OFFICEHOLDER FORM 
CAMPAIGN FINANCE REPORT COVER SHEET PG 1

 

 

1 Filer ID (Eihlcs Commission Fliers) 2 Total pages ?led:
The CIOH Instruction Guide exphins how to complete this form.

 

 

 

 

    

 

 

3 MSIMRSI MR FIRST M.
OFFICEHOLDER OFFICE USE ONLY
NAME . . DYI . . . annI I pf Date Received
NICKNAME LAST SUFFIX
\Ifnmf We 0A
4 ADDRESS I PO APT I SUITE ZIP CODE

OFFICEHOLDER
MAILING

ADDRESS M02 145? $47} IQIIZII

Change of Address

 

 

 

 

 

 

 

 

 

 

5 CANDIDATE AREA CODE PHONE NUMBER EXTENSION 
OFFICEHOLDER Dale Hand-delivered Date Postmarked-
PHONE 6250 4(9g2404

CAMPAIGN MS I MRS I MR FIRST MI Hecelm Amount 5
TREASURER 

NAME . . DirDate Processed
NICKNAME LAST SUFFIX 
Dale lmaged
6} 

7 CAMPAIGN STREET ADDRESS (N0 Po BOX APTI SUITE Ir; cm; ZIP CODE
TREASURER 
ADDRESS ?1?2 5 Wu Amie, ?Ea-o ?l 

(Residence or Business) .

Gift) TX 
a CAMPAIGN AREA CODE PHONE NUMBER EXTENSION

. -.
(rm ago



 

9 REPORT TYPE

 

 

 

 

 

 

 

 

I: January 15 30m day before election El Runoff 15th day alter campaign
Heasurerappoinlment
(0?iceholder On Iy]

July 15 CI 8th day before eIecIion Exceeded$500 imi1 Final Report (Attach CIDH FR)

10 PERIOD Month Day Year Month Day Year
COVERED 02 i 2? -
20M THROUGH 6-3 /2g 

11 ELECTION ELECTION DATE ELECTION TEE 

Month Day Year Primary Runo? 0thef_ .

Descriptlon

66 04 /Zdl? General Special

12 OFFICE OFFICE HELD [if any) I 13 OFFICE SOUGHT (if known)

NM @7139 564%. Trw'skc/
flag: 3

 

 

 

 

 

 

 

GO TO PAGE 2

 

 

 

Forms provided by Texas Ethics Commission Revised 9l8l2015

 

CANDIDATEI OFFICEHOLDER FORM cm?
CAMPAIGN FINANCE REPORT COVER SHEET PG 2

 

 

 

 

15 Filer ID (Ethics Commission Filers)

.i 

_14 NAME

 

 

16 NOTICE FROM THIS 30): Is FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED 0R EXPENDRURES MADE av POLITICAL To
POLITICAL SUPPORT THE OFFICEHOLDER. THESE EXPENDITURES IMV HAVE BEHJ MADE THE CANDIDATE's OR 
COMM S) KNOWLEDGE on CONSENT: CANDIIATES AND ARE REDUIRED To REPORT THIS INFORMATION ONLY THEY RECEIVE NOTICE

OF SUCH EXPENDITURES.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMMITTEE TYPE COMMITTEE NAME

GENERAL 
COMMITTEE ADDRESS I
DSPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME 
Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS 7
17 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN 
TOTALS PLEDGES. LOANS. 0R GUARANTEES OF LOANS), UNLESS ITEMIZED I 4 C7
2. TOTAL POLITICAL CONTRIBUTIONS . I
(OTHER THAN PLEDGES. LOANS. OR GUARANTEES OF LOANSTOTAL POLITICAL EXPENDITURES OF $100 OR LESS, 
UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES 4gb 7

5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY 2 .
0F REPORTING PERIOD 4&2- 5 I
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD 35 

 

 

 

 

 

 

 

 

1e AFFIDAVIT
lswear, or altinn, under penalty of perjury, that the accompanying report is
tme and correct and includes all information required to be reported by me

 

r'

underTItle 15, Election Code.
55% CARMEN 



or can. Inna-294020 . . .
SI@ot Candidate or Officeholder

AF FIX NOTARY SEALABOVE



 

