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CANDIDATE/ OFFICEHOLDER REPORT:
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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 flay not accept any campaign contributions
or make any campaign expenditures without a campaign treasurer
4 FILER WHO IS NOT AN OFFICEHOLDER
•• Complete A & B below only if you are not an officeholder. ••
on file.
of Candidate /Officeholder
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 1 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.
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 into 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
R
oe Cthissectiononly if you are an omplete officeholder
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 or other income frim political contri, utions, or assets purchased with political
contributions or interest or other income from political contributions. •,
Signature of Officeholder
www.ethics.state.tx.us Revised 09/28/2011