Talley Semi Jan 2020APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE PG 1
See CTA Instruction Guide for detailed instructions.
1 Total pages filed:
2 CANDIDATE
NAME
MS MR /MR FIRST/ MI
y� Cr ..0
� /Ie tl
�-
OFFICE USE ONLY
Filar ID #
/
/:J-�. . . . . . . . . . . . . . . . .
al'ox�lAM' �1 I'laI `ei1 sumix
D
�n RECEIVED
JAN 19 2020
3 CANDIDATE
MAILING
ADDRESS IPO BOX APrISUITE*' CITY;. STATEBPCODE
ADDRESS
IN
s1-Wd-dd1v..d.1PostmarkwJ
OFFICE OF CITY SECR
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
R
'
PHONE
P...d
5 OFFICE
HELD
Dam imaged
(if any)
8 OFFICE
SOown)
? ( ///jam/ l /
E4
se,
64 lllll'1.G' ! (�/
7 CAMPAIGN
TREANAMESURERI�/�,h'P'(L!
MBIMRS FlRJSTj j1 CMI NIICCK EE LAST �g' SUFFIX
V.• /'Ji"t//t,.Co'
8 CAMPAIGN
TREASURER
STREET ADDRESS (NO PO POBOOX��LEASE); APT/SUITE#, CITY; STATE; �
(residence or business)
9 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
10 CANDIDATE
SIGNATURE
I am aware of the Nepotism Law, Chapter 573 of the Texas Government Code.
I am aware of my responsibility to file timely reports as required by title 15 of
the Election Code.
I am aware of the restrictions in title 15 of the Election Code on contributions
from corporations and labor organizations.
Signature of CandlQNS, Date Signed
GO TO PAGE 2
Forms provided by Texas Ethics Commission w .sthics.state.tx.us Revised 121612019
ARY
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CANDIDATE I OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET FIG 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
10 / MR I MR FIRST MI
E'LL� !�
OFFICE USE ONLY
NAME
NICKNAME LAST SUFFIX
Date -Recaived RECEIVED
RECEIVED
JAN 1 5 2020
q CANDIDATE/
OFFICEHOLDER/
ADDRESS / PO BOX; �7 APT I SUITE #; CITY;
ADDRESS
ADDRESS
❑ Change of Address
OFFICE OF CITY SECRETAR
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
cw
11 ;dj
OFFICEHOLDER
PHONE
Date Hand -delivered or Date Postmarked
6 CAMPAIGN
MS / M/RSrI M�%/ FIRST
�� //G � MI �
Receipt M
Amount $
TREASURER
NAME.
.L� .�J�
Date Processed
NICKNAME LAST SUFFIX
Date Imaged
7 CAMPAIGN
TREASURER
STREET ADDRESS (/ PO BO �LEASAPTE #; CITY /
/
(Residence or Business)
6 CAMPAIGN
TREASURER
AREA CODEPHONE NUMBER EXTENSION
/ /
PHONE
\ ///LJJ1
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 CION -FR)
10 PERIOD
Month Day Year Month
Day year
COVERED
COVERED
THROUGH O/�
11 ELECTION
ELECTION DATE.
ELECTION TYPE
Month Day Year
❑ Primary ❑ Runoff ❑ Other
Description
._.
(' (I
PJrGeneral ❑ Special
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (if known)
GO TO PAGE 2
Forms provided by Texas Ethics Commission wwmethics.state.tx.us Revised 9/26/2019
CANDIDATE I 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 OLmCAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICAL
SUPPORT THE CANDIDATE / OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDERS
COMMITTEE(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, OR
CONTRIBUTIONS MADE ELECTRONICALLY), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS
$
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
EXPENDITURE
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
$
TOTALS
UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES
$
V
CONTRIBUTION
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
BALANCE
OF REPORTING PERIOD
OUTSTANDING
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$
LOAN TOTALS
LAST DAY OF THE REPORTING PERIOD
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
P� UM,&i AMY SHELLEY under Title 15, Election Code.
?x°J n's Natary Public, State of Texas
Comm. Exptres 12-02-2023
Notary ID 12476110.5—
Signature of Candidate'or.. f6caholder
AFFIX NOTARY STAMP/SEALABOVE
( r�
L(�`'Y 1' \ `"Q �{� 1 C(, �l e f.A this the �_ J
Sworn to and subscribed before me, by the said f�
day o - , 209 , to certify which, my hand and seal of i
11NNwitness
5'W`�
Signatur fficer administering oath Prinfigill name of offic dministering oath Title V.1 officer administe)bath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
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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
FILERNAMEJA�j
eC
Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAME07CHEDULE
SUBTOTAL
AMOUNT
1.
f SCHEDULEAI:
MONETARY POLITICAL CONTRIBUTIONS
$
2.
SCHEDULEA2:
NON-MONETARY(IN-KIND)POLITICAL CONTRIBUTIONS
$
3.
