Williamson Semi July 2017 1
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CANDIDATE l OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
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T 1 Finer ID (Ethhcs Commission Fllws) 2 Total pages filed:
The C/CDH instruction Guide explains how to complete this form.
f 3 CANDIDATE/ _MS;MRS "Enr3 FIRST MI
OFFICE USE ONLY
` OFFICEHOLDER1
NAME �� .. + m_
. . . . . . Q e eceiva
NICKNAME. LAST SUFFIX RECEIVED
f
1 12k Cj j,I/x .
i 4 CANDIDATE/ ADDRESS I P6 BOX; APT J SUITE p;.... CITY; STATE; ZIP CODE '.I I �
OFFICEHOLDER
F—] Change of Address OFFICE OF CITY S CRE FAY
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5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER /✓ ` Date Hand-delivered or Date Postmarked
OFFICE
6 CAMPAIGN Ms $f MR FIRST Mf Receipt rr Amount$
TREASURER -- ..--_
NAME - Data Prcoassad
NICKNAME LAST }} SUFFIX
Date Imaged
7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); API I SUITE lP, CITYs1A4E; ZIP CODE
TREASURER
ADDRESS �/
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8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE ✓ ,
9 REPORT TYPE
LlJanuary 15 ... tre� 301h day Before election Runoff 1 th day after cemasurer appointment
(Officeholder Only)
F-p"' L",Iy 15 ..� 8th day before election ❑ Exceeded$500 limit Final Report(Attach C/OH-FR)
10 PERIOD Month Day / Year Month Day Year
COVERED /3
THROUGH / //-;;1^'y,r'
11 ELECTION ELECTION DATE ELECTION'TYPE
Month Day Year Primary Runoff Other
Descnpt on
/ Generat ❑ Spacial
12 OFFICE OFFICF HELD (if any) 13 OFFICE SOUGHT (if known)
S r
GO TO RAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/201.5
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
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14 C/OH NAM r;: 15 Filer IID (Ethics Commission Filers)
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16 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE By POLITICAL COMMITTEES TO
POLITICAL SUPPORT THE CANDIDATE I 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.
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COMMITTEE TYPE COMMITTEE NAME
1:1 GENERAL
COMMITTEE ADDRESS
DSPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
Additional Pages
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COMMITTEE CAMPAIGN TREASURER ADDRESS
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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
(01 HER THAN PLEDGES, LOANS, OR GUARANTEES OF LOAN'S) $
EXPENDITURE 3, TOTAL POLITICAL, EXPENDITURES OF $100 OR LESS,
TOTALS UNLESS ITEMIZED $
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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 $ ei
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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
CAROL ANN BO RGES under Title 15,Ele(3ion Code.
NOTARY PUBLIC-STATE OF TEXAS
A
CNS
EXP 11-12-2017
NOTARY ID 129100482
NMI 11011 10"Op"Mom Signature of Candidate or Officeholder
AFFIX NOTARY STAMP/SEALABOVE
Sworn to and subscribed before me, by the said kezvL,&j
_, this the
day of J VL V 20_C7_to certify which,witness M,y hand and seal of office.
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Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics,sIate,tx.us Revised 9/8/2015