HomeMy WebLinkAboutCFR-04 thru 05.2012-HammerlunTexas Ethics Commission P.O. Sox 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CANDIDATE®R
CAMPAIGN FINANCE REPORT OVEN SHEET PG
The C/t;I-d Instruction Guide explains how to complete this fora,,
1 ACCOUNT # 2 Total pages filed:
(Ethics Commission Filers)
i
!I
3 CANDIDATE /
OFFICEHOLDER
MS/MRS/MR FIRST MI
j NAME
0 # a roed
NICKNAME LAST SUFFIX
AP's 0 2012
ADDRESS /PO BOX; APT/SUITE#, CITY; STATE; ZIP CODE
4 CANDIDATE /
OFFICEHOLDER
MAILING
ADDRESS
change of address
e eliv e
OeCR06VA,41
Receipt # Amount
AREA CODE PHONE NUMBER EXTENSION
Date Processed
5 CANDIDATE/
OFFICEHOLDER>>
PHONE
6_ CAMPAIGN
TREASURER
MS/MRS/MR ItRST Mt Date Imaged
NAME.
NICKNAME LAST SUFFIX
s
7 CAMPAIGN
STREETADDRESS (NO PO BOX PLEASE), APT/SUITE#: CITY; STATE; ZIP CODE
TREASURER
ADDRESS
(residence or business)
8 CAMPAIGN
TREASURER
PHONE
AREA CODE PHONE NUMBER EXTENSION
-
9 REPORT TYPE
January 15 30th day before election F-1 Runoff ❑ 15th day after campaign
treasurer appointment
(officeholderonly)
July 15 Bth day before election F-1 Exceeded $500 F-1 Final report (Attach C/OH - FR)
limit
10 PERIOD
COVERED
Mo h Day Year Month Day Year
THROUGH
11 ELECTION
ELECTION DATE
ELECTIONTYPE
Month Day Year
/
Prima ry Runoff General F Special
12 OFFICE OFFICE HELD (if any) 13 OFFICE SOUGHT (if known)
GOTGPGE
www.ethics.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Bax 12070 Austin, Texas 78711-2070 (512) 4.63-5800 (TDD 1-800-735-29891
www.ethics.state.tx.us Revised 09/2812011
CANDIDATE/ OFFICEHOLDER REPORT: FORM C/OH
SUPPORT & TOTALS COVER FEET PG 2
14 CIOH NAME
n R a
1S ACCOUNT# (Ethics Commission Filers)
16 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE
POLITICAL
CANDIDATE I OFFICEHOLDER, THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE`S OR OFFICEHOLDERS KNOWLEDGE OR
COMMITTEE (S)
CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
j
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
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
$ 0001
4. TOTAL POLITICAL EXPENDITURES
CONTRIBUTION
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
07
BALANCE
ttpp
$
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
ss e- is true a4corrnd includesall information required to be reported by
�pI-a1 f7.11 r eunciElection Code.
r
i xa s
jd
' yr*ng �s 4 3C a'€' t � .✓q E k � Vim„ --.,m. ^.n..cu+':--,R.mo-���cx ._
Signature of Candidate or Officeholder
AFFIX NOTARY STAMP J SEAL ABOVE
Sworn to and subscribed before me, by the said R.i d this the
day o� ,
— of _ 20 to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
www.ethics.state.tx.us Revised 09/2812011