Muller Semi July 2015TaYas Fthics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT
COVER SHEET PG 1
1 ACCOUNT #
2 Total pages filed:
The C/OH Instruction Guide explains how to complete this form.
(Ethics Commission Filers)
3 CANDIDATE /
/MRS/MR FIRST
MI
OFFICE USE ONLY
OFFICEHOLDER
Date Received
NAME
-� yj f
j. }
SUFFIX
/
REGENED
NICKNAME LAST
/; L
J U L 14 2015
4 CANDIDATE /
ADDRESS / PO BOX; APT/ SUITE #; CITY; STATE; ZIP CODE
OFFICEHOLDER
MAILING
ADDRESS
_ 7X 76'()Y.2Date
Hand -delivered or Postmarked
OFFICE OF CITY SECRETAFf
change of address
Receipt #
Amount (�6
5 CANDIDATE/
AREA CODE PHONE NUMBER
EXTENSION
Date Processed
OFFICEHOLDER
( F/ 7 6' /
PHONE
6 CAMPAIGN
MS/MRS/MR FIRST
MI
Date Imaged
TREASURER
//
NAME..........
.....................
NICKNAME LAST
SUFFIX
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT/SUITE#;
CITY; STATE;
ZIPCODE
TREASURER
ADDRESS
(residence or business).,
/',-, , i :
y
T �f� e -
8 CAMPAIGN
AREA CODE PHONE NUMBER
EXTENSION
(5 7 ` !4; _0
PHONE
PHO
.
9 REPORT TYPE
❑ January 15 30th day before election
Runoff
15th day after campaign
treasurer appointment
(officeholder only)
July 15 8th day before election
F-1 Exceeded $500
❑ Final report (Attach C/OH - FR)
limit
10 PERIOD
Month Day Year
Month Day
Year
COVERED
THROUGH
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
ElPrimary
Runoff F\ General Special
L:;;Ir
/P 7 //� f /.c e 5�
12 OFFICE
OFFICE HELD (if any)
13 OFFICESOUGHT (ifknown)
en r C /IJ C/
GO TO PAGE 2
www.ethics.state.tx.us Revised 07/28/2014
.41pr
Tcvnc Pfhie c r .nmmicsinn Po Rnx 17070 Austin. Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CANDIDATE / OFFICEHOLDER REPORT: FORM C/OH
SUPPORT & TOTALS COVER SHEET PG 2
14 C/01-11 NAME
15 ACCOUNT # (Ethics Commission Filers)
�1
16 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE
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
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
Q
$
TOTALS
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
a a O
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
J
EXPENDITURE
OF OR LESS, UNLESS ITEMIZED
TOTALS
3. TOTAL POLITICAL EXPENDITURES $100
4. TOTAL POLITICAL EXPENDITURES
$ r242 -P
CONTRIBUTION
5 TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE
OF REPORTING PERIOD
T
OUTSTANDING
6 TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$
'V
LOAN TOTALS
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
BRANDI HARRIS GARLOCK me under Title 15, Election Code.
P: Notary Public, State of Texas
..�� My Commission Expires
E"'
10, 2016 �0.�h-,der
�,,gn�atur-Candidat
`August
��„
AFFIX NOTARY STAMP / SEAL ABOVE
Q
Sworn to and subscribed before me, by the said `�c,r this the
day of % , 20 \S , to certify which, witness my hand and seal of office.
c 01��3 JJankm- fat GJ\&I Ywtr� s �a i\L��c. Wp-v..., � b\�L
Signature of officer administering oath Printed name of officer administering oath Title of offl4r administering oath
www.ethics.state.tx.us Revised 07/28/2014
TPYnQ Fthirrc C nmmissinn P O_ Box 12070 Austin. Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
POLITICAL CONTRIBUTIONS SCHEDULE A
OTHER THAN PLEDGES OR LOANS
1 Total pages Schedule A:
The Instruction Guide explains how to complete this form.
