Muller 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/ CPMRS/MR FIRST MI
OFFICEHOLDER OFFICE USE ONLY
NAMEt2/QA.
�� Date Received
NICKNAME LAST SUFFIX
fitio4 44_4 RECEIVEL)
4 CANDIDATE/ ADDRESS /PO BOX; APT/SUITE#; CITY; STATE; ZIP CODE
OFFICEHOLDER
MAILINGSG - 71 3 6 2 JUL ? 3 20
6
ADDRESS 2/ 4' W7Wc'"l 10 I?
•
I I Change of Address
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION OFFICE OF CITY SECRETARY
OFFICEHOLDER Date Hand-delivered or Date Postmarked
��.PHONE 7 / Yg.a -XI,/
6 CAMPAIGN MS/MRS/MR FIRST MI Receipt# Amount$
TREASURER fia-idafri
NAME Date Processed
NICKNAME LAST SUFFIX
Cie41C i Date Imaged
7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT/SUITE#; CITY; STATE; ZIP CODE
TREASURER
ADDRESS
' (Residence or Business) y alGk. Ph 44 A-R-6/6 IA)"t 7Y L'' 2-4 2
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER (9/7 ) ci ? o vL/ 4/
PHONE
9 REPORT TYPE
I January 15 30th day before election I I Runoff I I 15th day after campaign
treasurer appointment
(Officeholder Only)
IV July 15 I I 8th day before election I Exceeded$500 limit I I Final Report(Attach C/OH-FR)
10 PERIOD Month Day Year Month Day Year
COVERED
6/ / / 5 /0,2,0//C� THROUGH 4 7 / /.- / 241 4
11 ELECTION ELECTION DATE ELECTION TYPE
Month Day Year I Primary I I Runoff I Other
Description
4%5-/d 7 /2d`_c" . 21.General Special
12 OFFICE OFFICE HELD (if any) 13 OFFICE SOUGHT (if known)
,Setivi.4C.,7 y C o?JA/c, .e__
?)49-c4- 2-
,, ,
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
a
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C/OH NAME 15 Filer ID (Ethics Commission Filers)
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.
COMMITTEE TYPE COMMITTEE NAME
❑GENERAL
COMMITTEE ADDRESS
Ei SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
I 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 $
,—.-__
2. TOTAL POLITICAL CONTRIBUTIONS
$
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) ..,_.---
EXPENDITURE 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
TOTALS UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES $
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE OF REPORTING PERIOD ..,.......--
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ .......„--
18 AFFIDAVIT
I swear,or affirm,under penalty of perjury,that the accompanying report is
r i �`' true and correct and includes all information required to be reported by me
LW , TtCCI �!!Nll�d�r�l4tn under Title 15,Election Code.
. Notary Public,State of TeasComm..Expires 09-03.2017
;; Notary ID 125381736 ....r\i,/,..- C'"i
�__ 5 )Q-Q,t,1‘)
Signature of Candidate or iceholder
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me, bythe said i4YQ,-i� A- A �� this the,
day of v►. ,20 ( ( ,to certify which,witness my hand and seal of office.
4:::: .4.A.: ... ' ' . • , -
-Ak. a ► ' r
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
s
SUBTOTALS — C/OH FORM C/OH
COVER SHEET PG 3
19 FILER NAME 20 Filer ID(Ethics Commission Filers)
21 SCHEDULE SUBTOTALS SUBTOTAL
NAME OF SCHEDULE AMOUNT
1. SCHEDULE A1: MONETARY POLITICAL CONTRIBUTIONS $
2. SCHEDULE A2: NON-MONETARY(IN-KIND)POLITICAL CONTRIBUTIONS $
3. SCHEDULE B: PLEDGED CONTRIBUTIONS $
4. SCHEDULE E: LOANS $
5. SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $
6. SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $
7• SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $
8. SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $
9• SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS $
10. SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $
11.
SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $
12 SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS,AND CONTRIBUTIONS $
RETURNED TO FILER
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
1
The Instruction Guide explains how to complete this form. Total pages Schedule Al:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Full name of contributor ❑out-of-state PAC(ID#: ) 7 Amount of contribution ($)
6 Contributor address; City; State; Zip Code
8 Principal occupation/Job title (See Instructions) 9 Employer (See Instructions)
Date Full name of contributor ❑out-of-state PAC(ID#: ) Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation/Job title(See Instructions) Employer (See Instructions)
Date Full name of contributor ❑out-of-state PAC(ID#: ) Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation/Job title(See Instructions) Employer (See Instructions)
Date Full name of contributor ❑out-of-state PAC(ID#: ) Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation/Job title(See Instructions) 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 9/8/2015
NON-MONETARY (IN-KIND) POLITICAL
CONTRIBUTIONS SCHEDULE A2
The Instruction Guide explains how to complete this form. 1 Total pages Schedule A2:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED IN-KIND POLITICAL CONTRIBUTIONS
5 Date 6 Full name of contributor ❑out-of-state PAC(ID#: ) 8 Amount of . 9 In-kind contribution
Contribution $ . description
7 Contributor address; City; State; Zip Code •
Check if travel outside of Texas.Complete Schedule T.
10 Principal occupation/Job title (FOR NON-JUDICIAL)(See Instructions) 11 Employer (FOR NON-JUDICIAL)(See Instructions)
12 Contributor's principal occupation (FOR JUDICIAL) 13 Contributor's job title (FOR JUDICIAL)(See Instructions)
14 Contributor's employer/law firm (FOR 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 Full name of contributor ❑out-of-state PAC(ID#: ) Amount of In-kind contribution
Contribution $ . description
Contributor address; City; State; Zip Code •
Check if travel outside of Texas.Complete Schedule T.
Principal occupation/Job title (FOR NON-JUDICIAL)(See Instructions) Employer (FOR NON-JUDICIAL)(See Instructions)
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.us Revised 9/8/2015
a
PLEDGED CONTRIBUTIONS SCHEDULE B
1 Total pages Schedule B:
The Instruction Guide explains how to complete this form.
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED PLEDGES
5 Date 6 Full name of pledgor ❑ out-of-state PAC(ID#: ) 8 Amount . 9 In-kind contribution
of Pledge$ description
7 Pledgor address; City; State; Zip Code .
Check if travel outside of Texas.Complete Schedule T.
10 Principal occupation/Job title (See Instructions) 11 Employer (See Instructions)
DateFull name of pledgor El out-of-state PAC(ID#: ) Amount • In-kind contribution
of Pledge$ • description
Pledgor address; City; State; Zip Code •
•
Check if travel outside of Texas.Complete Schedule T.
Principal occupation/Job title(See Instructions) Employer (See Instructions)
DateFull name of pledgor ❑out-of-state PAC(ID#: ) Amount of In-kind contribution
Pledge$ • description
Pledgor address; City; State; Zip Code
•
•
Check if travel outside of Texas.Complete Schedule T.
Principal occupation/Job title (See Instructions) Employer (See Instructions)
Date Full name of pledgor ❑out-of-state PAC(ID#: ) Amount of In-kind contribution
Pledge$ 1 description
Pledgor address; City; State; Zip Code
•
Check if travel outside of Texas.Complete Schedule T.
Principal occupation/Job title(See Instructions) 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 9/8/2015
LOANS SCHEDULE E
The Instruction Guide explains how to complete this form. 1 Total pages Schedule E:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED LOANS $
5 Date of loan 7 Name of lender ❑out-of-state PAC(ID#: ) 9 Loan Amount($)
6 Is lender10 Interest rate
8 Lender address; City; State; Zip Code
a financial
Institution?
11 Maturity date
Y N
12 Principal occupation /Job title (See Instructions) 13 Employer (See Instructions)
14 Description of Collateral 15 Check if personal funds were deposited into political
account (See Instructions)
❑ none ❑
16 GUARANTOR 17 Name of guarantor 19 Amount Guaranteed($)
INFORMATION
18 Guarantor address; City; State; Zip Code
❑ not applicable
20 Principal Occupation (See Instructions) 21 Employer (See Instructions)
Date of loan Name of lender ❑out-of-state PAC(ID#: ) Loan Amount($)
Is lender Lender address; City; State; Zip Code Interest rate
a financial
Institution?
