
16 NOTICE rFROM iTHIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICALSUPPORT THE CANDIDATE/ OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE' S OR OFFICEHOLDER' S
COMM ITSKNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICEOF SUCH EXPENDITURES.
COMMITTEE. TYPE COMA, TITI EE is: AmL
GEN:• FY,
I COMMITTEE ADDP- EICSt-----• i
LT`•:,EIECIFIG
001•,'Ell 1 I Et- CAMPAI • ' CPEAS• IT, I• :,•“.11.-
I I A.. 1( WIGE•a; Paciesi
I COM'[ TCI C•'`. fTE' AIGE1 T REASIlEj-..P, AEDRESS
17 CONTRIBUTION1. TOTAL POLITICAL CONTRIBUTIONS OF 55r OR LESS ( OTHER THAN
521TOTALS PLEDGES. LOANS, OR GUARANTEES riT) LOANS), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS 00THEP, THAN PLEDGES, LOANS, OR .. LIARANTEES OF LOANS) 500
4EXPENDITURE
o. " I OTAL POLITICAL EXPENDITURES OF 100$ OR LESS. TOTALSCC)
UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES 5 / 73 , 61-CONTRIBUTION
5. TOTAL POLITICAL CONTRIBUTIONS MAINTHE LAST DAYTAINED AS OFBALANCE
LI fa D 9 .7 7OF REPORTING PERIOD
OUTSTANDING ' • b. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING' LOANS AS OF THELOAN TOTALS : LAST DAY OF THE REPORTING PERIOD 5
18 AFFIDAVIT
ieri;;;:P'
s MONIQUE TAMEfLERMAI swear. or affirm, under penalty of perjury, that the accompanying report is4
true and correct and includes all information required to bereported by mc114623 under Title 75, Election C•.-
4 kok: 41 */ Notary Publi4 '
1,..
1prowrtl,3•17 STATE OF j; •My COMM. Exp. 01- 23- 2021 0 Weir
Signature of Candidate or . ficeI older
AFFIX NOTARY STATIC SEALAE3GVE
Sworn' o and subscribed before me, by the saidL yeireik P.0 this the . 15-11---'
t
day of 20 I . to certify which. witness my hand and se of office.
I)
iv 7477--- tllovixTed akt,-- Lraka- klArP41Zig , atur2 o officer
actininisieri rj o, ti--AlApVtr, looted came of offgc.- adciiiliste! ii. g oat . Thtle. of officrr- ad linistering oath
c,": It` 7. p: OVit_iE, Oy Texas Eth' cs Ccrnm' s:,: iori www. ethics, state. tx. tis Revised 9/ 8/ 2015
SUBTOTALS - C/ OH FORM C/ OH
COVER SHEET PG 3
19 FILER NAME 20 Filer ID ( Ethics Commission Filers)
EA r 'i)C IA21 SCHEDULE SUBTOTALS SUBTOTAL
NAME OF SCHEDULE AMOUNT
1. [— I1CSCHEDULE Al: MONETARY POLITICAL CONTRIBUTIONS1____ J
1- 1
2. I SCHEDULE A2 NON- MONETARY( IN- KIND) POLITICAL CONTRIBLIHONS
3. [!!!!!!!!!!! 1 SCHEDULE B: PLEDGED CONTRIBUTIONS 0SCHEDULE E: LOANS
r------ 15. ! ! SCHEDULE Fl, POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS 5173. 6?-6. ;
F____,
25
I-I!'
I SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
H!---17.
SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBI Ii IONS
B. ! ! F4: EXPENDITURES MADE BY CREDIT CARDSCHEDULE1 $
SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
10• l I SCHEDULE H PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF CIOH $a
11. ! I SCHEDULE I: NON- POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS 1 $ 0SCHEDULE K, INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONSRETURNED TO FILER
iForms provided by Texas Ethics Comaussion wv,wethics. state. tx. us Revised 9/ 8/ 2015
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
The Instruction Guide explains how to complete this form. 1 Total pa/
0
Schedule Al:
2 FILER NAME 3 Filer ID Ethics CommissionFilers)
6.Pert17 / AV4 Date 5 Full name of contributor out. of- tate PAG ;! D; 7 Amount of contribution ($)
r l fig •SC( L s ssr
ao0
I 6 Contributor address; City; State; Zip Code
3-66) SJtorthi t a lvw, s4e a 2oo 9Conp0 17-pn0i
8 Principal occupation i Job title ( See Instructions) Tg Employer ( See Instructions)
Date Full name of contributor l out or , rate PAC di)#:• Amou of contribution ($)
Contributor address: City; State. Zip Code
Principal occupation ; Job title ( See Instructions) Er oyer ( See Instructions)
Date l Full name of contributor U out-, f- sl . PAC I05: IAmount of contribution ( 5)
Contributor address; City; State; Zip Code
Principal occupation 1 Job title ( See In. actions) Employer ( See Instructions)
Date FullFull na• e of contributorout- of- state PAC IDD Amount of contribution $)
Contributor address: City: State; Zip Code
Principal occupation Job title ( See Instructions) 1 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 918/ 2015
NON- MONETARY ( IN- KIND) POLITICAL
CONTRIBUTIONS SCHEDULE A2
T- 1 Total pages Fi( Theciule. A2:The Instruction Guide explains how to complete this form.
2 FILER NAME
Eu-tvei-1- 3 Filer ID ( Ethics Commission Filers
4 TOTAL OF UNITEMIZED IN- KIND POLITICAL CONTRIBUTIONS $
5 Date 6 Full name of contributor II out- ct• state PAC d011 8 Amount of 9 In- kind contributionContribution S description
7 Contributor address; City; State: Zip Code
if travel outside of Texas. Coiriple.te Schedule T.
10 Principal occupation 7 Job title ( FOR NON-JUDICIAL)( See Instructions) 11 Employer ( FOR NON- JUDICIAL 1( 550 Instructions)
12 Contributor' s principal occupation ( FOR JUDICIAL) 13 Contributor' s job title ( FOR JUDICIAL) rSee Ir structioos)
14 Contributor' s employer law firm ( FC) R 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 Hill name of contributor ] i• ot- stne PAC , 1!) 1' Amount of In kind cont( ibution
Contribution 5 description
Contributor address; City; State; Zip Code
Check it travel ottsiiie of Texas. -Complete Schbjole
Principal occupation / Job title ( FOR NON- JUDICIAL)( See Instructions) Employer FOR NON- JUDICIAL)( See Instructons)
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. LIS Revised 978/ 2015
PLEDGED CONTRIBUTIONS SCHEDULE B
1 Total pages Schedule B:The Instruction Guide explains how to complete this form.
2 FILER NAME3 Filer ID ( Ethics Commission Friers:
u-ere-ft /1 iezol4 TOTAL OF UNITEMIZED PLEDGES
0/1/
lJ' 11L
5 Date I 6 Full narne of pledger ! 1 out me PAC i.:; i 8 Amount 9 I, ekind contributionof Pledge $ description
7 Pledger address; City; State. Zip Code
i
Ci-ieck if crane! colo In of Texas. CoCompieto Schedule T.
10 Principal occupation Job title ( See Instructions) 11 Employer ( See Instructions)
DateFull name of pledger i offs- o
Amount In- kind contributionof Pledge $ description
Pledger address; City; State; Zip Code
i
Check if trarei outside of Te;,•as.1Complete Sci, edjie T.
Principal occupation Job title ( See Instructions) 1 Employer ( See Instructions)
Date, Full, tarns of pledger n_. i s ate PA( Ainoiint of In- kind contribution
Pledge $ description
Pledgor address; City: State: Zip Code
IL! Check it travel outs de of texts Complete SdiedUie I.