 

 

 

 

 

 

I .
Sworn to and subscribed before me. by the said thi it if . this the certify which. witness my hand and seal Of Office.
fix? .
ELL - . "Mg; I Ci WIN: "In; Lia 
Signature of Officer administering oath Printed name of officer administering oath of Officer administering oath

 

 

 

Forms provided by Texas Ethics Commission Revised 9/8l2015

 

SUBTOTALS - CIOH

FORM CIOH
COVER SHEET PG 3

 

 

19 FILER NAME

21 SCHEDULE SUBTOTALS
NAME OF SCHEDULE

JEWWIEW 

 

 

20 Filer ID (Ethics Commission Filers)

SUBTOTAL

 

SCHEDULE A1 MONETARY POLITICAL CONTRIBUTIONS

 

 

SCHEDULE B: PLEDGED CONTRIBUTIONS

 

SCHEDULE E: LOANS

 

 

 

 

SCHEDULE F2: UNPAID INCURRED OBLIGATIONS

 

 

 

SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD

 

 

EELS EL

 

RETURNED TO FILER

11- SCHEDULE I: EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS

 

 

 

 

 

AMOUNT
$38110
SCHEDULE A2: NONMONETARY (IN-KIND) POLITICAL CONTRIBUTIONS 


SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS 354% (off
5
SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS 
5
SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS 5 I 06'?
SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF CIOR 

SCHEDULE INTEREST, CREDITS, GAINS. REFUNDS. AND CONTRIBUTIONS 

 

 

 

 

Forms provided by Texas Ethics Commission



Revised 918/2015

 

MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A1

 

 

 

The Instruction Guide explains how to complete this form. 1 Tom pages SChedule 

 

2 FILER 3 Filer ID (Ethics Commission Filers)

Ck 

4 Date 5 Full name of contributor out-oi-stale pAc ?Du; 7 Amount of contribution 

615524 
Galaq/ i1 .6. Contributor address; City; State; ?Zip code I 76 8?6)

moi ?lm? Fla ITQJC ??wTi?wnT 7563;; 

8 Principal occupation I Job title (See Instru oins) Employer (See Instructions)
{64:129?

Date Full name of contributor CI out-of-siaie PAC Amount of contribution 

61?? Q'I?li?dr?xe. . -. .. 
613/2411 Contributi address: City; State; Zip Code $134635

7J3 we fsiiy?gg 

Principal occupation I Job title (See Instructions) Employer (See Instructions)

 

 

 

 

 

 

 

 

 

Date Full name of contributor out-of?stale PAC 1 Amount of contribution (55)

6155/29?? Loom State; Zip code $57930

9190 

 

 

 

 

 

 

 

 

 

 

 

Principal occupation I Job title (See Employer (See Instructions)

{(17 V64) 
Date name 0? contributor out?ot-stale PAC "Dir: Amount of contribution 

?ll'lj?i? . WMA . if 676' 82)
Contributor address; City: State; Zip Code
340 2 an dj? "bl (L HMKW 31301113 

Ia?fi? 

Principal occupation I Job title (See Instnictions) Employer (See Instructions)

T519 

 

 

 

 

ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
II contributor is out-ot-state PAC, please see instruction guide for additional reporting requirements.

 

 

 

Forms provided by Texas Ethics Commission Revised 9/812015

 

POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F1

 

 

 

EXPENDITURE CATEGORIES FOR BOX 8(a)

Adve rtis I my Expe se Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense

Accountinnganking F23 Of?ce Overhead/RentalExpense Transportation Equipment 8. Related Expense

Corsulting Expense FoodIBeverage Expense Polling Expense Travel in District

Cormibutionleonations Made By Gift/Awards/Memorials Expense Printing Experse Travel OutOf District
CardidatelOtTrceholdedPoitical Committee Legal Services Sab?eleages/Contract Labor Other [enter a category not Isted above)

Credit Card Payment

The Instruction Guide explains how to complete this form.

