HomeMy WebLinkAboutCFR-07.17.2017-JonroweCANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT
COVER SHEET PG 1
1
Filer ID (Ethics Commission Filers)
2 Total pages filed:
The C/OH Instruction Guide
explains how to complete this form.
MS / MRS / MR FIRST
MI
17
3 CANDIDATE/
OFFICEHOLDER
OFFICE USE ONLY
NAME
Ms. Rachael
Greulich
_ _ _
Date Received
NICKNAME LAST
SUFFIX
RECEIVED
Jonrowe
JUL 17 2017
4 CANDIDATE/
ADDRESS / PO BOX; APT / SUITE #; CITY;
STATE; ZIP CODE
OFFICEHOLDER
MAILING
308 S. Church Street Georgetown,
TX 78626
ADDRESS
CITY SEC.
❑ Change of Address
r V
5 CANDIDATE/
AREA CODE PHONE NUMBER
EXTENSION
OFFICEHOLDER
512 627-9596
Date Hand -delivered or Date Postmarked
PHONE
6 CAMPAIGN
MS / MRS / MR FIRST
MI
Receipt #
Amount $
TREASURER
Mari
Date Processed
NAME
. . . . . . . . . . . .
. . .
NICKNAME LAST
SUFFIX
Date Imaged
Ramirez
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
TREASURER
407 W University Ave Suite 120
ADDRESS
Georgetown, TX 78626
(Residence or Business)
8 CAMPAIGN
AREA CODE PHONE NUMBER
EXTENSION
TREASURER
512 )695-7226
PHONE
9 REPORT TYPE
El January 15 E-1 30th day before election � Runoff � 15th day after campaign
treasurer appointment
(Officeholder Only)
X❑ July 15 ❑ 8th day before election
❑ Exceeded $500 limit El Final Report (Attach C(OH - FR)
10 PERIOD
Month Day Year
Month Day Year
COVERED
64 / 27 / 2017
06 / 30 f 2017
THROUGH f
11 ELECTION
ELECTION DATE
ELECTION TYPE
❑ Primary
❑ Runoff ❑ Other
Month Day Year
Description
05 f 06 / 2017 X❑ General
OFFICE HELD (if any)
❑ Special
13 OFFICE SOUGHT (if known)
12 OFFICE
Georgetown City Council,
Georgetown City Council,
District 6
District 6
GO TO PAGE 2
Forms provided by Texas Ethics Commission www. ethics, state.tx. us Revised 9/8/2015
CANDIDATE / 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 POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICAL SUPPORT THE CANDIDATE / OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDER's
COMMITTEE(S) KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENDITURES.
COMMITTEE TYPE COMMITTE.EE N','AME
;/GENERAL""
ENERAL PA C -
COMMITTEE ADDRESS
SPECIFIC ?. 0. 6o X as q (A
Am . k 770� -� 8 —? (0
COMMITTEE CAMPAIGN TREASURER NAME
F—I Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
01 ce
17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIO OF $50 OR LESS (OTHER THAN
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $ 50. 00
2. TOTAL POLITICAL CONTRIBUTIONS $ 1, 050.00
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
TOTALS
EXPENDITURE 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, $ 238 .48
UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES $ 3,545.85
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE $ 12,023 .75
OF REPORTING PERIOD
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD 0
18 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the accompanying report is
MICME MMMKIN true and correct and includes all information required to be reported by me
Notary IDN 129233532 undo I 15, Election Code.
My Commission Expire
Deoemlber 13, 2020
AFFIX NOTARY STAMP I SEALABOVE
Sworn to and subscribed before me, by the said '\ �4A ✓ om-Owe.'
V
day of u l WS, , 20 , l ., to certify which, witness my hand and seal of office.
Signature §f OfficbZ administering
it ��4LJ1sw
Printed name oLoffic administering oath
or
this the
SC-- u
Title of offitoAaministarina oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
Forms provided by Texas Ethics Commission www. ethics. state. tx.us Revised 9/8/2015
SUBTOTALS
- C/OH FORM C/OH
COVER SHEET PG 3
19
FILER NAME
20 Filer ID (Ethics Commission Filers)
Rachael Jonrowe
21
SCHEDULE SUBTOTALS
SUBTOTAL
NAME OF SCHEDULE
AMOUNT
1•
IX
SCHEDULEAI:
MONETARY POLITICAL CONTRIBUTIONS
$ 1000.00
2.
❑
SCHEDULEA2:
NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS
$
3•
El
SCHEDULE B: PLEDGED CONTRIBUTIONS
$
4.
El
SCHEDULE E:
LOANS
$
5.
SCHEDULE Fl:
POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$ 3,307.37
$
$
6. SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
7. SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
8•
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.
El
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 www. ethics. state. tx.us Revised 9/8/2015
MONETARY POLITICAL
CONTRIBUTIONS Al
SCHEDULE
_ ...........
The Instruction Guide explains how to complete this form.
