HomeMy WebLinkAboutCFR-01.15.0215-GipsonTexas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
CANDIDATE / OFFICEHOLDER FORMCIOH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 ACCOUNT# 2 Total pages filed:
The C/014 Instruction Guide explains how to complete this form,
(Ethics Commission Filers)
3 CANDIDATE /
MS/MRS/MR FIRST MI OFFICE USE ONLY
OFFICEHOLDER
NAME"'"
0
Date Received
. . . . RECEIVED
NICKNAME LAST/ SUFFIX
ly
JAN 15 2015
ADDRESS / PO BOX; APT/SUITE#; CITY; STATE; ZIPCODE
4 CANDIDATE
OFFICEHOLDER
ll4C% e-tamfan
MAILING
ADDRESS
WAV -del Nd9M%WdW%A1
0 change of address
-*t Receipt # Amount
AREA CODE PHONE NUMBER EXTENSION
5 CANDIDATE/
OFFICEHOLDER//Date
PHONE
Processed
6 CAMPAIGN
MS/MRS/MR FIRST MI Date Imaged
TREASURER
NAME
111"
I 1�1 0 . . . . . .
-'5c— 1,7-r
E LAST SUFFIX
NICKNAME
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT/SUITE#; CRY, STATE; ZIPCODE
TREASURER
ADDRESS
7�
(residence or business)
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
?
9 REPORT TYPE
January 15 El 30th day before election ❑ Runoff ❑ 15th day after campaign
treasurer appointment
4
(officeholder only)
F-1 July 15 E-1 8th day before election El Exceeded $500 ❑ Final report (Attach CIOH - FIR)
limit
10 PERIOD
Month Day Year Month Day year
COVERED
71 ?- (-(/ / (—f THROUGH
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day} -ear
P
E-1 Primary cial
E-1 Runoff El General El Spe
117- -Year
,
"7/ 45
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (if known)
GO TO PAGE 2
www.ethics.state.tx.us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
CANDIDATE /OFFICEHOLDER REPORT: FORM CIOH
SUPPORT & TOTALS OVER SHEET PG
14 C/C)H NAME
15 ACCOUNT# (Ethics Commission Filers)
16 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTREUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE
POLITICAL.
CANDIDATE /OFFICEHOLDER.. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE`s OR OFFICEHOLDER's KNOWLEDGE OR
COMMITTEE(S)
CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEE NAME
COMMITTEE TYPE
a GENERAL
COMMITTEE ADDRESS
r7 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
EXPENDITURES OF $100 LESS, UNLESS ITEMIZED
Q
$
TOTALS
3. TOTAL POLITICAL OR
4. TOTAL POLITICAL EXPENDITURES
CONTRIBUTION
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
@
BALANCE
OF REPORTING PERIOD
W
OUTSTANDING
6 TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS
LAST DAY OF THE REPORTING PERIOD
18 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 under Title 15, Election Code.
•. ,JESSICA ERIN BRETTLE
° I NOTARY PUBLIC
° i State of Texas
;•°"° Comm. Exp. 06-01-2015 Sign t andidateorOfficehalder
AFFIX NOTARY STAMP I SEAL ABOVE
Sworn to and subscribed before me, by the said ( PSOYI , this the
.,
day of 20 to certify which, witness my hand and seal of office.
r.
Wit` CCk f J't G
S' natueofofficer administeringoath Printed name of officer administering oath Titlefficeradministerinb h
ww .et Ics.state.tx..us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
POLITICAL CONTRIBUTIONS
SCHEDULE A
OTHER THAN PLEDGES OR LOANS
The Instruction Guide explains how to complete this form.
1 Total pages Schedule A:
2 FILER NAME 6
3 ACCOUNT# (Ethics Commission Filers)
4 Date
5 Full name of contributor ❑ out-of-state
7 Amount of 8 In-kind contribution
contribution description (if applicable)
Cont ributor address; City; State; Zip Code
MN
(If travel outside of Texas, complete Schedule T)
9 Principal occupation / Job title (See Instructions)
10 Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC (ID#:
Amount of I In-kind contribution
contribution 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 El out-ofstatePAC(ID#: I
Amount of In-kind contribution
contribution description (if applicable)
Uj
Contr or address; City; State; -Zip Code
r
77
(if travel outside of 1—as, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor El out-of-state PAC (ID#:
Amount of In-kind contribution
contribution description (if applicable)
Cont rib utor address; City; State; Zip Code
if travel outside offiexas, com ,late Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC (ID#:
Amount of In-kind ..ntrib.tior,
contribution description (if applicable)
Contributor address; City; State; Zip Code
If travel outside of I.A.., complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide foradditional reporting requirements.
www.ethics.state.tx.us Revised 07/28/2014