HomeMy WebLinkAboutUnexpended Contributions-01.14.2013-HellmannTexas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDI) 1-800-735-2989?
CANDIDATE
I OFFICEHOLDER FORM C/OHwUC
REPORT OF
UNEXPENDED CONTRIBUTIONS COVER SHEET PG 1
1 ACCOUNT# (Ethics ConunssoAf1ers)
The C/OH-UC Instruction Guide explains how to complete this forth.
2 CANDIDATE
IAS(AiRSAIR FIRST €.tl
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OFFICEHOLDER
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NAME
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. NICKNAI.tE LAST . .SUFFIX
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3 CANDIDATE)
ADDRESS /PO BOX: APT ISUITE &; CITY STATE; ZIP CODE
OFFICEHOLDER
ADDRESS
Qchange of address
Receipt u
Amount
4 REPORT
Q Final Disposition
Date Processed
TYPE
Annual
r
5 PERIOD
Month Day Year hionth Day Year
Date Imaged
COVERED
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6 TOTALS
1. TOTAL AMOUNT OF UNEXPENDED POLITICAL CONTRIBUTIONS AS OF
$ ' ?
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DEC. 31 OF THE PREVIOUS YEAR.
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2. TOTAL AMOUNT OF INTEREST AND OTHER INCOME EARNED ON
' 4
UNEXPENDED POLITICAL CONTRIBUTIONS DURING THE PREVIOUS
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YEAR.
7 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the accompanying
report is true and correct and includes all information required to be
reported by me underTitle 15, Election Code.
<4,S€gnatureofCandidateorOfficeho€der
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AFFIX NOTARY STAMP
/ SEAL ABOVE
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Sworn to and subscribed before me, by the said this the day
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, to certify which, witnessw hand and seal ofoffice.
Jess
'oath —
Sig ature of officerdmin€steringoath Printed nameofofficer administering Title of offibaradministerin oath
ethics.state.tx.us Revised 0613012006
ry
Texas Ethics Commission P.Q. Box 12070 Austin, Texas 78711-2070 (512)463-5800 DD 1-800-735-2989
C/OH REPORT OF UNEXPENDED CONTRIBUTIONS FORM C/OH-UC
EXPENDITURES PG 2
8 C/OH NAME -
9 ACCOUNT#(EthksCwwdss3onRers)
10 Date
11 Payee name
13 Amount
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12 Payee address; C€ty; State; Z€p Code
14 Purpose of expenditure
g
Is expenditure a contribution Q Yes
to a candidate, officeholder, or
Q No
political committee?
(if travel outside of Texas, complete Schedule T) (See Instruction Guide)
Date
Payee name
Amount
M
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Payee address; City; State; Zip Code
Purpose of expenditure
1
Is expenditure a contribution Yes
to a candidate, officeholder, or
political committee? No
(if travel outside of Texas, complete Schedule €7 (See Instruction Guide)
Date Payee name
Amount
..........................................
Payeeaddress; City; State; Zip Code
Purpose of expenditure
15
Is expenditure a contribution F"I Yes
to a candidate, officeholder, or
political committee? Q No
(if travel outside of Texas, complete Schedule T) (See Instruction Guide)
Date Payee name
Amount
..........................................
Payee address; City-, State; Zip Code
Purpose of expenditure
15
Is expenditure a contribution Q Yes
to a candidate, officeholder, or
political committee? 0 No
(if travel outside of Texas, complete Schedule T) (See instruction Guide)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED
wmethics.state.tx.us Revised 06/30/2006