1 Total pages Schedule Al.
1
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
Rachael Jonrowe
4 Date
5 Full name of contributor
❑ out-of-state PAC (ID#: I
7 Amount of contribution ($)
4-28-17
Jerry & Sharon Harris
$250.00
6 Contributor address;
City; State; Zip Code
111 Congress Ave Ste 1400, Austin, TX 78704
8 Principal occupation / Job title (See Instructions)
9 Employer (See Instructions)
Lawyer
Date Full name of contributor
❑ out-of-state PAC (ID#: I Amount of contribution ($)
4-28-17 Husch Blackwell LLP
$750.00
Contributor address;
City; State; Zip Code
190 Carondelet Plaza,
STe 600, St Louis, MO 63105
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Law firm
Date Full name of contributor
❑ out-of-state PAC (ID#: I Amount of contribution ($)
Contributor address;
City; State; Zip Code
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date Full name of contributor
❑ out-of-state PAC (I047 I Amount of contribution ($)
Contributor address;
i
City; State; Zip Code
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Business Owner
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 9/8/2015
PLEDGED CONTRIBUTIONS
SCHEDULE B
The Instruction Guide explains how to complete this form. 1 Total pages Schedule B;
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED PLEDGES
5 Date 6 Full name of pledgor ❑ out-of-state PAC (ID#:
) a 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 Full name of pledgor ❑ out-of-state PAC (ID#:
)
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)
Date
.................. .... ---------- ---- -----
Full name of pledgor ❑ out-of-state PAC tiIL)n
I
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.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
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 ❑ out-of-state PAC'{IGii ) 9 Loan Amount ($)
6 Is lender 8 Lender address; City; State; Zip Code 10 Interest rate
a financial
Institution?
11 Maturity date
Y N
12 Principal occupation / Job title (See Instructions) 13 Employer (See Instructions)
14 Description of Collateral 15 Check if personal funds were deposited into political
account (See Instructions)
❑ none ❑
76 GUARANTOR 17 Name of guarantor 19 Amount Guaranteed ($)
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#: ) Loan Amount ($)
.... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Is lender Lender address; City; State; Zip Code Interest rate
a financial
Institution?
Maturity date
Y N
.................
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Description of Collateral Check if personal funds were deposited into political
account (See Instructions)
❑ none ❑
GUARANTOR Name of guarantor Amount Guaranteed ($)
INFORMATION
Guarantor address: City; State; Zip Code .
❑ not applicable
I
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.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F1
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/FundraisingExpense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memodals Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political 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 Fl.
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
Rachael Jonrowe
4 Date
5 Payee name
5-16-2017
E1 Monumento
6 Amount ($)
7 Payee address; City; State; Zip Code
205 2nd Street, Georgetown, TX 78626
301.68
8 (a) Category (See Categories listed at the top of this schedule) (b) Description
Volunteer Event ❑ Check if travel outside of Texas.CompleteScheduleT.
PURPOSE
OF ❑ Check if Austin. TX, officeholder living expense
EXPENDITURE
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Williamson County Sun
5-3-2017
Amount ($)
Payee address; City; State; Zip Code
866.25
707 S. Main St, Georgetown, TX 78626
Category (See Categories listed at the top of this schedule)
Description
❑ Check if travel outside of Texas.CompleteScheduleT.
PURPOSE
OF
Advertising
❑
Check if Austin, TX, officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Office Depot
5-1-2017
Amount ($)
Payee address; City; State; Zip Code
117.18
1013 W. University, Georgetown, TX 78626
Category (See Categories listed at the top of this schedule)
Description
❑
PURPOSE
Check if travel outside of Texas. Complete Schedule T.
OF
Printing
❑ Check if Austin, TX, officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F1
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/FundraisingExpense
Accounting/Banking Fees Office Overhead/Rental Expense Trans
Transportation Equipment &Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In n District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
Rachael Jonrowe
4 Date
5 Payee name
5-6-2017
Graphismo
6 Amount ($)
7 Payee address; City; State; Zip Code
407 E 4th Street, Georgetown, TX 78626
750.00
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
Graphic Design
❑ Check iftravel outside ofTexas. Complete Schedule T.
PURPOSE
OF
❑ Check if Austin, Tx, officeholder living expense
EXPENDITURE
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Ink Images
5-1-2017
Amount ($)
Payee address; City; State; Zip Code
1272.26
2544 Shell Road, Georgetown, TX 78628
Category (See Categories listed at the top of this schedule)
Description
❑ Check if travel outside of Texas Complete Schedule T.
PURPOSE
printing
OF
❑ Check if Austin, TX, officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
❑
PURPOSE
Check iftravel outside ofTexas.Complete ScheduleT.
OF
❑ Check it Austin, TX, officeholder living expense
EXPENDITURE
.......... .
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 9/8/2015
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
UNPAID INCURRED OBLIGATIONS SCHEDULE F2
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense
Event Expense Loan Repaymenf/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking
Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense
Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By
Gift/AWards/Memodals Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SalariesNdages/Contract Labor Other (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1
Total pages Schedule F2: f 2
FILER NAME 3 Filer ID (Ethics Commission Filers)
4
TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS $
5
Date 6
Payee name
7
Amount ($) 8
Payee address; City; State; Zip Code
9
TYPE OF
EXPENDITURE
❑ Political ❑ Non -Political
10
(a)
Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑ Check if travel outside of Texas. Complete Schedule T.