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
C4F,2
IVe= M v 44,,---R-
4 Date
4
5 Full name of contributor ❑ out-of-state PAC(ID#: )
7 Amount of 8 In-kind contribution
contribution ($) description (if applicable)
/yam c ��..tr AtJdQ�
I
y/%A71
6 Contributor address; City; State; Zip Code
/X/
I
(If travel outside of Texas, complete Schedule T)
9 Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Date
Full name of contributor ❑ out-of-statePAC (ID#: )
Amount of I In-kind contribution
contribution ($) description (if applicable)
.S 172117 Ij 2
W /7%/f y
Contributor address; City; State; Zip Code
mors
2 3 /�.� 57GC>dZ3� �2 s k 7e-o?,.,—
Go?,.,—If
(iftravel outside of Texas, complete Schedule T
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
/ZF 7//LKil.�
Date
Full name of contributor ❑ out-of-state PAC (ID# )
Amountof In-kind contribution
S
contribution ($) description (if applicable)
Cf/rz%l
G M/.j'
Contributor address; City; State; Zip Code
a 3 s k 740? z
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
J
Date
Full name of contributor ❑ out-of-state PAC (ID#: )
Amount of I In-kind contribution
contribution ($) I description (if applicable)
Contributor address; City; State; Zip Code
I
If travel outside of Texas complete Schedule
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor out -of -state PAC (ID#: >
Amount of In-kind contribution
contribution ($) description (if applicable)
Contributor address; City; State; Zip Code
If travel outside of Texas, complete Schedule
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 foradditional reporting requirements.
www.ethics.state.tx.us Revised 07/28/2014
ToYas Fthirrs Cnmmission P_O. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
PLEDGED CONTRIBUTIONS SCHEDULE B
1 Total pages Schedule B:
The Instruction Guide explains how to complete this form.
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED PLEDGES: C b b
$
5 Date
6 Full name of pledgor ❑ out-of-state PAC (11W )
8 Amount of 19 In-kind description
pledge ($) (if applicable)
7 Pledgor address; City; State; Zip Code
(If travel outside of Texas, complete Schedule T)
10 Principal occupation / Job title (See Instructions)
11 Employer (See Instructions)
Date
Full name of pledgor ❑ out-of-state PAC (ID#: )
Amount of I In-kind description
pledge ($) (if applicable)
Pledgor address; City; State; Zip Code
(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 I In-kind description
pledge ($) (if applicable)
Pledgor address; City; State; Zip Code
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of pledgor ❑ out-of-state PAC (ID#: )
Amount of In-kind description
pledge ($) (if applicable)
Pledgor address; City; State; Zip Code
(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 description
pledge ($) I (if applicable)
Pledgor address; City; State; Zip Code
(If travel outside of Texas, complete Schedule 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.
www.ethics.state.tx.us Revised 07/28/2014
Tavac Pthirc (:nmmicsinn P O_ Box 12070 Austin. Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
www.ethics.state.tx.us Revised 07/28/2014
LOANS
SCHEDULE E
1 Total pages Schedule E:
The Instruction Guide explains how to complete this form.
2
FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4
TOTAL OF UNITEMIZED LOANS: C*
$
5
Date of loan
7 Name of lender ❑ out-of-state PAC (ID#:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 Lender address; City, State; Zip Code
9 Loan Amount ($)
6 Is lender
10 Interest rate
a financial
Institution?
11 Maturity date
Y N
12
Principal occupation / Job title (See Instructions)
13 Employer (See Instructions)
14
Description of Collateral
15 Check if personal funds were deposited into political account
❑ none
❑
16
GUARANTOR
17 Nameofguarantor
19 Amount Guaranteed($)
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 ❑ out-of-state PAC (ID#:
Lender address; City; State; Zip Code
Loan Amount ($)
Is lender
Interest rate
a financial
Institution?
Maturity date
Y N
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Description of Collateral
Check if personal funds were deposited into political account
❑ none
❑
GUARANTOR
Name of guarantor
Amount Guaranteed ($)
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.
www.ethics.state.tx.us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
POLITICAL EXPENDITURES SCHEDULE F
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made By
Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F:
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4 Date
5 Payee name
S
(2 csr, 5 7AA1
6 Amount ($)
7 Payee address; City; State; Zip Code
% / G
/�° G / % %' %�f'/� �c� ✓r.'c 'i rJ i */ASC?/t/� N
8 PURPOSE
(a) Category (See categories listed at the top. of this schedule)
(b) Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE/.
��/ f1 `�
Check ifAustin, TX, living
❑ officeholder expense
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH �/,/", /_ 'fr�/17 � --
I'�^ U .
