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Muller Semi Jan 2017CANDIDATE / 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/ Z/MS RS / MR FIRST MI OFFICE USE ONLY OFFICEHOLDER NAME ��% / Date Received NICKNAME LAST SUFFIX �r 4 CANDIDATE/ ADDRESS ! PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE OFFICEHOLDER _ xv, r, MAILING ADDRESS v�/ Gf�%� %GL'�SL %5l O ❑ Change of Address 0j .r.i- E `' I��'j.r �°:€�F rCi / ?`f 5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION OFFICEHOLDERDate �/ % f�� G Hand -delivered or Date Postmarked PHONE 6 CAMPAIGN MS / MRS / MR FIRST MI Receipt # Amount $ TREASURER NAME`. . . . . . . . . . Date Processed NICKNAME LAST SUFFIX Date Imaged 7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY, STATE; ZIP CODE TREASURER C� ADDRESS / 4,7^4-1, �� �jC� (Residence or Business) 8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER //'!S2- � ;7 ) %—£�f� V'/PHONE '-8' 9 REPORT TYPE January 15 ❑ 30th day before election ❑ Runoff ❑ 15th day after campaign treasurer appointment (Officeholder Only) ❑ July 15 ❑ 8th day before election ❑ Exceeded $500 limit ❑ Final Report (Attach C/OH - FR) 10 PERIOD Month Day Year Month Day Year COVERED U / / / / -z b/7 07 /16 /���� THROUGH 11 ELECTION ELECTION DATE ELECTION TYPE Month Day Year ❑ Primary ❑ Runoff ❑ Other Description b e,—/ v jad jS General ❑ Special 12 OFFICE OFFICE HELD (if any) 13 OFFICE SOUGHT (if known) C 4 Forms provided by Texas Ethics Commission GO TO PAGE 2 www.ethics.state.tx.us Revised 9/8/2015 CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT 14 C/OH NAME FORM C/OH COVER SHEET PG 2 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 COMM ITTEE(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 ❑ Additional Pages 17 CONTRIBUTION TOTALS EXPENDITURE TOTALS CONTRIBUTION BALANCE OUTSTANDING LOAN TOTALS 18 AFFIDAVIT GENERAL COMMITTEE ADDRESS ❑ SPECIFIC COMMITTEE CAMPAIGN TREASURER NAME COMMITTEE CAMPAIGN TREASURER ADDRESS 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) 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, $ i - UNLESS ITEMIZED 4. TOTAL POLITICAL EXPENDITURES $ 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY $ i OF REPORTING PERIOD 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORTING PERIOD $ ,0 Ity P`e•, Yvette M. Ruiz Zo.;:4� Notary Public, State of Texas 9 +P Comm. Expires 06-16.2019 °'••'; OF Notary ID 128649462 AFFIX NOTARY STAMP / SEALABOVE 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. Signature of Candidate or Officeholder Sworn— ooand subscribed before me, by the said V)k (V\' E\ CN `' Q r day of . Ja�t taf A 20 to certify which, witness my hand and seal of office. �/i/alure of officer administ ri g oath I APr,ted name of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us this the Till of officer administering oath Revised 9/8/2015 SUBTOTALS - C/OH 19 FILER NAME FORM C/OH COVER SHEET PG 3 20 Filer ID (Ethics Commission Filers) 21 SCHEDULE SUBTOTALS NAME OF SCHEDULE 1. ❑ SCHEDULEAi: 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. El SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $ 8. ❑ SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $ 9. 1-1 SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS $ 10. ❑ SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $ 11. F-1 SCHEDULE 1: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ 12 SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS $ RETURNED TO FILER SUBTOTAL AMOUNT MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al The Instruction Guide explains how to complete this form. 1 Total pages Schedule At: 2 FILER NAME $ Filer ID (Ethics Commission Filers) 4 Date 5 Full name of contributor ❑ out-of-state PAC (ID#: t 7 Amount of contribution ($) 6 Contributor address; City; State; Zip Code 8 Principal occupation / Job title (See Instructions) 9 Employer (See Instructions) Date Full name of contributor ❑ out-of-state PAC (ID#: t Amount of contribution ($) . . . . . . . . . . . . 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#: t Amount of contribution ($) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor ❑ out-of-state PAC (ID#: t Amount of contribution ($) 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 The Instruction Guide explains how to complete this form. 2 FILER NAME SCHEDULE A2 1 Total pages Schedule A2: 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#: t 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) 14 Contributor's employer/law firm (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#: 13 Contributor's job title (FOR JUDICIAL) (See Instructions) 15 Law firm of contributor's spouse (if any) (FOR JUDICIAL) . . . . . . . . . . . . . . . . . . . . . . . Contributor address; City; State; Zip Code Principal occupation / Job title (FOR NON -JUDICIAL) (See Instructions) Contributor's principal occupation (FOR JUDICIAL) Contributor's employer/law firm (FOR JUDICIAL) If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL) Amount of In-kind contribution Contribution $ description ❑ Check if travel outside of Texas. Complete Schedule T. Employer (FOR NON-JUDICIAL)(See Instructions) Contributor's job title (FOR JUDICIAL) (See Instructions) Law firm of contributor's spouse (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 PLEDGED CONTRIBUTIONS The Instruction Guide explains how to complete this form. 2 FILER NAME SCHEDULE B 1 Total pages Schedule B: 3 Filer ID (Ethics Commission Filers) 4 TOTAL OF UNITEMIZED PLEDGES I $ 5 Date 6 Full name of pledgor ❑ out-of-state PAC (ID#: 1 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) 111 Employer (See Instructions) Date Full name of pledgor ❑ 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) I Employer (See Instructions) Date Full 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#: t 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) 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 ($) . . . . . . . . . . . . . . 