Principal occupation ; Job title ( See Instructions) Employer ( See Instructions)
Date Full name of pledger otn, o6- state eec, ( OP: Amount. cif Irn kind cor, h- ibu; ion
Pledge $ description
Pledger address; City; State; Zip Code
Ctre;; k if travel outside of Texas Compleite Schede T.
Principal OCC upation Job title ( See Instructions) Employer ( SeeInstructions)
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 SCHEDULE E
lThe Instruction Guide explains how to complete this form.
1 Totapages Schedule E
2 FILER NAME I 3 Filer ID ( Ethics CorErnssico
Evtft-ff4 TOTAL OF UNITEMIZED LOANS
A) o eif/
55 Date of loan 7 Name of lender out- of- s! ate PAC urn. 9 Loan Amount( 5)
6 Is lender 108 Leerndaddress; City; State: Zip CodeInterest rate
a financial
Institution?
11 Maturity dateY N
12 Principal occupation Job title ( Sec Instructions) I 13 Employer iSre Insti•tIctions)
14 Description of Collateral 115 Check if personal funds were deposited into political
account ( See Instructions)
none
16 GUARANTOR I 17 Name of guarantorI 19 Amount Guaranteed( 5)
INFORMATION
18 Guarantor address; City; State; Zip Code
not applicable
20 Principal Occupation , Seo Instructions) 21 Employer ( See Instructions)
Date of loan Name of lender H opt- of- state PAC( II: Pt: Loan Amount( 5)
Interest rateIs lender Lender address; City; State; Zip Codea financial
Institutton?
Maturity dateY N
Principal occupation ' Job title ( See Instructions Employer See Instructionsl
Description of CollateralI Check if personal funds were deposited into political
account ( See Instructions)
11 none
GUARANTOR 1 Name of guarantor Amount Guaranteed( Si
INFORMATION
1Guarantor address: City; State; Zip Code
j not applicable
Principal Occupation Son 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.
Forms provided by Texas Ethics Commission wmv.ethics. siate. ix. us Revised 9/ 8/ 2015
POLITICAL EXPENDITURES MADEFROM POLITICAL CONTRIBUTIONSSCHEDULE Fl
1-(9, ylizec?
EXPENDITURE CATEGORIES FOR BOX 8( a)
Advertising Expense Event Expense Loan RepaymerfERercnbursement Solicitation Fundraising ExpenseAccorrnrinaaanking Fees Office Overhead/ Rental Expense Transportation Equipment& Related ExpenseConsulting Expense FoodfBeverage Expanse Polling Expense Travel In DetectContributiorlsf' Donations Made By GifIrAwards/ rAemenals Expense Printir xp n Tavel Or; I Of Distt
Candidate, OffieeholdePPolitical Committee Legal Senirces SalarresMages. Contract Lat-doi Other( enter a categery rot listed aboveCredit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule C1: 12 FILER NAME 3 Filer ID ( Ethics Comimssion Filers)
krvel) i.t4 OfV4Z- 1±. Ry4 Date 15 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
T/f"1/ 248 a) Category s Categcrrier Idrted at the lop of tills senedrder ( b) Description
PURPOSE Check rl travel CqiiSide of Tercfc,. Complete: 3f: he: dere
OFAustm TX oftD. Trolder
EXPENDITURE
9 Complete ONLY if direct Candidate/ Officeholder name Office sought Office held
expenditure to benefit C. OH
Date Payee name
Amount ($) Payee address; City; Stale; Zip Code
Category dee Cateaciies lisded at the top Iiiis scrfcdclif Description