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
L`7 &./0 2 7
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
lL/
❑ Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH �jc./// e' ',r�J��J/ A
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
PURPOSE
OF
/1`iiT7i� !G
EXPENDITURE
Check if Austin, TX, officeholder livingexpense
❑ P
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OHJ�j//_—
Date
Payee name
Q
V Ss S
Amount ($)
Payee address; City; State; Zip Code
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
PURPOSE
OF
EXPENDITURE
4z'
V0 S
❑ 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
www. ethics. state.tx. us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
POLITICAL EXPENDITURES
SCHEDULE G
MADE FROM PERSONAL FUNDS
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made By
Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G:
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
!� Reimbursement from
2/ L1
u political contributions
/
intended
$ PURPOSE
(a) Category (See categories listed at the top of this schedule)
(b) Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
El Check if Austin, TX, officeholder living expense
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Check if Austin, TX, officeholder living expense
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Reimbursement from
F-1 political contributions
intended
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Check if Austin, TX, officeholder living expense
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Reimbursement from
F-1 political contributions
intended
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Check if Austin, TX, officeholder living expense
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www. eth i cs . state. tx. us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
PAYMENT FROM POLITICAL CONTRIBUTIONS
SCHEDULE H
TO A BUSINESS OF C/OH
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made By
Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H:
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4 Date
5 Business name
6 Amount ($)
7 Business address; City; State; Zip Code
8 PURPOSE
(a) Category (See categories listed at the top of this schedule)
(b) Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
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 ($)
Business address; City; State; Zip Code
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate /Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Business name
Amount ($)
Business address; City; State; Zip Code
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Ej 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 ($)
Business address; City; State; Zip Code
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www. eth i cs. state. tx. us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
NON-POLITICAL EXPENDITURES SCHEDULE I
MADE FROM POLITICAL CONTRIBUTIONS
The Instruction Guide explains how to complete this form.
1 Total pages Schedule is
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
8 PURPOSE
OF
EXPENDITURE
(a)Category (See instructions for examples of acceptable
categories)
(b) Description (See instructions regarding type of information
required.)
Date
Payee name
Amount ($)
Payee address; City, State; Zip Code
PURPOSE
OF
EXPENDITURE
(a) Category (See instructions for examples of acceptable
categories)
(b)Description (See instructions regarding type of information
required.)
Date
Payee name
Amount ($)
Payee address, City; State; Zip Code
PURPOSE
OF
EXPENDITURE
(a) Category (See instructions for examples of acceptable
categories)
(b) Description (See instructions regarding type of information
required.)
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
PURPOSE
OF
EXPENDITURE
(a) Category (See instructions for examples of acceptable
categories)
(b) Description (See instructions regarding type of information
required.)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
INTEREST EARNED, OTHER CREDITS/GAINS/
SCHEDULE K
REFUNDS, AND PURCHASE OF INVESTMENTS
The Instruction Guide explains how to complete this form.
1 Total pages Schedule K:
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4 Date
5 Name of person from whom amount is received
8 Amount
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6 Address of person from whom amount is received; City; State, Zip Code
7 Purpose for which amount is received
Date
Name of person from whom amount is received
Amount
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
Date
Name of person from whom amount is received
Amount
($)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City, State; Zip Code
Purpose for which amount is received
Date
Name of person from whom amount is received
Amount
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www. ethics. state. tx. us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
IN-KIND CONTRIBUTION OR POLITICAL EXPENDITURE SCHEDULE T
FOR TRAVEL OUTSIDE OF TEXAS
The Instruction Guide explains how to complete this form.
1 Total pages Schedule T:
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
4 Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
5 Contribution / Expenditure reported on:
❑ Schedule A ❑ Schedule B ❑ Schedule C ❑ Schedule D ❑ Schedule F ❑ Schedule G
❑ Schedule H ❑ Schedule N ❑ COH-UC ❑ COH-T ❑ PAC -C ❑ PAC -E
6 Dates of travel
7 Name of person(s) traveling
8 Departure city or name of departure location
9 Destination city or name of destination location
10 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 A ❑ Schedule B ❑ Schedule C ❑ Schedule D ❑ Schedule F ❑ Schedule G
❑ Schedule H ❑ Schedule N ❑ COH-UC ❑ COH-T ❑ PAC -C ❑ PAC -E
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 A ❑ Schedule B ❑ Schedule C Schedule D ❑ Schedule F ❑ Schedule G
❑ Schedule H ❑ Schedule N ❑ COH-UC ❑ COH-T ❑ PAC -C ❑ PAC -E
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
www.ethics.state.tx.us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CANDIDATE/ OFFICEHOLDER REPORT:
FORM C/OH - FR
DESIGNATION OF FINAL REPORT
The Instruction Guide explains how to complete this form.
•• Complete only if "Report Type" on page 1 is marked "Final Report" ••
1 C/OH NAME
2 ACCOUNT # (Ethics Commission Filers)
3 SIGNATURE
I do not expect any further political contributions or political expenditures in connection with my candidacy. I understand that designating 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 NOT AN 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:
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 ••
0 I am aware that I remain subjectto filing requirements applicable to an officeholderwho 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 political
contributions or interest or other income from political contributions.
Signature of Officeholder
www. ethics. state. tx. us Revised 07/28/2014