Huffman Semi Jan 2017CANDIDATE / OFFICEHOLDER
CAMPAIGN FINANCE REPORT
FORM C/OH
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/
OFFICEHOLDER
NAME
Mss MR FIRST MI
//�yA_ -�
v
OFFICE USE ONLY
N
ry
Date Received R t.._� F I E D
V i�
NICKNAME SUFFIX
�.jLAST
`��Mm h
4 CANDIDATE/
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
7
N 1 ?017
JA /
OFFICEHOLDER
MAILING
ADDRESS
Change of Address
/
K.',' Ver �,Ol � TY 760l'-72,
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDERq05-5
PHONE
(�'� �
`-1 l"� ) ?,Dq— ff.// Q 5- 3
Date Hand -delivered or Date Postmarked
6 CAMPAIGN
MS /pu+ay MR FIRST MI
Receipt #
Amount $
TREASURER
��/
NAME
V.'.t Z! •rJ�! ' - . . . . . . . . . . . . . . . . .( .
Date Processed
NICKNAME L AV SUFFIX
Date Imaged
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE;
ZIP CODE
TREASURER
t.1q ` J,JY
_r V /'/ j/t 1'I(ra
ADDRESS
�
(Residence or Business)
( — � 4e, TR _ `f 4) J
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASPHONE URER
M��
9 REPORT TYPE
!1/I January 15 ❑ 30th day before election Runoff
Kms\
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
/ �I /Z.OI16 THROUGH 12- /� I / fes/ 6
11 ELECTION
ELECTION DATE ELECTION TYPE
Month Day Year ❑ Primary ❑ Runoff ❑ Other
Description
❑ General ❑ Special
12 OFFICE
OFFICE HELD (if
�/any) 13 OFFICE SOUGHT (if known)
S>�" (a �, cL
GO TOPAGE 2
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 115 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 OFFICEHOLDERIS
COMMITTEE(S) KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENDITURES.
❑ Additional Pages
17 CONTRIBUTION
TOTALS
EXPENDITURE
TOTALS
CONTRIBUTION
BALANCE
OUTSTANDING
LOAN TOTALS
18 AFFIDAVIT
COMMITTEE TYPE COMMITTEE NAME
❑ 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,
UNLESS ITEMIZED
$
/ CI
4. TOTAL POLITICAL EXPENDITURES
$
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
OF REPORTING PERIOD
$
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$
^
LAST DAY OF THE REPORTING PERIOD
ll1
,�0°� ;;�- Lori Payne
�arns,,�
Notary Public, State of Texas
?"�+P Comm. Expires 10-27-2017
„°;,�.•�` Notary ID 11019863
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 Titl 15, Election Co e.
Sig atur of an ate or Officeholder
Sworn to and subscribed before me, by the said 30 `V1 YCA--
day of 201, to certify which, witness my hand and seal of office.
C.e� P
a�, t Le -
Signature of officer admi is�ath Printed name of officer apministering oath
, this the
Title of Ifficer administering oWh
Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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
SUBTOTAL
NAME OF
SCHEDULE
AMOUNT
1.
❑
SCHEDULEAI:
MONETARY POLITICAL CONTRIBUTIONS
$
2•
❑
SCHEDULEA2:
NON-MONETARY(IN-KIND) POLITICAL CONTRIBUTIONS
$
3.
F-1
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
The Instruction Guide explains how to complete this form. 1 Total pages Schedule A1:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date rj Full name of contributor ❑ out-of-state PAC (ID#: 7 Amount of contribution ($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Contributor address; City; State; Zip Code
8 Principal occupation / Job title (See Instructions) 19 Employer (See Instructions)
Date Full name of contributor ❑ out-of-state PAC (ID#: Amount of contribution ($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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#: 1 Amount of contribution ($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributor address; City; State; Zip Code
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date Full name of contributor ❑ out-of-state PAC (ID#: 1 Amount of contribution ($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 (IDs: 8 Amount of g 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 (IDs:
13 Contributor's job title (FOR JUDICIAL) (See Instructions)
15 Law firm of contributor's spouse (if any) (FOR JUDICIAL)
I Amount of In-kind contribution
Contribution $ description
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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)
❑ 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 SCHEDULE B
The Instruction Guide explains how to complete this form. 1 Total pages Schedule B:
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)
Date Full name of pledgor ❑ out-of-state PAC (ID#: t 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#: 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)
Date Full name of pledgor ❑ out-of-state PAC (ID#: I Amount of In-kind contribution
Pledge $ description
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Pledgor address; City; State; Zip Code
Principal occupation / Job title (See Instructions)
❑Check if travel outside of Texas. Complete Schedule T.