PURPOSE Crock rf lravel eutsde cf Texas Complete Schcfo, re
OFcheck i 4t1;: t1,,. IX, oitic. ei. oj! Jer
EXPENDITURE
Complete ONLY if direct Candidate Officeholder name Office sought Office held
expenditure to benefit DOH
Date 1 Payee name
Amount ($ 1 1 Payee address; City; State; Zip Code
Category iSee Categorres listed at Plc top c rSo r-, cffedgler Description
PURPOSE L._. 1 Check if tfavol outsde. of Static. CoropkfleScheduieT
OFcm. N: k if Stalin, TX. Dfrcenolddr rld, ng expanse
EXPENDITURE
Complete ONLY if direct Candidate Officeholder name Cfflice seurpt Office held
expenditure to benefit DOH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics. state. tx. us Revised 918/ 2015
FINAL JANUARY 15 2019 EVERETT ROY CAMPAIGN
VENDER EXPENSES ( Schedule F)
Expenses Amount Date Category/ Purpose AddressMilestone Collaborative $ 2500. 00 12/ 21/ 18 Camp Exp- Advertising, Marketing, 3522 S. Alameda St, C. 0, TX 78411
Svc ( MCS) Design
Chris Scott 250. 00 12/ 29/ 18 Camp Signs Pick up 338 Bermuda PI, Corpus Christi, T X
78333
Look now media 1375. 00 12/ 24/ 18 Camp Exp- Writer, Editor 3522 S. Alameda St, C. C, TX 78411Texas Al 406. 33 12/ 18/ 18 Election Runoff gathering 14241 Northwest Blvd, CC, TX 78412Grunwald Printing 647. 34 12/ 20/ 18 Marketing runoff 1418 Morgan Ave, CC, TX 7804
TOTAL EXPENSES 5178. 67
UNPAID INCURRED OBLIGATIONS SCHEDULE F2
EXPENDITURE CATEGORIES FOR BOX 10( a)
Advertising Expense Event Expense Loan Repayment. Reimbur se: ment Solicitation: Fundraising ExpenseAccounting,; Banking Fees Office Overhead/ Rental Expense Transportation Equipment& Related ExpenseConsulting Expense Food/ Beverage Expense Polling Expense Travel In DistrictConlributions/ Donations Made By Ii it Awai ds- Mernoi cls Expense Printing Expense Travel Out Of District
Candidate Otficeholder PcPolitical Committee Legal Services Salaries vNrig=. Contract Labor Other( enter a categoiy not littted above,
The Instruction Guide explains how to complete this form.
1 Total pages Schedule 52: 2 FILER N MEnn 3 Filer ID ( Ethics Comm ssiu, Filers)
of e-
4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATI NS nv m e5 Date 6 Payee name
7 Amount ($) 8 Payee address; City; State: Zip Code
I------
TYPE OF
EXPENDITURE Political Non- Political
10 a) Category ; See Categar e, listed a. Pip top of this__ F,;,: a. b) Description
PURPOSE
OF
EXPENDITURE Orreck IFa.. is Tr l. c ooi( t- ex;
I I
11 Complete ONLY if direct Candidate 1 Officeholder name Office sought Office heldexpenditure to benefit C- OH
Date Payee name
Amount ($) Payee address; City: State; Zip Code
TYPE OF
EXPENDITURE Political Nor- Political
Cate or asee Catepor; l: si cd at Descriptiong y e top of gni a... dcrc P
PURPOSEr i tra. tt tsrae ciT xr . 6loi chetii- r.
OFAii r i . fi ,. older hsingG. > e
EXPENDITURE
Complete ONLY if direct Candidate : Officeholder name Office sought Office held
expenditure to be: Tetit 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 MADEFROM POLITICAL CONTRIBUTIONS SCHEDULE F3
1 Total paafs Schedule F3:
r1The Instruction Guide explains how to complete this form.
