Bledsoe Semi Jan 2016 CANDIDATE !OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 Filer ID(Ethics Commlaslon Filers) 2 Total pages filed,
The C/OH Instruction Guide explains how to complete this form. 2-
3
3 CANDIDATE/ MS 1 MAS C:y FIRST MI
OFFICEHOLDER OFFICE USE ONLY
NAME IJ r
Date Received
NICKNAME LAST SUFFIX RECEIVED
4 CANDIDATE/ ADDRESS /PO BOX; APT I SUITE#; CITY; STATE; ZIP 000E JAN
At Ji
OFFICEHOLDER 12 ) Z c d. Pc-/ , T/�, f JAN 1 5 2016
MAILING
ADDRESS :. k
❑ Change of Address
OFFICE OF CITY SECRE TARY
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER (8-1-7 77 Date Hand-delivered or Date Postmarked
PHONE
6 CAMPAIGN MS M 1 MR FIRST MI Receipt A Amount$
TREASURER \j fl/ha n fig
NAMEDate Processed
NICKNAME LAST SUFFIX
jo olsoe_ Date Imaged
7 CAMPAIGN STREET ADDREBS (NO PO BOX PLEASE); APT I BUTTE M CITY; STATE; ZIP CODE
TREASURER i Z /2- �c r�L, �r r,� Te, . !
ADDRESS
(Residence or Business)
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER /g1-7 1 � 7/`Ct�
PHONE l I
9 REPORT TYPE
January 1B ❑ 301h day before election ❑ Runoff I 51 day after campaign
treasurer appoinimeni
(Officeholder Only)
❑ July is Bih day before election Exceeded$sop limit Final Report(Attach C10H-FR)
10 PERIOD Monlh Day Year Month bay Year
COVERED 0 -71 o f / Z o j 5 THROUGH
11 ELECTION ELECTION(SATE ELECTION TYPE
Month Day Year ❑ Primary ❑ Runoff ❑ Other
Description
J / ❑ Ovneral ❑ Special
12 OFFICE OFFICE HELD (if any) 13 OFFICE souaw of known)
P, 73
GO TOPAGE 2
Forms provided by Texas Ethics Commission wwmethics.state.N.us Revised 9/812015
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C1OI-I NAME cJ I L B Ie, d y5 Flier!D (Ethics Commission F11ers)
16 NOTICE FROM THIS Box Is FOR NOTICE OF POLrr(OAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MAUI:BY POLITICAL COMMITTEES To
POLITICAL SUPPORT THE CANDIDATE/OFFICEHOLDER. THESE EXPENC)TURES MAY HAVE SEEN MADE WlrHOUr THE CANDIDATE'S OR OFFICEHOLDER'S
COMM ITTEE(S) KNOWLECOe OA CONSENr. CANDIDATES AND OFFICEHOLDERS ARE REOUMED TO REPORT THIS INFORMATION ONLY IF TKY RECEIVE NOTICE
OF SUCH EXPENDITURES.
COMMITTEE TYPE COMMITTEE NAME
1
❑GENERAL
_ COMMITTEE ADDRESS
E]SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
i
47 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF$50 OR LESS (OTHER THAN -
TOTALS PLEDGES,LOANS,OR GUARANTEES OF LOANS), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS $ ji 00
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
EXPENDITURE 3. TOTAL POLITICAL EXPENDITURES OF$100 OR LESS,
TOTALS UNLESS ITEMIZED $ �'00
4. TOTAL POLITICAL.EXPENDITURES $ �,oo
BALANCE CONTRIBUTION S. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY $ 0, 0(,"
OF REPORTING PERIOD
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD s
18 AFFIDAVIT
swear,or affirm,under penalty of perjury,that the accompanying report Is
true and correct and includes all Information required to be reported by me
-— � under Title 15,Election Code.
J�bSpNYPUB` SHANNON StateGILCHRIST
State
Notary Public. of Texas
My Commission Expires
•,n°F+�+t` July 26, 2016
Signature of Candidate or Officeholder
AFFIX NOTARY STAMP/SEALAS0VF �f( ,i �}
Sworn to and subscribed before me,by the said �t�!► 1�� � 1� (� this the ✓
day of ,20—W ,to certify which,witness my hand and seal of office.
Signature of offlcer administering oath Printed name of officer administering oath Title of officer administering oath
Farms provided by Texas Ethics Commission wwmethics,state.N.us Revised 8/8/2015