HomeMy WebLinkAboutCFR-04.11.2013-HesserTexas Ethics Commission
P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CANDIDATE I OFFICEHOLDER
FORMC/OH
FINANCECAMPAIGN `f
COVER SHEET PG I
1
ACCOUNT #
2 Total pages file
The C/OH instruction Guide explains how to complete this form.
(Ethics commissionRiers)
3 CANDIDATE 1
MS/MRSIMR FIRST
MI
OFFICE USE ONLY
OFFICEHOLDER
?/`t
Date Received
NAME
NICKNAME LAST
_ . . . _ . .
SUFFIX
ADDRESS / PO BOX; APT! SUITE #; CITY; j STATE; ZIP CODE
e r"`
TXMAILING
4 CANDIDATE 1
OFFICEHOLDER
°�'
Date Hand-delivered or Postmarked
ADDRESS
❑ change of address
AREA CODE PHONE NUMBER
.
PHONE
B CAMPAIGN
MSIMRSIMR FIRST
Date Imaged
TREASURER
�»
NAME.........
....... .........
NICKNAME LAST
SUFFIX
VERW e° j
AI
7 CAMPAIGN
TREASURER
STREET ADDRESS (NO PO BOX PLEASE); APTISUITEtt;
CITY; STATE;
^ZIP CODE
ADDRESS
(residence or business)
8 CAMPAIGN
AREA CODEHO NUMBERrN
PHONE
9 REPORT TYPE
January 15 l ° 30th day before election
y +,
Runoff
ED 15th day after campaign
treasurer appointment
(officeholder only)
July 15 ED 8th day before election
E-1 Exceeded $500
Ll Final report (Attach C/OH -FR)
limit
10 PERIOD
Month Day year
Month Day
Year
COVERED
45 / 5 THROUGH
11 ELECTION
ELECTION DATE
ELECTIONTYPE
Month Day Year
Primary
F]�`
� Runoff Genera! � special
�ry / 1/®
iY4J,//
12 OFFICE
OFFICE HE (if any)
13 OFFICESOUGHT it k vnj O t
f
B PQAP6
GO TO PAGE 2
www.ethics.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
OFFICEHOLDERCANDIDATE I T: FORM
SUPPORT TOTALS C€VER SHEET PG
14 CIOFI NAME 15 ACCOUNT # (Ethics Commission Filers)
fw e
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 MTHOUT THE CANDIDATE'S OR OFFICEHOLDERS KNOWLEDGE OR
COMMITTEE (S) CONSENT CANDIDATES AND OrnCrHOLDERs ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES,
COMMITTEE NAME
COMMITTEE TYPE
GENERAL
COMMITTEE ADDRESS
a SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THANi
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $ (f%y
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 / Ji
BALANCE OF REPORTING PERIOD $ / ^1 i
OUTSTANDING 6, TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE i
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD J
18 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the accompanying report
is true and correct and includes all inform ion required to be reported by
clam'
MICHELE NMNG me under Title 15, Election Code.
o
% Signat re of Candidate or Officeholder
AFFIX NOTARY STAMP/ SEAL ABOVE
\ r
Sworn to and subscribed before me, by the saidthis the
i1 day of n 6� 20 3 to certify which, witness my hand and seal of office.
Signature of office admt stering oath Printed name of offi ad inistering oath Title of officer ad Ing oath
www.ethics.state.tX.us Revised 09/28/2011
-r..,. e^ miccinn P n Roy 12070 Austin. Texas 78711-2070 (512) 463-5800 (T -DD 1-800-735-2889)
www.ethies.state.tx.us Revised 09/28/2011
LIT'ICAL. EXPENDITURES SCHEDULE
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense SalarieslWages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made By
Event Expense Polling Expense Travel Out Of District CandidatelOfficeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F:
2 FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
g. A
C111iijA. J
4 Date
5 Payee name
i
S Amount (mow}
7 Payee address; City; State; Zip Code
lel 1
_
8 PURPOSE
(a) Category (See categories listed at the top of this schedule)
(b) Description (if travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
9 Complete ONLY if direct Candidate l Offi8eholdefir Ame Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount (S)
Payee address; City; State; Zip Code
PURPOSE
Category (See categories listed at the top of this schedule)
Description (It travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Complete ONLY if direct Candidate t Officeholder name Office sought Office held
expenditure to benefit CIOH
Date
Payee name
Amount (S)
Payee address; City; State; Zip Code
PURPOSE
Category (See categories listed at the top of this schedule)
Description (if travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Completet� if direct Candidate 1 Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
1
t
f
Amount (S)
Payee address; City; State; Zip Code
PURPOSE
Category (See categories listed at the top of this schedule)
Description (If travel outside of Texas, complete Schedule T)
OF
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit CION
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethies.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (b12) 4bJ-bdUU (f UU "1-zsutrr 3o-�aoa/
POLITICAL CONTRIBUTIONS
SCHEDULE
OTHERTHAN PLEDGESLOANS
1 Total pages Schedule A:
The Instruction Guide explains how to complete this form.
2 FILER NAME.
3 ACCOUNT # (Ethics Commission Filers)
M . Ogp
4 Date
5 Full name of contributor (� out-ot-state PAC (10# j
7 Amountof $ In-kind contribution
contribution (S} I description (if applicable)
3/9-3/"3-6-
Contributor address; City; State; Zip Code
4.C)D
rcjc*, 1c ,)(
(if travel outside of Texas, complete Schedule T)
9 Principal occupation ! Job title (See Instructions)
10 Employer (See Instructions)
' it' y € mit f
Date
Full name of contributor ❑ out-of-state PAC (10#: }
Amount of I In-kind contribution
contribution (S) I description (if applicable)
Contributor address; t City; State; Zip Code
I
I
If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See instructions)
Employer (See Instructions)
Date
Full name of contributor ❑ out-of-statePAC(IM }
Amountof in-kind contribution
contribution (S) I description (if applicable)
Contributor address: City; State: Zip Code
(if travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See instructions)
Date
Full name of contributor ❑ out-of-statePAC(IN: )
Amountof In-kind contribution
contribution (S) I description (if applicable)
Contributor address; City; State; Zip Code
(
I
if travel outside of Texas, complete Schedule T
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC (ID#: )
Amountof in-kind contribution
contribution ($} description (if applicable)
I
Contributor address; City; State; Zip Code
I
I
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
It contributor Is out-of-state PAC, please see instruction guide foradditional reporting requirements,
www. ethics. state.tx.us
Revised 09/28/2011