McCaskill Semi Jan 2020CANDIDATE / OFFICEHOLDER
FORM CIOH
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.
1U
3 CANDIDATE/
MS/MR /MR FIRST MI
OFFICEHOLDER
OFFICE USE ONLY
NAME
S—�
Date Receivetl
NICKNAME LAST SUFFIX
0i-
4 CANDIDATE/
OFFICEHOLDER
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
MAILING
ADDRESS
❑ Change of Address
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER
PHONE
r`� C' 1 I
`•7( /
Dat elivered or Data Postmarked
6 CAMPAIGN
MSMR /MR FIRST MI
Receipt #
Amount $
TREASURER
I
I_.-I�' �
Date Processed
NAME
. . . . . . . . . . . . . . . .
NICKNAME LAST SUFFIX
JL CC i C
t �-L
Data Imaged
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CIN;
STATE; ZIP CODE
TREASURER
n ,�t p
Lout l�V Li'l �C- L/%�—C--c
ADDRESS
1
(Residence or Business)
_
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
c7-1,.1 \ 9'Ja-
9 REPORT TYPE
January 15 30th day before election El 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
1 L 1 _
V`"I / �`% /c���� THROUGH -t "''V
_,)
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
❑ Primary ❑ Runoff ❑ Other
Hr". `1 1�
/ `' _ `
Description
General ❑ Special
NIS dim 5
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (IT known)
Cl r-( Cid aU4ti I l- 1 ���
CCT— L-C1iLiJ t-1 L �L./!LCA= r�
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
CANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C/OH NAME
S'NV�'viti
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 I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDER'S
COMMITTEE(S)
MOWLEUGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENDITURES.
COMMITTEE TYPE
COMMITTEE NAME
GENERAL
SPECIFIC
COMMITTEE ADDRESS
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, OR
$
CONTRIBUTIONS MADE ELECTRONICALLY), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS
$
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
TOTALS EXPENDITURE
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
$
UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES
$
CONTRIBUTION
5.
BALANCE
TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
OF REPORTING PERIOD
OUTSTANDING
LOAN TOTALS
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$
LAST DAY OF THE REPORTING PERIOD
j(�., L�< d 1 �O
r I
1S 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
�puul� - under Title 15, Election Code.
o`;wYPo'% AMY SHELLEY �
4t,. COMM.ublic,Expires
State 2 Texas � � // 1A-
3.4�.mra Com. Expires 12.02-2023 ,,,/// t ////// 111 4 l0 ll �•/
• •
1�"� Notary ID 12478110-5
Signature of Candidate or Officeholder
AFFIXNOTARY STAMP/SEALABOVE
' , • (�� ,
Sworn toand subscribed before me, by the said _�f' ��, I V `—�I°lLl. K-L �� this the �—
a of l lrVl , 20020 , to certify which, witness my hand and seal of office.
W 5Ccilei
Si a of officer roistering oath Pri name of o Ice administering oath Title of officer admin' ing oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
Forms provided by Texas Ethics Commission w .ethics.state,tx.us Revised 9/26/2019
SUBTOTALS
- C/OH FORM C/OH
COVER SHEET PG 3
19
FILER NAME
C
)\A21
20 Filer ID (Ethics Commission Filers)
SCHEDULE SCHEDULE SUBTOTALS
NAMEOFSCHEDULE
SUBTOTAL
AMOUNT
1.
SCHEDULEAI:
MONETARY POLITICAL CONTRIBUTIONS
$
2.
SCHEDULEA2:
NON -MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS
$
3.
El SCHEDULE B:
PLEDGED CONTRIBUTIONS
$
4.
F—I 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
$
6.
F—I 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 1: 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 w .ethics.state,tx.us Revised 9/26/2019
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
The Instruction Guide explains how to complete this form.
1 Total pages Schedule A1:
2 FILER NAME
11
3 Filer ID (Ethics Commission Filers)
4 Date
5 Full name of contributor ❑ out-of-state PAC po#: I
6 Contributor address; City; State; Zip Code
7 Amount of contribution ($)
6 Principal occupation / Job title (See Instructions) -Ti-
Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC (10#: t
Contributor address; City; State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC (MM I
Contributor address; City; State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor out-of-state PAC (10#: t
Contributor address; City; State; Zip Code
Amount of contribution ($)
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 w .ethics.state.u.us Revised 9/26/2019
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 (IM:
7 Contributor address; City; State;
I
Zip Code
8 Amount of g In-kind contribution
Contribution $ description
❑ 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 fine of parent(s) (if any) (FOR JUDICIAL)
Date
Full name of contributor ❑out-of.state PAC (If)#:
Contributor address; City; State;
l
Zip Code
Amount of In-kind contribution
Contribution $ description
❑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)
Contributors job title (FOR JUDICIAL) (See Instructions)
Contributor's employer/law firm (FOR JUDICIAL)
Law firm of contributors 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 9/26/2019
PLEDGED CONTRIBUTIONS SCHEDULE B
The Instruction Guide explains how to complete this form.