 

 

 

 

 

 

 

 

 

 

 

 

 

1 Total pages Sghedule F1: 2 FILER NAME . - I 3 Fiat If) (Eifcs Commission Filers)
4/ Jammie-r Wood
4 Date 5? Payee name . 
O?/aif/Za?- Burl am 51514. (an/k
3 Amount 7 Payee address; City; State: Zip Code
4% - (a [/52 5A simmer/mu Sade {0a, A or sin, ?66 745 3-58
?3 Category (See Cgegories listed at the top at this schedule) Description
PURPOSE Check iftravel outside of Texas. Complete Schedub T.
OF A V5 717 '3 Check if Austin, Tx. Officeholder living expense
EXPENDITURE - - 913 f? P671455
3 Complete ONLY it direct Candidate I Officeholder name Office sought Office held_ 

expenditure to benefit CIOH

 

 

 

 

 

 

 

 

 

 

 

Date Payee name
Amount (55) Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE 1: Checkiftravel outside of Texas. Complete Schedule T.
OF El Check it Austin. TX. office-holder living expense
EXPENDITURE
Complete ONLY if direct Candidate Officeholder name 1 Office sought Office held

expenditure to benefit CIOH

 

 

 

 

 

 

 

 

 

 

Date Payee name 
Amount (i5) Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE Check ifltavet Dimide of Texas. Complete Schedule T.
OF Check if Austin, TX. o?iceholder living expense
EXPENDITURE
Complete ONLY it direct Candidate I Officehoider name Office sought Office held

Expenditure to benefit CIOH

 

ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED

 

 

 

Forms provided by Texas Ethics Commission Revised 9I8l2015

 

Advertising Expense

Consulting Expense

Credt Card Payment

1 Total pages Schedule G:

4 Date

o%/05/%11

Connibu?ons/Donations Made By
CandhatelOf?whober/Poitical Committee

POLITICAL EXPENDITURES
MADE FROM PERSONAL FUNDS

SCHEDULE 

 

EXPENDITURE CATEGORIES FOR BOX 8(a)

Event Expense Loan Repaymenti?einbutsemenl
Fees Of?ce Overheadl?ental Expense
FoodIBeverage Expense Poling Expense
GirlIAwardsIMemolials Expense Printing Expense

Legal Services Sah?esANageleormact Labor

The Instruction Guide explains how to complete this form.

Solicitatioanundraising Experse
Transportation Equipment& Related Expense
Travel In District

Travel Out OI District

Other (enter a category not isted above)

 

 

 

2 FILER NAME 

f?I?m?iQ/r Weak-

 

3 Filer ID (Ethics Commission Fliers]

 

- 5? Payee name

twig, may?

 

 

6 Amount 

{c3160


political contributions
Intended

PURPOSE
OF
EXPENDITURE

9 Complete ONLY it direct

 

 

7 Payee address; State; Zip Code

W2 A614 61"-
?t _4?s_o2??o

Category [See Categories listed at the top of this s?chedule) Description

l:l Check if travel outside of Texas. Complete Schedule T.

l::l Check it Austin. TX. ol'ficeholder living expense

 

Amer-{165% {?ll-7201456
Candidate Officeholder name

Office sought

expenditure to bene?t 

Office held

 

 

 

 

Date

Amount 


political contributions
intended

PURPOSE
OF
EXPENDITURE

 

Payee name

 

 

Payee address; City; State; Zip Code

 

Category [See Categories listed at the top at this schedule) Description

 

Check it travel outside of Texas. Complete Schedule T.
l:l Check if Austin. TX. Officeholder living expense

 

 

Complete ONLY it direct

Candidate Olficeholder?name Office sought

expenditure to bene?t CIOH

Office held

 

 

 

Date

 

Amount 

Reimbursement from
political contributions
interxbd

Payee name

 

Payee address; City: State; Zip Code

 

 

PURPOSE
OF
EXPENDITURE

 

Category (See Categories listed at the top of this schedule) an Description

 

l:l Check if travel outside of Texas. Complete Schedule T.
Check if Austin, TX, o?iceholder living expense

 

 

 

 

Complete ONLY it direct

Candidate I Officeholder name Office sought

expenditure to benefit CIOH

Office held

 

 

 

 

ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED

 

 

Forms provided by Texas Ethics Commission



Revised 9181?2015