SCHEDULE B:
PLEDGED CONTRIBUTIONS
$
4.
SCHEDULE E:
LOANS
$
5.
El SCHEDULE F1:
POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
6.
SCHEDULE F2:
UNPAID INCURRED OBLIGATIONS
$
T.
F� SCHEDULE F3:
PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$
S.
71 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 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 At:
2 FILER NAME `
Ch' - �`eJ�l -7✓r7✓ �i lA� �'
3 Filer ID (Ethics Commission Fliers)
4 Date
5 Full na a of contribu r (
❑ out-of-state PAC ID#: )
IAII
Co�Jnt/i/rybfor/a✓dd7�res�City; � Ziq)Cjod�e /
�
7 Amount of contribution ($)
8 Principal ocypation / Job title (See Instructions) ,,./
"v .07�-6kal'r-- �' 7 5, rol✓u�(-G �
9 Employer (See Instructions)
Date
Full name of contributor ❑ out -of -stale PAC (ID#: )
Contributor address; City; State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (SjInstructions)
Date
Full name of contributor ❑ out-of-state PAC IID#:
Contributor address; City; State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC (ID#: )
Contributor address; City; State; Zip Code
Amount of contribution ($)
—T
Principal occupation / Job title (See Instructions)
--
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS 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
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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-af-state PAC (ID#: )
7 Contributor address; City; State; 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 firm of parent(s) (if any) (FOR JUDICIAL)
Date
i
Full name of contributor ❑ out-of-state PAC (ID#: )
Contributor address; City; State; 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)
Contributor's job title (FOR JUDICIAL)(See Instructions)
Contributor's employer/law firm (FOR JUDICIAL)
Law firm of contributor's an (' spouse if
p y) (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
1 Total pages Schedule B:
The Instruction Guide explains how to complete this form.
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED PLEDGES
$
5 Date
5 Full name of pledgor ❑ out-of-state PAC (lo#: )
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
g out-of-state PAC pD#: )
Full name of pledgor
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)
Dateout-of-state
Full name of pledgor ❑ PAC (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)
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)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
ra../
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
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Forms provided by Texas Ethics Commission www.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)
4
TOTAL OF UNITEMIZED LOANS
$
5
Date of loan
7 Name of lender
. . . . . . . . . . . . . .
8 Lender address;
E] out-of-state PAC(IID#: 1
. . . . . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
9 Loan Amount ($)
6 Is lender
10 Interestrate
a financial
Institution?
11 Maturity date
Y N
12
Principal occupation / Job title (See Instructions)
13 Employer (See Instructions)
14
Description of Collateral
15
Check if personal funds were deposited into political
El
❑ none
account (See Instructions)
16
GUARANTOR
17 Nameofguarantor
19 Amount Guaranteed($)
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
. . . . . . . . . . . . . .
Lender address;
❑ out-of-state PAC (ID#: )
. . . . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
Loan Amount ($)
Is lender
Interest rate
a financial
Institution?
Maturity date
Y N
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Description of Collateral
❑ Check if personal funds were deposited into political
❑ none
account (See Instructions)
GUARANTOR
Name of guarantor
Amount Guaranteed ($)
INFORMATION
. . . . . . . . . . . . . .
Guarantor address;
. . . . . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
❑ not applicable
Principal Occupation (See Instructions)
77
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
SCHEDULE F1
FROM POLITICAL CONTRIBUTIONS
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense
Event Expense Loan Repaymam/Reimbursement
Solicitation/Fundraising Expense
Acommiting/Banking
Fees Office Ovemead/Rental Expense
Transportation Equipment& Related Expense
Consulting Expense
FoodlBeverage Expense Polling Expense
Travel In District
Co bibutions/Donations Made By Gift/Awards/Memorials Expense Printing Expense
Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SaladesAVages/Conhact Labor
Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule Fl:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City;
State; Zip Code
$
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(C) ❑ Check iftrivelcutside of Texas. Complete Schedule T. 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 ($)
Payee address; City;
State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check if travel outside offems. Complete Schedule L Check if Austin,
TX, officeholder living expense
Complete ONLY if direct
Candidate / Officeholder name Office sought
Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City;
State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check iftmvel outside of Texas. Complete 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 SCHEDULEAS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised U/Ai/1019
r -
UNPAID INCURRED OBLIGATIONS
SCHEDULE F2
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense
Event Expense Loan Repayment/Reimbursement
Sollcitation/Fundraising Expense
Accounting/Banking
Fees Office Overhead/Rental Expense
Transportation Equipment& Related Expense
Consulting Expense
Food/Beverage Expense Polling Expense
Travel In District
ConidbutionalConations Made By Glit/AWardsrMemedals Expense Printing Expense
Travel Out Of District
Candidate/Officeholdedleolitical Committee Legal Services Saladea/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 FILERNAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS
$
5 Date
6 Payee name
7 Amount ($)
8 Payee address; City;
State; Zip Code
9 TYPE OF
Political Non -Political
EXPENDITURE
10
(a) Category (See Categories listed at the lop of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(C) Check'diravei outside of Texas. Complete Schedule T ❑ Check if Austin, TX, officeholder living expanse
11 Complete ONLY if direct
Candidate / Officeholder name Office sought
Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City;
State; Zip Code
TYPE OF
❑ Political ❑ Non -Political
EXPENDITURE
Category (Sea Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check Rtravel outside of Texas. Complete 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
PURCHASE OF INVESTMENTS MADE SCHEDULE F3
FROM POLITICAL CONTRIBUTIONS
The Instruction Guide explains how to complete this form.