7 Total pages Schedule B: 1
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
= -� A In l rJ 0 C
`% TOTAL OF LINITEMIZED PLEDGES
$
5 Date
6 Full name of pledgor ❑ out-of-state PAC (ID#: 1
6 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
FUJI name of pledgor out-of-
p g ❑ state PAC (ID#: 1
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) 77_Employer
(See Instructions)
Date
Full name of pledgor ❑ out-of-state PAC (ID#: 1
Amount of In-kind contribution
Pledge $ description
. . . . . . . . . . . . . . . . . . . . . . . . . .
Pledgor address; City; State; Zip Code
❑ Check if travel cutsida of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of pledgor ❑ out-of-state PAC JIM: 1
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 w .ethics.state.tx.us Revised 9/26/2019
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)
C ta-t;
4 TOTAL OF LINITEMIZED LOANS
$
5 Date of loan
7 Nameoflender E] out-of-state PAC (IDA. )
......................................
8 Lender address; City; State; Zip Code
9 LoanAmount($)
6 Is lender
10 Interestrate
a financial
Institution?
11 Maturitydate
Y N
12 Principal occupation / Job title (See Instructions)
13 Employer (See Instructions)
14 Description of Collateral
15
if personal funds were deposited into political
El
❑ none
account
account (See Instructions)
16 GUARANTOR
17 Name ofguarantor
19 Amount Guaranteed($)
INFORMATION
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18 Guarantor address; City; State; Zip Code
❑ not applicable
20 Principal Occupation (See Instructions)
21 Employer (See Instructions)
Date of loan
Nameof lender out-of.state PAC (IDM: )
. . . . . 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lender address; City; State; Zip Code
Loan Amount ($)
Is lender
Interest rate
a financial
Institution?
Maturity date
Y N
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Description of Collateral
if personal funds were deposited into political
El
F-1noneaccount
account (See Instructions)
GUARANTOR
Name of guarantor
Amount Guaranteed ($)
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 9/26/2019
POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F1
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Rapayment/Reimbumement SolicitatioNFundmising Expense
Accountmgleanking Facts Office Oveihead/Rentalense
ExP Transportation Equipment&Relatetl Expense
Consulting Expense Food/Bevsm s Expense Polling Expense Travel In
emorials Expense Priming Expense Travel Out Of District
CC.ndigdons/Doaahons Made By Out
Legal Sorel..
Cantlidate/OffirzholdeHPolltical Committee Legal Services SeladesMlages/Contract Labor Other (entero category not listed above)
Craft 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)
5 H A ij fV IV,
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
8
(a) Category (See Categorieslisted etthetopofthisschedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check Htravel cu6ideofTe�ms. CompletescM1etlulaT. Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
❑ Check lf1mvei outside of Texas. Complete Schedule T. El Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate/ Officeholder name Office soughtOffice held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See Categories listed at the top ofthis schedule)
Description
PURPOSE
OF
EXPENDITURE
Checkiftravel outside of Texas. Complete ScheduleT. F-1 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 wvvw.ethics.state.tx.us Revised 9/26/2019
UNPAID INCURRED OBLIGATIONS
SCHEDULE F2
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense
Event Expense Loan Repayment/Reimbursement
Solidtation/Fundmising Expense
Accounfing/Banking
Fees Office Ovemead/Remal Expense
Transportation Equipment& Related Expense
Consulting Expense
Food/Beverage Expense Polling Expense
Travel In District
Contributions/Donations Made By GiR/Awards/Memodals Expense Printing Expense
Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salanes/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)
i
`i F-1 -A, r.J jA C LA I �,i__-
4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS
$
5 Date
6 Payee name
7 Amount ($)
8 Payee address; City;
State; Zip Code
9 TYPE OF
EXPENDITURE
F-1 Political F-1 Non -Political
10
(a) Category (See Categories listed at the top of this schedule)
(b) Description
"
PURPOSE
OF
EXPENDITURE
(C) ❑ Checkfftmwlou6ideafTexas.Complete Schedule T. F-] Check if Austin, TX, officeholder living expense
11 Complete ONLY if direct
Candidate / Officeholder name Office sought
Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City;
State; Zip Code
TYPE OF
EXPENDITURE
F-1 Political Non -Political
Category(See Categories listed at the top ofthis schedule)
Description
PURPOSE
OF
EXPENDITURE
Check iftravel outside of Texas. Complete Scheduler 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.bcus Revised 9/26/2019
PURCHASE OF INVESTMENTS MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F3
The Instruction Guide explains how to complete this farm.