CAn2 FILER NAME 3 Filer ID ( Ethics Commissior File s'
eV.._vvt- H--- Roy14 Date 5 Name of person from whom investment is purchased
1 6 Address of person from whom investment is purchased; City; State: Zip Code
7 Description of investment
8 Amount of investment ($)
Date Name of person from whom investment is purchased
Address of person from whom investment is purchased: City: Stat}e:. Zip Code
Description of investment
Amount of investment ($)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www. ethics. state tx. us Revised 9.8. 2015
EXPENDITURES MADE BY CREDIT CARDSCHEDULE F4
EXPENDITURE CATEGORIES FOR BOX 10( a)Advertising ExpenseAccounting/ Banking Event Expense
Fees Loan Repayment/ ReimbursementSolicitation/ Fundraising ExpenseConsulting Expense
Food/ Beverage Expense Office Overhead/ Rental ExpenseContributions/ Donations Made By Polling Expense Transportation Equipment 8 Related ExpenseCandidate/ Officeholder/ Political CommitteeifVAwards/ Memorials Expense Travel In District
G
Legal Services Printing ExpenseTravel Out Of DistrictSalaries/VVages/ Contract Labor
Other( enter a category not listed above)The Instruction Guide explains how to complete this form.1 Total pages Schedule Fa:
I
tQFILER NAME
3 Filer ID ( Ethics Commission Filers))0 a Cu
4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TO A C• EDIT CARD5 Date
6 Payee nameUi)
7 Amount ($) 8 Payee address; City; State; Zip Code
9TYPE OF
EXPENDITURE 1 Political 1 I Non- Political10
a)
Cate or9 y ( See Categories listed at the lop of this schedule)b) DescriptionPURPOSE
EXPENDITUREOF
Check if travel outside of Texas. Complete Schedule T.
Check if Austin, TX, officeholder living expense
11 Complete ONLY if directCandidate / Officeholder nameexpenditure to benefit C/ OH Office sought
Office held
DatePayee name
Amount ($) Payee address; City: State; Zip Code
TYPE OFEXPENDITURE I I Political CJl Non- Political
Category ( See Categories listed at the top of this schedule)PURPOSE Description
O F E Check if travel outside of Texas. Complete Schedule TEXPENDITURE
LiCheckif Austin, TX, officeholder living expense
Complete ONLY if directCandidate / Officeholder nameexpenditure to benefit C/ OH Office sought
Office held
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDForms provided by Texas Ethics Commissionwww. ethig6tate. tx. u5
Revised 9/ 8/ 2015
POLITICAL EXPENDITURESMADE FROM PERSONAL FUNDS SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8( a)Advertising ExpenseAccounting/ Banking
Event Expense
Loan Repayment/ ReimbursementConsultingFeesSolicits
Transportation
quisingExpenseExpense
Food/ Beverage Expense Office Overhead/ Rental ExpenseContributions/ Donations Made By Polling Expense Transportation Equipment& Related ExpenseCandidate/ Officeholder/ Political CommitteeGift/ Awards/ Memorials Expense Travel In DistrictLegal Services Printing Expense
Credit
Cadid
Payment Salaries// ages/ Contract Labor Other( enter a
District
The Instruction Guide explains how to complete this form.Otner( enteracategorynoUistedabove)
1 Total pages Schedule G: 2 FILER NAMEOt1 z. A Re. 3 Filer ID ( Ethics Commission Filers)
4 Date5 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
0pi) Reimbursement from
political contributionsintended
a) Category ( See Categories listed at the top of this schedule) ( b) DescriptionPURPOSEOF
EXPENDITURE Check if travel outside of Texas. Complete Schedule T.0 Check if Austin, TX, officeholder living expense9 Complete ONLY if direct
Candidate / Officeholder nameexpenditure to benefit C/ OH Office soughtOffice held
DatePayee name
Amount ($) Payee address; City; State; Zip Code
riReimbursement frompolitical contributionsintended
Category ( See Categories listed at the top ClIhis schedulePURPOSE bJ DescriptionOF
