l, ,.,,.:•, i rol · candidate / officeholder form c/ oh campaign finance report cover sheet pg 2...

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.)



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)



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)


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


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


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 ($)


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)


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


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


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


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


Complete ONLY if direct Candidate/ Officeholder nameexpenditure to benefit GOH Office soughtOffice held


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


8

PURPOSE a) Category ( See instructions for examples of acceptableb) Description ( See instructions regarding type of informationO F

required.)

EXPENDITURE

DatePayee name


PURPOSE Category ( See instructions for examples of acceptableO F

categories.) Description ( See instructions regarding type of

informationEXPENDITURErequired.)

DatePayee name


PURPOSE Category ( See Instructions for examples of acceptableO F categories.) Description ( See instructions regarding type of rnformatronEXPENDITURErequired.)

DatePayee name


PURPOSE Category ( See instructions for examples at acceptableOF

categories,) Description ( See instructions regarding type of informationEXPENDITURE

required.)


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



Purpose for which amount is receivedCheck if political contribution returned to filer

Date



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


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

l, ,.,,.:•, i rol · candidate / officeholder form c/ oh campaign finance report cover sheet pg 2...

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