6 Is lender 8 Lender address; . . . . . . . . . . . . . . . . . . . . . . . City; State; Zip Code . 10 Interest rate a financial Institution? 11 Maturity date Y N 12 Principal occupation / Job title (See Instructions) 13 Employer (See Instructions) 14 Description of Collateral 15 Check if personal funds were deposited into political account (See Instructions) ❑ none ❑ 16 GUARANTOR 17 Name of guarantor 19 Amount Guaranteed ($) 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. POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS EXPENDITURE CATEGORIES FOR BOX 8(a) SCHEDULE 171 Advertising Expense Accounting/Banking Event Expense Fees Loan Repayment/Reimbursement Solicitation/Fundraising Expense Consulting Expense Food/Beverage Expense Office Overhead/Rental Expense Polling Expense Transportation Equipment & Related 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 Ft: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 Date 5 Payee name 6 Amount ($) 7 Payee address; City; State; Zip Code 8 PURPOSE OF EXPENDITURE 9 Complete ONLY if direct expenditure to benefit C/OH Date Amount ($) PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH Date Amount ($) PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH (a) Category (See Categories listed at the top of this schedule) (b) Description ❑ Check if travel outside of Texas. Complete Schedule T. ❑ Check if Austin, TX, officeholder living expense Candidate / Officeholder name Payee name Payee address; City; State; Zip Code Category (See Categories listed at the top of this schedule) Candidate / Officeholder name Payee name Payee address; City; State; Zip Code Category (See Categories listed at the top of this schedule) Candidate / Officeholder name Office sought Office held Description ❑ Check if travel outside of Texas. Complete Schedule T. ❑ Check if Austin, TX, officeholder living expense Office sought Office held Description ❑ Check if travel outside of Texas. Complete Schedule T. ❑ Check if Austin, TX, officeholder living expense Office sought ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Office held 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: I 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS $ 5 Date 6 Payee name 7 Amount ($) 8 Payee address; City; State; Zip Code 9 TYPE OF EXPENDITURE ❑ Political ❑ Non -Political 10 (a) Category (See Categories listed at the top of this schedule) (b) Description PURPOSE ❑ Check if travel outside of Texas. Complete Schedule T. OF EXPENDITURE ❑Check if Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Amount ($) Payee address; City; State; Zip Code TYPE OF Political Non -Political EXPENDITURE 1-1 Category (See Categories listed at the top of this schedule) Description PURPOSE ❑ Check if travel outside of Texas. Complete Schedule T. OF ❑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 The Instruction Guide explains how to complete this form. 2 FILER NAME SCHEDULE F3 1 Total pages Schedule F3: 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 EXPENDITURE CATEGORIES FOR BOX 10(a) SCHEDULE F4 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 Contnbutions/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 F4: I 2 FILER NAME 13 Filer ID (Ethics Commission Filers) 4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TO A CREDIT CARD $ 5 Date 6 Payee name 7 Amount ($) 8 Payee address; City; State; Zip Code 9 TYPE OF EXPENDITURE ❑ Political ❑ Non Political 10 (a) Category (See Categories listed at the top of this schedule) (b) Description PURPOSE ❑ Check if travel outside of Texas. Complete Schedule T. OF EXPENDITURE ❑Check if Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Amount ($) Payee address; City; State; Zip Code TYPE OF EXPENDITURE ❑ Political Non -Political Category (See Categories listed at the top of this schedule) Description PURPOSE ❑ Check if travel outside of Texas. Complete Schedule T. OF ❑ 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 MADE FROM PERSONAL FUNDS EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan Repayment/Reimbursement Accounting/Banking Fees Office Overhead/Rental Expense Consulting Expense Food/Beverage Expense Polling Expense Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Credit Card Payment The Instruction Guide explains how to complete this form. 1 Total pages Schedule G: 2 FILER NAME 4 Date 6 Amount ($) ❑Reimbursement from political contributions intended 5 Payee name 7 Payee address; City; State; Zip Code SCHEDULE G Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) 3 Filer ID (Ethics Commission Filers) 8 (a) Category (See Categories listed at the top of this schedule) (b) Description PURPOSE OF ❑ Check if travel outside of Texas. Complete Schedule T. EXPENDITURE ❑ Check if Austin, TX, officeholder living expense 9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Amount ($) 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 ❑ 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 ($) ❑Reimbursement from political contributions intended PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH Payee address; City; State; Zip Code Category (See Categories listed at the top of this