Muller Semi Jan 2015Texas Ethics Commission PO. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CANDIDATE 1 OFFICEHOLDER FORM CIOH
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 Filers)
3 CANDIDATE/
1MRS IMR FIRST MI
OFFICE USE ONLY
OFFICEHOLDER
IMICINVED
NAME
Date Received
NICKNAME LAST SUFFIX
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JAN 13 2015
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4 CANDIDATE /
ADDRESS IPOBOX; APTISUITE#; CITY; STATE; ZIP CODE
OFFICEHOLDER
MAILING
ADDRESS
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Dat e' MSEC
❑ change of address
Receipt #
Amourn
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
Date Processed
OFFICEHOLDER/
PHONE
1
i 8%%J --Ige -DQ g
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B CAMPAIGN
MSIMRSIMR FIRST MI Date lmaged
TREASURER
r-�f /
NAME......................
NICKNAME LAST SUFFIX
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7 CAMPAIGN
STREETADDRESS (NOPOBOXPLEASE); APTISUITE#; CITY; STATE; ZIPCODE
TREASURER
ADDRESS
(residence or business)
11 27 1j 6
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
l U
PHONE
9 REPORT TYPE
January 15 301h day before election ❑ Runoff ❑ 15th day after campaign
treasurer appointment
(oFficeholderonly)
❑ July 15 ❑ 8th day before election ❑ Exceeded $500 ❑ Final report (Attach CICH - FR)
limit
10 PERIOD
Month Day Year Month Day Year
COVERED
` 2 O THROUGH
11 ELECTION
ELECTION DATE
ELECTIONTYPE
Month Day Year
Runoff L J General Special
❑ Primary ❑ IJ ❑
12 OFFICE
OFFICE HELD (ifany)
13 OFFICESOUGHT (Ifknown)
C-/�"y
GO TOPAGE 2
www.ethics.state.tx.us Revised 07/28/2014
rARY
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CANDIDATE I OFFICEHOLDER REPORT FORM CIOH
SUPPORT & TOTALS COVER SHEET PG 2
14 C/OH NAME
15 ACCOUNT # (Ethics Commission Filers)
18 NOTICE FROM
THIS BOX IS FOR NOTICE
OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITfEESTOSUPPORTTHE
POLITICAL
CANDIDATE /OFFICEHOLDER.
THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES 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
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
additional pages
COMMITTEE= CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
TOTALS
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)
v
EXPENDITURE
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED
Q
$
TOTALS
4. TOTAL POLITICAL EXPENDITURES
CONTRIBUTION
BALANCE
5 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
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 under Title 15, Election Code.
----------------
LORI PAYNE
NOTARY PUBLICME
eom ammwIP n:
ar 0..27_20 17 Signa#fie of Candidate or Officeholder
AFFIX NOTARY STAMP I SEAL ABOVE P f
P�iVIPi a- �G[.(le- ec
Sworn and subscribed before me, by the said —this the
day J&PIL11111I20
of Wto certify which, witness my hand and seal of office.
Signature of officer ad I istering oath Printed name of offiler administering oath Titletof officer administerin oath
www.ethics.state.tx.us Revised 07/28/2014