Maturity date
Y N
Principal occupation /Job title (See Instructions) Employer (See Instructions)
Description of Collateral Check if personal funds were deposited into political
account (See Instructions)
❑ none ❑
GUARANTOR Name of guarantor Amount Guaranteed($)
INFORMATION
Guarantor address; City; State; Zip Code
❑ not applicable
Principal Occupation (See 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 www.ethics.state.tx.us Revised 9/8/2015
POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE Fl
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
8 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE Check if travel outside of Texas.Complete Schedule T.
OF I Check if Austin, TX,officeholder living expense
EXPENDITURE
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE Check if travel outside of Texas.Complete Schedule T.
OF I Check if Austin,TX,officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE I 1 Check if travel outside of Texas.Complete Schedule T
OF I Check if Austin,TX,officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit 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
UNPAID INCURRED OBLIGATIONS SCHEDULE F2
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other(enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F2: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UN ITEM IZED UNPAID INCURRED OBLIGATIONS $
5 Date 6 Payee name
7 Amount ($) 8 Payee address; City; State; Zip Code
9 TYPE OF
EXPENDITURE Political Non-Political
10 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE I Check if travel outside of Texas.Complete Schedule T.
OF
EXPENDITURE I Check if Austin,TX,officeholder living expense
11 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE Political Non-Political
Category (See Categories listed at the top of this schedule) Description
PURPOSE I Check if travel outside of Texas.Complete Schedule T.
OF I !Check if Austin,TX,officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit 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 MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F3
1 Total pages Schedule F3:
The Instruction Guide explains how to complete this form.
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Name of person from whom investment is purchased
6 Address of person from whom investment is purchased; City; State; Zip Code
7 Description of investment
8 Amount of investment($)
Date Name of person from whom investment is purchased
Address of person from whom investment is purchased; City; State; Zip Code
Description of investment
Amount of investment($)
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 CARD
SCHEDULE F4
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SalariesNVages/Contract Labor Other(enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F4: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TOACREDITCARD $
5 Date 6 Payee name
7 Amount ($) 8 Payee address; City; State; Zip Code
9 TYPE OF
EXPENDITURE Political Non-Political
10 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE I Check if travel outside of Texas.Complete Schedule T.
OF
EXPENDITURE I Check if Austin,TX,officeholder living expense
11 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE Political Non-Political
Category (See Categories listed at the top of this schedule) Description
PURPOSE I I Check if travel outside of Texas.Complete Schedule T.
OF I Check if Austin,TX,officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit 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
POLITICAL EXPENDITURES
SO
MADE FROM PERSONAL FUNDS SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
8 (a)Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE I Check if Austin,TX,officeholder living expense
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE I Check if Austin,TX,officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE I Check if Austin,TX,officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
PAYMENT MADE FROM POLITICAL
CONTRIBUTIONS TO A BUSINESS OF C/OH SCHEDULE H
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Business name
6 Amount ($) 7 Business address; City; State; Zip Code
8 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE I I Check if travel outside of Texas.Complete Schedule T.
OF
EXPENDITURE I Check if Austin,TX, officeholder living expense
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Business name
Amount ($) Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE Check if travel outside of Texas.Complete Schedule T.
OF
EXPENDITURE I I Check if Austin,TX,officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Business name
Amount ($) Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE I Check if travel outside of Texas.Complete Schedule T.
OF I Check if Austin,TX,officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit 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
.
NON-POLITICAL EXPENDITURES
MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE
The Instruction Guide explains how to complete this form.
1 Total pages Schedule I: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
8 (a)Category (See instructions for examples of acceptable (b)Description (See instructions regarding type of information
PURPOSE categories.) required.)
OF
EXPENDITURE
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Category (See instructions for examples of acceptable Description (See instructions regarding type of information
PURPOSE categories.) required.)