schedule) (b) Description ❑ Check if travel outside of Texas. Complete Schedule T. ❑ Check if Austin, TX, officeholder living expense Candidate / Officeholder name Office sought Office held ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH EXPENDITURE CATEGORIES FOR BOX 8(a) SCHEDULE H Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In District Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services SalariesWages/Contract Labor Other (enter a category not listed above) Credit Card Payment The Instruction Guide explains how to complete this form. 1 Total pages Schedule H: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 Date 5 Business name 6 Amount ($) 7 Business address; City; State; Zip Code 8 (a) Category (See Categories listed at the top of this schedule) (b) Description PURPOSE ❑ Check if travel outside of Texas. Complete Schedule T. OF EXPENDITURE ❑ 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 ($) PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH Date Amount ($) PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH Business address; City; State; Zip Code Category (See Categories listed at the top of this schedule) Description ❑ Check if travel outside of Texas. Complete Schedule T. ❑ Check if Austin, TX, officeholder living expense Candidate / Officeholder name Business name Business address; City; State; Zip Code Office sought Office held Category (See Categories listed at the top of this schedule) Description ❑ Check if travel outside of Texas. Complete Schedule T. ❑ Check if Austin, TX, officeholder living expense Candidate / Officeholder name Office sought ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Office held Revised 9/8/2015 NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS The Instruction Guide explains how to complete this form. 1 Total pages Schedule I: 2 FILER NAME 4 Date 5 Payee name 6 Amount ($) 7 Payee address; City; State; Zip Code SCHEDULE 3 Filer ID (Ethics Commission Filers) 8 (a)Category (See instructions for examples of acceptable (b) Description (See instructions regarding type of information PURPOSE categories.) required.) OF EXPENDITURE Date Payee name Amount ($) Payee address; City; State; Zip Code PURPOSE Category (See instructions for examples of acceptable categories.) OF EXPENDITURE Date Payee name Amount ($) Payee address; City; State; Zip Code PURPOSE Category (See instructions for examples of acceptable OF categories.) EXPENDITURE Date Payee name Amount ($) Payee address; City; State; Zip Code PURPOSE Category (See instructions for examples of acceptable categories.) OF EXPENDITURE Description (See instructions regarding type of information required.) Description (See instructions regarding type of information required.) Description (See instructions regarding type of information required.) 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 The Instruction Guide explains how to complete this form. 1 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 ($) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Address of person from whom amount is received; City; State; Zip Code 7 Purpose for which amount is received ❑ Check if political contribution returned to filer Date Name of person from whom amount is received Amount ($) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received Check if political contribution returned to filer Date Name of person from whom amount is received Amount ($) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received Check if political contribution returned to filer Date Name of person from whom amount is received Amount ($) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received ❑ 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 13 Filer ID (Ethics Commission Filers) 4 Name of Contributor / Corporation or Labor Organization / Pledgor / Payee 5 Contribution / Expenditure reported on: ❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1 ❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COH-UC ❑ 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 111 Purpose of travel (including name of conference, seminar, or other event) Name of Contributor / Corporation or Labor Organization / Pledgor / Payee Contribution / Expenditure reported on: ❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1 ❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COWLIC ❑ 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 I Purpose of travel (including name of conference, seminar, or other event) Name of Contributor / Corporation or Labor Organization / Pledgor / Payee Contribution / Expenditure reported on: ❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1 ❑Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COWLIC ❑ 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 I 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 CANDIDATE /OFFICEHOLDER REPORT: DESIGNATION OF FINAL REPORT FORM C/OH - FR 1 C/OH NAME 3 SIGNATURE The Instruction Guide explains how to complete this form. •• Complete only if "Report Type" on page 1 is marked "Final Report" •- 2 Filer ID (Ethics Commission Filers) 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: 0 I do not have unexpended contributions or unexpended interest or income earned from political contributions. E-1 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: F__1 I do not retain assets purchased with political contributions or interest or other income from political contributions. 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 •- F7 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