EXPENDITURE I I Check if travel outside of Texas Complete Schedule ILJ Check it Austin, TX, officeholder living expenseComplete ONLY if direct
Candidate/ Officeholder nameexpenditure to benefit GOH Office soughtOffice held
DatePayee name
Amount ($) Payee address; City; State; Zip Code
efromIpoliticalReimbursemcontributionsintended
PURPOSE Category ( See Categories listed at the toe of this schedule) ( b) DescriptionOF
I II Check it travel outside of Texas. Complete Schedule TEXPENDITURE
i____]Check if Austin, TX, officeholder living expenseComplete CNLY if direct
Candidate/ Officeholder nameexpenditure to benefit C/OH Office soughtOffice held
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDForms provided by Texas Ethics Commission
www. ethiS htate. tx. usRevised 9/ 8/ 2015
PAYMENT MADE FROM POLITICALCONTRIBUTIONS TO A BUSINESS OF C/ OH SCHEDULE H
EXPENDITURE CATEGORIES FOR BOX 8( a)Advertising ExpenseAccounting/ Banking
Event ExpenseLoan Repayment/ ReimbursementFees
Solicitation/ FundraisingConsulting ExpenseFood/ Beverage Expense Office Overhead/ Rental Expense9 ExpenseContributions/ Donations Made
ByPollingExpenses Transportation Equipment 8 Related ExpenseGift/ Awards/ Memorials ExpenseTravel In DistrictPe seCandidate/Officeholder/ Political Committee Legal Printing Expense
CCaitdidaPaymec( ga Services
Salaries/ VVages/ Contract Labor Other( enter a
District
The Instruction Guide explains how to complete this form.Other( enteracategorynotlistedabove)
1 Total pa. es Schedule H: 2 FILER NAMEU/LULre
f 3 Filer ID ( Ethics Commission Filers)ti-6(` J f yl4 Date 5 Business name
V
6 Amount ($) 7 Business address; City; State; Zip Code
v8
a) Categoryg y ( See Categories listed at the top of this schedule) ( b) DescriptionPURPOSE
O F HCheckif travel outside of Texas Complete Schedule TEXPENDITURE
I
C] Check if Austin, TX, officeholder living expense9 Complete ONLY if direct Candidate/ Officeholder nameexpenditure to benefit GOH Office sought
Office held
DateBusiness name
Amount ($) Business address; City; State; Zip Code
Category ( See Categories listed at the top of This schedule) DescriptionPURPOSE
O nF El Check tt travel outside of Texas. Complete Schedule TEXPENDITURE
Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder nameexpenditure to benefit C../OHOffice sought
Office held
DateBusiness name
Amount ($) Business address; City; State; Zip Code
Category ( See Categories listed at the top of this schedule)DescriptionPURPOSE
OF I I Check if travel outside of Texas. Complete Schedule T.EXPENDITURE I I
Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate/ Officeholder nameexpenditure to benefit GOH Office soughtOffice held
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDForms provided by Texas Ethics Commission
www. ethi88tate. tx. usRevised 9/ 8/ 2015
NON- POLITICAL EXPENDITURESMADE FROM POLITICAL CONTRIBUTIONS SCHEDULE
The Instruction Guide explainstom otxrplete this form
1 Total pages Schedule I: 2 FILER NAME
x) C( t. ^
3 Filer ID ( Ethics Commission Filers)H
4 Date5 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
8
PURPOSE a) Category ( See instructions for examples of acceptableb) Description ( See instructions regarding type of informationO F
required.)
EXPENDITURE
DatePayee name
Amount ($) Payee address; City; State; Zip Code
PURPOSE Category ( See instructions for examples of acceptableO F
categories.) Description ( See instructions regarding type of
informationEXPENDITURErequired.)
DatePayee name
Amount ($) Payee address; City; State; Zip Code
PURPOSE Category ( See Instructions for examples of acceptableO F categories.) Description ( See instructions regarding type of rnformatronEXPENDITURErequired.)