OF
EXPENDITURE
❑Check if Austin, TX, officeholder living expense
11
Complete ONLY if direct
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
1
❑ Political L Non -Political
TYPE OF
EXPENDITURE
Category (See Categories listed at the top of this schedule)
Description
[--] Check if travel outside of Texas Complete Schedule T.
PURPOSE
OF
❑ Check if Austin, TX, officeholder living expense
EXPENDITURE
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 9/8/2015
PURCHASE OF INVESTMENTS MADE
FROM POLITICAL CONTRIBUTIONS
The Instruction Guide explains how to complete this form.
2 FILER NAME
4 Date g Name of person from whom investment is purchased
SCHEDULE F3
1 Total pages Schedule F3:
$ Filer ID (Ethics Commission Filers)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - - . . . . . . . . . . . . . . . . . . .
6 Address of person from whom investment is purchased; City; State; Zip Code
7 Description of investment
8 Amount of investment ($)
Date IName of person from whom investment is purchased
Address of person from whom investment is purchased; City; State; Zip Code
Description of investment
Amount of investment ($)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www. ethics. state.tx. us Revised 9/8/2015
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/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By
Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract 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 UNITEM IZED EXPENDITURES CHARGED TO A CREDIT CARD
$
5 Date
6
8
-------------------------------------------------------------------------
Payee name
Payee address; City; State; Zip Code
7 Amount ($)
9 TYPE OF
EXPENDITURE
(a)
Political ❑ Non -Political
Category (See Categories listed at the top of this schedule) (b) Description
10
PURPOSE
❑ Check if travel outside of Texas. Complete Schedule T.
OF
EXPENDITURE
❑Check it Austin, TX, officeholder living expense
11 Complete ONLY if direct
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE
Political Non Political
Category (See Categories listed at the top of this schedule)
Description
❑ Check if travel outside of Texas. Complete Schedule T.
PURPOSE
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
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
POLITICAL EXPENDITURES
MADE FROM PERSONAL FUNDS SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Re paymenUReimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SalariesANages/Contract Labor Other (entera 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 ($)
7 Payee address; City; State; Zip Code
Reimbursementfrom
political contributions
intended
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑ Check if [ravel outside of Texas. Complete Schedule T.
OF
EXPENDITURE
❑ Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
F7Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
❑ Check 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
Payee name
Amount ($)
Payee address; City; State; Zip Code
❑Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
�
El Check if travel outside of Texas. Complete Schedule T.
OF
EXPENDITURE
❑ Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www. ethics. state. tx.us Revised 9/8/2015
PAYMENT MADE FROM POLITICAL
CONTRIBUTIONS TO A BUSINESS OF C/OH SCHEDULE H
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salarier(Wages/Contract Labor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Business name
6 Amount ($)
7 Business address; City; State; Zip Code
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
❑ Check 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
Business address; City; State; Zip Code
Amount ($)
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
❑ Check if travel outside of Texas. Complete Schedule T.
OF
❑
EXPENDITURE
Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Business name
Amount ($)
Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
❑
PURPOSE
Check if [ravel outside of Texas. Complete Schedule T.
OF
❑ Check if Austin, TX, officeholder living expense
EXPENDITURE
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 9/8/2015
NON-POLITICAL EXPENDITURES
MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE
The Instruction Guide explains how to complete this form.
1 Total pages Schedule I; 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
8
(a) Category (See instructions for examples of acceptable
(b) Description (See instructions regarding type of information
PURPOSE
categories.)
required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
PURPOSE
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
OF
categories.)
required.)
EXPENDITURE
Date Payee name
Amount ($)
Payee address; City; State; Zip Code
PURPOSE
Category (See instructions for examples of acceptable Description (See instructions regarding type of information
OF
categories.) required.)
EXPENDITURE
Date
Payee name
Amount ($)
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 www. ethics. state.tx.us Revised 9/8/2015
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER SCHEDULE K
The Instruction Guide explains how to complete this form. 1 Total pages Schedule K:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
.....................
4 Date 5 Name of person from whom amount is received 8 Amount ($)
6 Address of person from whom amount is received; City; State; Zip Code
7 Purpose for which amount is received Check if political contribution returned to filer
Date Name of person from whom amount is received Amount ($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received Check if political contribution returned to filer
Date Name of person from whom amount is received Amount ($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received ❑ Check if political contribution returned to filer
Date Name of person from whom amount is received Amount ($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
Check if political contribution returned to filer
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
IN-KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES
FOR TRAVEL OUTSIDE OF TEXAS
SCHEDULE T
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
B 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 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 Fi
❑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 9/8/2015
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 1 is marked "Final Report" --
1 C/OH NAME 1 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 NOT AN OFFICEHOLDER
•• Complete A & B below only if you are not an officeholder. •-
A. CAMPAIGN FUNDS
Check only one:
F-1 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:
EJ I do not retain assets purchased with political contributions or interest or other income from political contributions -
LJ 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 o6iti-
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 9/8/2015