1 Total pages Schedule F3:
2 FILERNAME
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 9/26/2019
EXPENDITURES MADE BY CREDIT CARD
SCHEDULE F4
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense
Event Expense Loan Repay ardVIR imbursement
Solicuation/Fundmising Expense
AccountingBarking
Fees Office Ovemead/Renfal Expense
Transportation Equipment & Rakded Expense
Consulting Expense
FoodBeverage Expense Polling Expense
Travel in District
Contributlona/Donations Made By GWAwanls/Memorials Expense Printing Expense
TravelOut Df District
Candidate/Officeholder/Political Committee Legal Services SaladesNdages/ConkactLabor
Other (enter a categary 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)
—idV v 0 CI.CcLt,.—
4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TO ACREDIT CARD
$ /
l
5 Date
6 Payee name
7 Amount ($)
a Payee address; City;
State; Zip Code
9 TYPE OF
EXPENDITURE
❑ Political Non -Political
10
(a) Category (See Categories listed at the top ofthis schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(6) ❑ CheckiftmveloutsideofTexas.Complete Schedule T. Check if Austin, TX, officeholder living expense
11
Candidate / Officeholder name Office sought
Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City;
State; Zip Code
TYPE OF
EXPENDITURE
F-1 Political Non -Political
Category (See Categodes listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check Rtavel outside of Texas. Complete Schedule T 7 Check If Austin, T%, officeholder living expense
Candidate / Officeholder name Office sought
Office held
Complete ONLY if direct
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 9/26/2019
POLITICAL EXPENDITURES
MADE FROM PERSONAL FUNDS SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
AccountingManking Fees Office Oveihead/Rental Expense Transportation Equipment& Related Expense
Consulting Expense FooNaeveage Expense Polling Expense Travel In District
Co bibullons/Donafions Made By GWAvvmds/Memodels Expense Printing Expense Travel Out Of District
Candidate/Officeholder/PoINical Committee I -eget Services SalanesMages/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)
In L'i eJ 1� � L o-, ✓ t Li
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
❑Reimbursementfiom
political contributions
Intended
$
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(C) Checkiftmvel outside of Texas. Complete 5cheduleT. Check if Austin, TX, officeholder living expense
9 Candidate / Officeholder name Office sought Office held
Complete ONLY If direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Reimbursementfrom
Elpolitical contributions
Intended
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Checkifhavel outside of Texas. Complete 5cheduleT Check if Austin, TX, officeholder living expense
Candidate/ Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
❑Reimbursementimm
political contributions
intended
Category (See Categories listed at the top ofthis schedule)
Description
PURPOSE
OF
EXPENDITURE
Check iflavel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.stateAx.us Revised 9/26/2019
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/Rombursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office OverheadlFtental Expense Transportation Equipment$ Related Expense
ConsuNng Expense FoodlReverage Expense Polling Expense Travel In District
Contributions/Donagons Made By Glfi/AWards/rvtemarials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Polltlral Committee Legal Services Salaries/Wage./Contract]-also, Other(entera 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)
� A -v>, J i� C V-4-1 C l L�
4 Date
5 Business name
6 Amount ($)
7 Business address; City; State; Zip Code
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) ❑ Check RtmveloulsidedTems.Complete Schedule T. 71 Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Business name
Amount ($)
Business address; City; State; Zip Code
Category(See Categories listed at the top ofthis schedule)
Description
PURPOSE
OF
EXPENDITURE
Cheekifhavel ouehmefTexas. Complete ScheduleT. 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 ($)
Business address; City; State; Zip Code
Category (See Categories listed at the top ofthis schedule)
Description
PURPOSE
OF
EXPENDITURE
F7Checklrf veloutsideo Texas.Complele Schedule T. Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
NON-POLITICAL EXPENDITURES
MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE I
The Instruction Guide explains how to complete this form.
1 Total pages Schedule I:
2 FIIL/LERNAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
T 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 ($)
Payee address; City State Zip Code
PURPOSE
Category (See instructions for examples of acceptable
Description (See Instructions regarding type of information
categories.)
required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
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 ($)
Payee address; City State Zip Code
PURPOSE
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
categories.)
required.)
OF
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER SCHEDULE K
The Instruction Guide explains how to complete this form.
1 Total pages Schedule K: i
2 FILER NAME / /
i"1 }V Imo' C
3 Filer ID (Ethics Commission Filers)
% Date
5 Name of person from whom amount is received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Address of person from whom amount is received; City; State; Zip Code
8 Amount ($)
7 Purpose for which amount is received Check if political contribution returned to filer
Date
Name of person from whom amount is received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Amount ($)
Purpose for which amount is received Check if political contribution returned to filer
Date
Name of person from whom amount is received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Amount ($)
Purpose for which amount is received ❑ Check if political contribution returned to filer
Date
Name of person from whom amount is received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Amount ($)
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 9/26/2019
IN-KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES SCHEDULE
FOR TRAVEL OUTSIDE OF TEXAS
The Instruction Guide explains how to complete this form,
1 Total pages Schedule T.
2 FILER NAME '� {
14 0
3 Filer ID (Ethics Commission Filers)
4 Name of Contributor/ Corporation or Labor Organization/ Pledger/ Payee
5 Contribution / Expenditure reported on:
❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule Ft
❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COH-UC ❑ Schedule B-SS
6 Dates of travel
7 Name of person(s) traveling
6 Departure city or name of departure location
9 Destination city or name of destination location
10 Means of transportation
77 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 COH-UC ❑ Schedule BSS
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:
❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1
❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COH-UG ❑ 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 9/26/2019
CANDIDATE/ OFFICEHOLDER REPORT -
DESIGNATION OF FINAL REPORT FORM C/OH - FR
The Instruction Guide explains how to complete this form.
•• Complete only if "ReportType" 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 NOTAN 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.
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 ••
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 9/26!2019