I Total pages Schedule F3:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Name of person from whom investment is purchased
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 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 w .ethics.stete.tx.us Revised 9/26/2019
C
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/aeverage Expense Polling Expense
Travel In District
ConMbutiens/Donations Made By Gilt/Awards/Memorials Expense Printing Expense
Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SaladesM/ages/Conmect 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 UNITEMIZED
EXPENDITURES CHARGED TOACREDIT CARD
$
5 Date
6 Payee name
7 Amount ($)
8 Payee address; City;
State; Zip Code
9 TYPE OF
Political ❑ Non -Political
EXPENDITURE
10
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check ifinvel outside of Texas. Complete Schedule T. ❑ Check if Austin, TX, officeholder living expense
11
Candidate / Officeholder name Office sought
Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City;
State; Zip Cade
TYPE OF
EXPENDITURE
F-1 Political 71 Non -Political
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check fftravelouaide of Texas. Complete Schedule T. ❑ Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought
Office held
Complete ON LV 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
SCHEDULE G
MADE FROM
PERSONAL FUNDS
EXPENDITURE CATEGORIES FOR SOX 8(a)
Advertising Expense
Event Expense Loan Repayment/Reimbursement
Salicifation/Fundraising Expense
Accounting/Banking
Fees Office Overmead/Rental Expense
Transportation Equipment B Related Expense
Consulting Expense
Food/Beverage Expense Polling Expense
Travel In District
Contributions/Donations Made By
GilbAwards/Mamonals Expense Panting Expense
Travel Out Of District
Candidate/OfficeholdedPolitical 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 G:
2
FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5
Payee name
6 Amount ($)
7
Payee address; City;
State; Zip Code
❑Reimbumementhrom
political contributions
intended
g
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check iftraveloubide of Texas. Complete Schedule T Check if Austin, TX, officeholder living expense
9
Candidate / Officeholder name Office sought
Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City;
State; Zip Code
❑Reimbursamemfmm
polificalcontnbutions
Intended
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check Vial oul afTexas. 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
Date
Payee name
Amount ($)
Payee address; City;
State; Zip Code
Reimbumementfmm
Elpolitical contributions
intended
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check Iftravel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expanse
Candidate / Officeholder name Office sought
Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Farms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
r
PAYMENT MADE FROM POLITICAL
CONTRIBUTIONS TO A BUSINESS OF C/OH SCHEDULE H
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Acccunting/Banking Fees Office Ovemead/Rental Expense Transportation Equipment& Related Expense
Consulting Expense Fcod/Severage Expense Polling Expense Travel In District
Contributions/Donadons Made By GiItAwards/Memodals Expense Printing Expense Travel Out Of District
Candidata/Officeholder/Political Committee Legal Services Salades/Wages/Contract Labor Other (enter a category not isted above)
Credh Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Business name
S Amount ($)
7 Business address; City; State; Zip Code
a
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check ifirsvelcutside of Texas. Complete Schedule T. F-1 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 ($)
Business address; City; State; Zip Code
Category (See Categores listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check ifiravel outside of Texas. Complete Schedule T. Ll Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Business name
Amount ($)
Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
❑ Check if travel cutede of Texas. Complete Schedule L 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 vnvw.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 l:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City State Zip Code
6
(a)Category (See Instructions for examples of acceptable
(b)Description (See instructions regarding type of information
PURPOSE
categories.)
required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
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
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
PURPOSE
categories.)
required.)
OF
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission w .ethics.state.tx.us Revised 9/26/2019
Q—
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER SCHEDULE K
The Instruction Guide explains how to complete this form.
7 Total pages Schedule K:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 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 ($)
7 Purpose for which amount is received F--] Check if political contribution returned to filer
Date
Name of person from whom amount is received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Amount ($)
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 ($)
Purpose for which amount is received F7 Check if political contribution returned to filer
Date
Name of person from whom amount is received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Amount ($)
Purpose for which amount is received Check if political contribution returned to flier
ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS 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
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
7 Name of person(s) traveling
S Departure city or name of departure location
9 Destination city or name of destination location
70 Means of transportation
11 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 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)
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 Ft
❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COH-UC ❑ 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 "Report Type" on page 'I 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:
I do not have unexpended contributions or unexpended interest or income earned from political contributions.
F-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:
0 I do not retain assets purchased with political contributions or interest or other income from political contributions.
0 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