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 ($)
6 Is lender 8 Lender address;
City; State; Zip Code
10 Interest rate
a financial
Institution?
11 Maturity date
Y N
12 Principal occupation / Job title (See Instructions)
13 Employer (See Instructions)
14 Description of Collateral
15 Check if personal funds were deposited into political
account (See Instructions)
❑ none
❑
16 GUARANTOR 17 Nameofguarantor
19 Amount Guaranteed($)
INFORMATION
. . . . . . . . . . . . . . .
18 Guarantor address;
. . . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
.
❑ not applicable
20 Principal Occupation (See Instructions)
121 Employer (See Instructions)
Date of loan Name of lender ❑ out-of-state PAC (I D#: I
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is lender Lender address; City; State; Zip Code
a financial
Institution?
Y N
Principal occupation / Job title (See Instructions)
Description of Collateral
❑ none
Loan Amount ($)
Interest rate
Maturity date
Employer (See Instructions)
Check if personal funds were deposited into political
account (See Instructions)
GUARANTOR Name of guarantor Amount Guaranteed ($)
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
EXPENDITURE CATEGORIES FOR BOX 8(a)
SCHEDULE F1
Advertising Expense
Event Expense
Loan Repayment/Reimbursement
Solicitatiort/FundraisingExpense
Accounting/BanWng
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 ($)
7 Payee address; City; State;
Zip Code
8
PURPOSE
OF
EXPENDITURE
9 Complete ONLY if direct
expenditure to benefit C/OH
Date
Amount ($)
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
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
UNPAID INCURRED OBLIGATIONS
EXPENDITURE CATEGORIES FOR BOX 10(a)
SCHEDULE FL
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/Memodals 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 F2:
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
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 it 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:
$ 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/AwardsMlemorials Expense Printing Expense Travel Out Of District
Candidate/CWiceholder/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: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UN ITEMIZED EXPENDITURES CHARGED TOA 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
EXPENDITURE ❑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
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 ($)
❑Reimbursementfrom
political contributions
intended
8 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF
EXPENDITURE
9 Complete ONLY if direct
expenditure to benefit C/OH
5 Payee name
7 Payee address; City; State; Zip Code
SCHEDULE G
Solicitation/Fundraising Expense
Transportation Equipment & Related Expense
Travel In District
Travel Out Of District
Other (enter a category not listed above)
3 Filer ID (Ethics Commission Filers)
❑ Check if travel outside of Texas. Complete Schedule T.
El Check if Austin, TX, officeholder living expense
Candidate /Officeholder name Office sought Office held
Date
Amount ($)
❑Rein'bursomentfrom
political contributions
intended
Payee name
Payee address; City; State; Zip Code
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 ($) Payee address; City; State; Zip Code
❑Reimbursementfrom
political contributions
intended
Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF ❑ Check if travel outside of Texas. Complete Schedule T.
EXPENDITURE ❑ Check it Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
PAYMENT MADE FROM POLITICAL
CONTRIBUTIONS TO A BUSINESS OF C/OH
EXPENDITURE CATEGORIES FOR BOX 8(a)
SCHEDULE H
Advertising Expense
Event Expense
Loan Repayment/Reimbursement
Solicitation/Fundraising Expense
Accounting/Banking
Fees
Office Overhead/Rental Expense
Transportation Equipment & Related Expense
Consulting Expense
Food/Beverage Expense
Polling Expense
Travel In District
Contributions/Donations Made By
Gift/Awards/Memodals Expense
Printing Expense
Travel Out Of District
Candidate/Offioeholder/Political Committee Legal Services
Salanes/Wages/Contract Labor
Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H: 2
FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date 5
Business name
6 Amount ($) 7
Business address; City; State;
Zip Code
6 (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 ($)
PURPOSE
OF
EXPENDITURE
Complete ONLY if direct
expenditure to benefit C/OH
Date
Amount ($)
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
PURPOSE ❑ Check if travel outside of Texas. Complete Scheduler.
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
NON -POLITICAL EXPENDITURES
MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE
The Instruction Guide explains how to complete this form.
1 Total pages Schedule
r 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
PURPOSE
Category (See instructions for examples of acceptable Description (See instructions regarding type of information
OF
categories.) required.)
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
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 F—] 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 F—] 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:
❑ 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 I 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 I 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 I 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.
0 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:
0 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 --
0 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