HomeMy WebLinkAboutCFR-01.14.2013-HammerlunTexas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070
(512) 463-5800
I1 ACCOUNT#
The C/01-1Instruction Guide explains how to complete this dorm, (Ethics Commission Filers)
4 CANDIDATE /
OFFICEHOLDER
MAILING
ADDRESS
E] change of address
5 CANDIDATE/
OFFICEHOLDER
PHONE
CAMPAIGN
TREASURER
NAME
ADDRESS /PO BOX;
APT! SUITE #:
AREA CODE PHONE
MS/MRS/MR
. HR .05
NICKNAME
CITY, STATE;
EXTENSION
ZIP CODE
IN
SUFFIX
1-800-735-2989)
2 Total pages filed:
JAN 14 2013
Date Imaged
8 CAMPAIGN
TREASURER
PHONE
9 REPORT TYPE
C
10 PERIOD
COVERED
January 15 El 30th day before election
El RunoffEl 15th day after campaign
treasurer appointment
(officeholder only)
Exceeded $500 Final report (Attach C/OH - FR)
limit
Month Day Year
1 ELECTION ELECTION DATE ELECTION TYPE
Month Day I Year ❑ ry a
PrimaRunoff
/ / General ElSpecial
i // 20
www.ethics.state.tx.us Revised 09/28/20'11
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CANDIDATE / OFFICEHOLDER REPORT: FORMC/OH
SUPPORT & TOTALS COVER SHEET PG
14 Clot I NAME 5 ACCOUNT# (Ethics Commission Filers) I
\Jtf
116 NOTICE FRO THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLn1CAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORTTHE
POLITICAL CANDIDATE I OFFICEHOLDER, THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUF THE CANDIDATE`S OR pFFICEHOLDER`S KNOWLEDGE OR
C O M M I TT EE(S) CONSENT, CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES,
COMMITTEE NAME
COMMi IEE TYPE I
s �
GENERAL
COMMITTEE ADDRESS
SPECIFIC
i
i
COMMITTEE CAMPAIGN TREASURER NAME I
additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
i
17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
EXPENDITURE
TOTALS 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED
4 TOTAL POLITICAL EXPENDITURES
CONTRIBUTION 5 TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY li
BALANCE OF REPORTING PERIOD
OUTSTANDING g TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD
13 AFFIDAVIT
woul 110
I swear, or affirm, under penalty of perjury, that the accompanying report
�. JESSICA ER:BREMLE 1E
�q �.�Y is true and co ect and includes all information required to be reported by
Ayy,�R.Ymeunder Titl 'i5Election Code.
to iQyJ �
I I
Signature of Candidate or Officeholder y
I
i
I AFFlX NOTARY STAMP / SEAL ABOVE
I J i
�nrorrto end subscribed bprary me, by the said
1 ��1 :his the ;
J
day cf , 20 to certify which, }witness my hand and seal of office.
I H
+44t OL
Si natu e of officer a Inisternng oath Printed name of officer administering oath
TtA of officer administe g ath (;
t
www.ethics.state.tx.us Revised 09/28/2011
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�4npJ LUIIt'J VVI�IIII�JJIIi OFFICEHOLDER'
/�ovRI�t_V! V KU5UI1, IC-'Xd5 too 1 I-Lviu
CANDIDATE / OFFI..i(/EHOLDER' REPORT".
(5"I L) 4bd-5t5uu
1
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 ay not accept any campaign contributions
or make any campaign expenditures without a campaign treasurer appointn'lpnt on file.
of Candidate / Officeholder
4 FILER WHO IS NOT AN OFFICEHOLDER
a. Complete A & B below only if you are not an officeholder. as
Check only one:
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.
1 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 inco e from political contributions to personal
use. I also understand that I must dispose of assets purchased wit olitical contribu Ions in accordance with the requirements
of Election Code, § 254.204.
Signature of Candidate
OFFICEHOLDER
officeholder*a Complete this section only if you are an
I am aware that I remain subject to filing requirements applicable to an officeholderwho does not have a campaign treasurer on file.
1 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 orother income fr1m political contri utions, or assets purchased with political
contributions or interest or other income from political contributions. °\ A..
Signature of Officeholder
www. ethics. state.tx.us Revised 09/28/2011