OF
EXPENDITURE
Date Payee name
Amount ($) Payee address; City; State; Zip Code
PURPOSE Category (See instructions for examples of acceptable Description (See instructions regarding type of information
OF categories.) required.)
EXPENDITURE
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Category (See instructions for examples of acceptable Description (See instructions regarding type of information
PURPOSE categories.) required.)
OF
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER SCHEDULE K
1
The Instruction Guide explains how to complete this form. Total pages Schedule K:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Name of person from whom amount is received 8 Amount($)
6 Address of person from whom amount is received; City; State; Zip Code
7 Purpose for which amount is received I Check if political contribution returned to filer
Date Name of person from whom amount is received
Amount($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received I Check if political contribution returned to filer
Date Name of person from whom amount is received Amount ($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received I Check if political contribution returned to filer
Date Name of person from whom amount is received Amount ($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received I 1 Check if political contribution returned to filer
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
.
IN-KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES
FOR TRAVEL OUTSIDE OF TEXAS SCHEDULE T
The Instruction Guide explains how to complete this form. 1 Total pages Schedule T:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Name of Contributor/Corporation or Labor Organization/Pledgor/Payee
5 Contribution/Expenditure reported on:
LI Schedule A2 Li Schedule B LI Schedule B(J) LI]Schedule C2 Li Schedule D Li Schedule Fl
LII Schedule F2 Li Schedule F4 LI Schedule G Li Schedule H Li Schedule COH-UC Li Schedule B-SS
6 Dates of travel 7 Name of person(s)traveling
8 Departure city or name of departure location
9 Destination city or name of destination location
10 Means of transportation 11 Purpose of travel(including name of conference,seminar,or other event)
Name of Contributor/Corporation or Labor Organization/Pledgor/Payee
Contribution/Expenditure reported on:
Li Schedule A2 Li Schedule B Li Schedule B(J) Li Schedule C2 Li Schedule D Li Schedule Fl
Li Schedule F2 Li Schedule F4 Li Schedule G Li Schedule H Li Schedule COH-UC Li Schedule B-SS
Dates of travel Name of person(s)traveling
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/Payee
Contribution/Expenditure reported on:
Li Schedule A2 Li Schedule B ❑Schedule B(J) Li Schedule C2 ❑ Schedule D ❑ Schedule Fl
Li Schedule F2 Li Schedule F4 Li Schedule G Li Schedule H Li Schedule COH-UC Li Schedule B-SS
Dates of travel Name of person(s)traveling
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)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
i
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 2 Filer ID (Ethics Commission Filers)
3 SIGNATURE
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 campaign
contributions or make any campaign expenditures without a campaign treasurer appointment on file.
Signature of Candidate/Officeholder
4 FILER WHO IS NOT AN OFFICEHOLDER
— Complete A & B below only if you are not an officeholder. ••
A. CAMPAIGN FUNDS
Check only one:
1 I do not have unexpended contributions or unexpended interest or income earned from political contributions.
,
I I have unexpended contributions or unexpended interest or income earned from political contributions. I understand that I
may not convert unexpended political contributions or unexpended interest or income earned on political contributions to
personal use. I also understand that I must file an annual report of unexpended contributions and that I may not retain
unexpended contributions or unexpended interest or income earned on political contributions longer than six years after filing
this final report. Further, I understand that I must dispose of unexpended political contributions and unexpended interest or
income earned on political contributions in accordance with the requirements of Election Code,§254.204.
B. ASSETS
Check only one:
I I I do not retain assets purchased with political contributions or interest or other income from political contributions.
I I I do retain assets purchased with political contributions or interest or other income from political contributions. I understand
that I may not convert assets purchased with political contributions or interest or other income from political contributions to
personal use. I also understand that I must dispose of assets purchased with political contributions in accordance with the
requirements of Election Code,§254.204.
Signature of Candidate
5 OFFICEHOLDER
— Complete this section only if you are an officeholder •-
1 1 I am aware that I remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer on
file. I am also aware that I will be required to file reports of unexpended contributions if,after filing the last required report as an
officeholder,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 of Officeholder
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015