Williamson Semi Jan 2015Texas Ethics Commission P.O. Box 12070 Austin: Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CANDIDATE ! OFFICEHOLDER FORM C101-1
CAMPAIGN FINANCE REPORT COVER SHEET PG 1.
1 ACCOUNT #
2 Total pages filed:
The C10H Instruction Guide explains how to complete this form.
(Ethics Commission Fliers)
3 CANDIDATE /
MSIM M FIRST MI
OFFICE USE ONLY
OFFICEHOLDER,
f`
Date Receives HLQL
NAME
Ak—
..
NICKNAME . ... .LAST_ - . .. .._ .. SUFFIX
A }� (J! GL/✓1�i'u SO 4-)
O'''CJJj
J01 - 6 2015
4'
4 CANDIDATE I
ADDRESS IPO BOX; APTISUITE#, CITY; STATE; ZIPCODE
OFFICEHOLDER
MAILINADDRESS
�
°I'1iEii 1 T r7C+RE
❑ change of address
Recefpt #
Amount
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
Date Processed
OFFICEHOLDER//
[� �/�
PHONE
6 CAMPAIGN
TREASURER
MS & MR FIRST MI Date Imaged
A,
NAME
.✓'.1 +."�. . . . . . . .
NICKNAME LAST SUFFIX
ljitr G! Au ..
7 CAMPAIGN
STREETADDRESS (NO PO BOX PLEASE); APTISUITE#; CITY; STATE; ZIPCODE
TREASURER
ADDRESS
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
9 REPORT TYPE
January 15 301h day before electionRunoff 15th day after campaign
treasurer appointment
- - - - {officeholderenly)
❑ July 15 El Bth day before election ❑ Exceeded $500 ❑ Final report (Attach CIOH . FR)
limit
10 PERIOD
Month ON Year Month Day Year
COVERED
471 rl�df� THROUGH
11 ELECTION
ELECTIONDATE
ELECTIONTYPE
Montle Day Year
❑ Primary F-1 Runoff General Special
12 OFFICE
OFFICE HELD (ifany) -
13 OFFICESOUGHT (lfknoi - -
GO TO PAGE 2
www.ethics.state.tx.us Revised 07/28/2014
ARY
Texas Ethics Commission P.O.Box 12070 Austin, Texas 78711-2070 .(512) 463-5800 (TDD 1-800=735-2989)
CANDIDATE/ OFFICEHOLDER REPORT. FORM CIOH
SUPPORT & TOTALS COVER SHEET PG 2
14 C/OH NAME
ACCOUNT# (Ethics Commission Filers)
16 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLmCAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPDRT THE
POLITICAL
CANDIOATE I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE's OR OFFICEHOLDERS KNOWLEDGE OR
COMMITTEE (S)
CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEE NAME
COMMITTEE TYPE
GENERAL
COMMITTEE ADDRESS
0 SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME ..
additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
@@
TOTALS
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
$ Lry
2. TOTAL POLITICAL CONTRIBUTIONS
!,
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
C/
EXPENDITURE
3. TOTAL POLITICAL EXPENDITURES OF OR LESS, UNLESS ITEMIZED
$ O
TOTALS
$100
4. TOTAL POLITICAL EXPENDITURES
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY(�
OF
$ a r
REPORTING PERIOD
OUTSTANDING
LOAN TOTALS
8 TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$ %
LAST DAY OF THE REPORTING PERIOD
• /
18 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the accompanying report
is true and correct anl includes all: information required to be reported by
me under Title 1I/Olepion Code.
�►*" LOR# PAYNE
NOTARY PUBLIC Signature of Candidate or Officeholder
COWB MON:70.lOU.
°F '1110-27-20-117
AFFIX NOTARY STAMP / SEAL ABOVE
Swornt and subscribed before me, by the said a W i, ` this the
LO Wu 20
_ day of , _ , to certify which, witness my.hand and seal of office.
— ll -n
Signature of officer adf. istering oath Printed name of o ceradministering oath Title orofficer administering o th
www.ethics.state.lx.us Revised 07/28/2014