Patton 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 /
MS / MRS / R FIRST MI
OFFICE USE ONLY
OFFICEHOLDER
�a
C�
Date Received
Date
AME
NAME
. . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
NICKNAME LAS.T�.f_�,, SUFFIX
RECEIVED
JAN 1 1 2017
4 CANDIDATE /
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
OFFICEHOLDER
f (_a GL�f�tMw
MAILING
ADDRESS
�L�t1✓1L� 6%vfl"(A1ee_, TX 7Wq-L
❑ Change of Address
OFF'rr OF Clrr' SECRE
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
Date Hand -delivered or Date Postmarked
OFFICEHOLDER
/ g 1"7 ` 73 j ''7' 9 / _ � -e uc
PHONE
\ I
6 CAMPAIGN
MS /MRS MR FIRST MI
Receipt #
Amount $
TREASURER
W L/i r tt-M
Date Processed
NAME
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NICKNAME LAST SUFFIX
Date Imaged
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE;
ZIP CODE
TREASURER
ADDRESS
�I
c�c fSL% �av Oack
(Residence or Business)
P
J J ,,,'� L1f Z'_ � X % & C) 7 2-
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
4 a D S— _ 7q R-S
PHONE
9 REPORT TYPE
YJanuary 15 ❑ 30th day before election ❑ Runoff
❑ 15th day after campaign
treasurer appointment
(Officeholder Only)
❑ July 15 ❑ 8th day before election ❑ Exceeded $500limit
❑ Final Report (Attach C/OH - FR)
10 PERIOD
Month Day Year Month
Day Year
COVERED
o-7 / /(O 110 !L /
31
THROUGH
11 ELECTION
ELECTION DATE
ELECTION TYPE
❑ Primary ❑ Runoff ❑ Other
Month Day Year
Description
/ /
❑ General ❑ Special
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (if known)
j ti CUVIACf G
(a re 3
GO TOPAGE 2
ARY
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
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 CANDIDATES 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
❑ GENERAL
COMMITTEE ADDRESS
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
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
_A
TOTALS EXPENDITURE
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES
$
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
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
true and correct and includes all information required to be reported by me
under Title 15, Election Code.
1
PvekG.�^ LAfl Payne_0, `h Texas
: Notary Public, State of .
:,;z= 10-27-201 7
Comm. Expires
Signature of Candidate or Officeholder
Notary ID 11019863
ALABOVE
�i
Sworn to and subscribed before me, by the said C-'6't ��" n this the
day of aK 20 to certify which, witness my hand and seal of office.
Signature of officer adn i Istering oath Printed name of Officer administering oath le of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015