DatePayee name
Amount ($) Payee address; City; State; Zip Code
PURPOSE Category ( See instructions for examples at acceptableOF
categories,) Description ( See instructions regarding type of informationEXPENDITURE
required.)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDForms provided by Texas Ethics Commission
www. ethiaQtate. tx. usRevised 9/ 8/ 2015
INTEREST, CREDITS, GAINS, REFUNDS, ANDCONTRIBUTIONS RETURNED TO FILER SCHEDULE K
The Instruction Guide explains how to complete this form 1 oral pages Schedule K:
2 FILER NAME
Ee-ett 3 Filer ID ( Ethics Commission Filers)
4 Date
5 Name of person from whom amount is received8 Amount ($)
6 Address of person from whom amount is received; City; Slate; Zip Code
7 Purpose for which amount is receivedCheck if political contribution returned to filer
Date
Name of person from whom amount is receivedAmount ($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is receivedLi Check if political contribution returned to filer
Date
Name of person from whom amount is receivedAmount ($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is receivedCheck if political contribution returned to filer
Date
Name of person from whom amount is receivedAmount ($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is receivedE Check if political contribution returned to filer
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDForms provided by Texas Ethics Commission
www. ethi9Otate. tx. usRevised 9/ 8/ 2015
IN- KIND CONTRIBUTIONS OR POLITICAL EXPENDITURESFOR TRAVEL OUTSIDE OF TEXASSCHEDULE T
The Instruction ( abide explains how to complete this form 1 Total pages Schedule T: \ J0l ) e2 FILER NAME
3 Filer ID ( Ethics Commission Filers)4 Name of Contributor/ Corporation or Labor Organization/// ledgor/ Payee
5 Contribution/ Expenditure reported on:LJ Schedule A2 Schedule B
Schedule B J Schedule C2 Schedule DSchedule F2 Schedule F4 Sch
Schedule F1edule G Schedule H
Schedule COH- UC Schedule 8- SS6 Dates of travel
7 Name of person( s) traveling
8 Departure city or name ofd location
9 Destination city or name of destination location10 Means of transportation
11 Purpose of travel( including name of conference, seminar, or other event)
Name of Contributor/ Corporation or Labor Organization/ Pledgor/ PayeeContribution Expenditure reported on:
Schedule A2 Schedule B Schedule B( J)( ) Schedule C2 Schedule D Schedule F1Schedule F2 Schedule F4 El Schedule G Schedule H
Schedule COH- UCDates of travel
Name of person( s) traveling Schedule 8- SS
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/ PayeeContribution/ Expenditure reported on:
Schedule A2 Schedule B Schedule B J Schedule C2 Schedule DSchedule F2 El Schedule F1Schedule F4 Schedule G Schedule H
Schedule COH- UC Schedule 8- SSDates of travelName of person( s) traveling
Departure city or name of departure location
Destination city or name of destination locationMeans of transportation
Purpose of travel( including name of conference, seminar, or other event)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDForms provided by Texas Ethics Commissionwww. ethieltate. tx. us
Revised 9/ 8/ 2015
CANDIDATE / OFFICEHOLDER REPORT:DESIGNATION OF FINAL REPORT
FORM C/ OH - FR
The Instruction Guide explains how to complete this form.Complete only if " Report Type" on page 1 is marked " Final Report" ••
1 C/ OH NAME
O 1CCC1 2 Filer ID ( Ethics Commission Filers)
3 SIGNATURE
jr'(` IJ
I do not expect any further political contributions or political expenditures in connection with my candidacy. I understand that designat-ing a report as a final report terminates my campaign treasurer appointment. I also understand that I may not accept any campaigncontributions or make any campaign expenditures without a campaign treasurer appointment on file.
Signature of Candidate/ 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 do not have unexpended contributions or unexpended interest or income earned from political contributions.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 do not retain assets purchased with political contributions or interest or other income from political contributions.r )
I do retain assets purchased with political contributions or interest or other income from political contributions. I understandthat I may not convert assets purchased with political contributions or interest or other income from political contributions topersonal use. I also understand that I must dispose of assets purchased with political contributions in accordance with therequirements of Election Code, § 254. 204.
Signature of Candidate
5 OFFICEHOLDER
Complete this section only if you are an officeholder ••n
I am aware that I remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer onfile. I am also aware that I will be required to file reports of unexpended contributions if, after filing the last required report as anofficeholder, I retain political contributions, interest or other income from political contributions, or assets purchased with politi-cal contributions or interest or other income from political contributions.
Signature f OfficeholderForms provided by Texas Ethics Commission
www. ethie2tate. tx. usRevised 9/ 8/ 2015