CANDIDATE I OFFICEHOLDER
CAMPAIGN FINANCE REPORT
FORM C/OH
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 I
OFFICEHOLDER
NAME
OFFICEHOLDER
MAILING
ADDRESS
o
Change of Address
5 CANDIDATE!
OFFICEHOLDER
PHONE
6 CAMPAIGN
TREASURER
NAME
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4 CANDIDATE I
MI
( ) FIRST
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ADDRESS I PO BOX: .('yJ>T I SUITE #;
STATE;
CITY;
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(~)QlV\ Wv-aJL1.o 'T,{
PHON~)UMBER AREA CODE
(3~_5)
Date Hand-delivered or Date Postmarked
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MI
LAST SUFFIX
STREET ADDRESS (NO PO BOX PLEASE);
A mount $
Date Processed
Date Imaged
If) DCaJJ.J
7 CAMPAIGN
TREASURER
ADDRESS
I
Receipt #
FIRST ::]6'
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NICKNAME
/(~ 1-11-1(p
ZIP CODE
EXTENSION
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MSIMRSIMR
Date Received
SUFFIX
Ku\J\cLS
LAST
OFFICE USE ONLY
APT I SUITE #;
STATE;
CITY;
ZIP CODE
(Residence or Business)
8 CAMPAIGN
TREASURER
PHONE
9 REPORT TYPE
(~ )
~my15
0
30th day before election
0
0
8th day before election
July 15
10 PERIOD
COVERED
Month
Day
/ 01
DI
Month
Day
/ D.D\lp Year
~ /01 /(~"
OFFICE HELD (if any)
0
Runoff
0
15th day after campaign treasurer appointment (Officeholder Only) Exceeded $500 limit
0
Final Report (Attach CIOH - FR)
Month
Year ELECTION DATE
11 ELECTION
12 OFFICE
EXTENSION
PHONE NUMBER AREA CODE
General
/DI
Year
/ ~DI~
ELECTION TYPE
~
o
b1
THROUGH
Day
Runoff
0
o
Other
Description
SpeCial
13
OFFICE SOUGHT
(~
known)
GO TO PAGE 2
Forms provided by Texas Ethics Commission
www.ethlcs.state.tx.us ReVised 02/27/2015
CANDIDATE I OFFICEHOLDER
CAMPAIGN FINANCE REPORT
FORM C/OH
COVER SHEET PG 2
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14 C/OH NAME
15 Filer ID (Ethics Commission Filers)
THIS BO~ ~~R NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
SUPPORT ECANDIDATE 1 OFFICEHOLDER. THESE EXPENDITURES IIfAY HAVE BEEN IIfADE W"HOUT THE CANDIDATE'S OR OFFICEHOLDER'S
KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENDITURES.
16 NOTICE FROM
POLITICAL
COMMITTEE(S)
COMMITTEE NAME
COMMITTEE TYPE
DGENERAL
COMMITTEE ADDRESS
DSPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
0
Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
TOTALS
1.
TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
2.
TOTAL POLITICAL CONTRIBUTIONS
$
$
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
· .....
· .
EXPENDITURE
TOTALS
· . . .
·
. .
TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
UNLESS ITEMIZED
$
4.
TOTAL POLITICAL EXPENDITURES
$
5.
TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
OF REPORTING PERIOD
$
6.
TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LAST DAY OF THE REPORTING PERIOD
$
......
CONTRIBUTION
BALANCE
·
3.
. · ..
-e-e­
-e...e­
.-B­
...
OUTSTANDING
LOAN TOTALS
~-
18 AFFIDAVIT
I swear, or affinm, under penalty of perjury, that the accompanying report is
true and correct and indudes all information required to be reported by me
under Title 15, Election Code.
I~,FRANCESL.AEED
N
*'." \',~
otary Public
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Of
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STATE OF TEXAS
My Camm,
1
Exp. 02-07-2018
-
Sig natu(3" of Candidate or Officeholder
AFFIX NOTARY STAMP I SEALABOVE
Sworn to and subscribed before me, by the said
day
of:SM!:iNL~
,20
I (c
~)LMlCM;I ~d
Signature of officer administering oath
Forms provided by Texas EthiCS Commission
1Jec~~ ~Qble~
,this the
JO-lJl
, to certify which, witness my hand and seal of office.
KOt1Ce7
~. ~eed
Printed name of officer administering oath
www.ethlcs.state.tx.us
uJf)"-Q~
Title of officer administering oath
ReVised 02/27/2015