Williamson Semi July 2016 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 FIRST MI
OFFICEHOLDER OFFICE USE ONLY
NAME IV 4 l liC-, if .
Date Received
NICKNAME LAST SUFFIX
RECEIVED
/2.A--)0 o y/ tA) 1 L L//=--at-fo,ilk ‘''°dir
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4 CANDIDATE/ ADDRESS /PO BOX; APT/SUITE#; CITY; STATE; ZIP CODE
OFFICEHOLDER
�‘ �-
I Change of Address OFFICE OF CITY SECRETARY
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER /
6 CAMPAIGN MS/ :i /MR FIRST MI Receipt# Amount $
TREASURER '41 k
NAME . Date Processed,
NICKNAME LAST SUFFIX
tl,1 co
Date Imaged
7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT/SUITE#; CITY; STATE; ZIP CODE
TREASURER
` �"
(Residence e ce or
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
9 REPORT TYPE
January 15 i 30th day before election Runoff 15th day after campaign
treasurer appointment
(Officeholder Only)
R/July 15 8th day before election Exceeded$500 limit Final Report(Attach C/OH-FR)
10 PERIOD Month Day Year Month Day Year
COVERED
/ f 6 7 /X 1.
( THROUGH
11 ELECTION ELECTION DATE ELEQTION TYPE
Month Day Year Primary Runoff ether
Description
/ / General Special
12 OFFICE OFFICE HELD (if any) 13 OFFICE SOUGHT (if known)
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cL,--1_,, c.,,,,,,,,,If p I b-e-e- V
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C/OH NAME �� /2-
k.� Y , `f.j r(����� 15 Filer ID (Ethics Commission Filers)
All /4`1`,/t7
16 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICAL SUPPORT THE CANDIDATE/OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S
COMMITTEE(S) KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENDITURES.
i• COMMITTEE TYPE COMMITTEE NAME
El GENERAL
COMMITTEE ADDRESS
El SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
6
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) (;)
EXPENDITURE 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
TOTALS $
UNLESS ITEMIZED 6
4. TOTAL POLITICAL EXPENDITURES $ 6
CONTRIBUTION
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY L L
BALANCE3
S I
OF REPORTING PERIOD
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE l4 76) - 60
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ (,
18 AFFIDAVIT
I 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.
ilf(4)
lorl Payne
1,11\;t:i!**.V. Notary Public,State of Texas A' Signature of Candidate or Officeholder
•' Ex ires 10-27-2017
;�,,�. +�''s Comm, p
F1 \'ST tO MA TOT E9 8 6 3win _
1 Sef'
Sworn to and subscribed before me, by the said R bo 1 ( Gt lam- a4 ,this the 2-I
day of k. 4L Ag., ,20 `(0 ,to certify which,witness y hand and seal of office.
.12diA.:p
Lof,-P ve_ e,t-ek cre
Signature of officer inistering oath Printed name of o icer administering oath Title o officer administerin oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015