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The C/OH Instruction Guide explains how to complete this form.
I ACCOUNT# 2 Total pages filed:
(Ethics Commission Filers)
Q—S
3 CANDIDATE /
MSIMRSIMR FIRST
MI OFFICE USE ONLY
OFFICEHOLDER
NAME
NICKNAME LAST
Date Received
SUFFIX RECEIVED
/-:�B y APR 0 8 2015
ADDRESS I PO BOX; APTISUITE#; CITY" STATE; ZIP CODE
a
,
4 CANDIDATE
OFFICEHOLDER
MAILING
ADDRESS
/ --7—V
6,6066 -i -c Oa)10 A-)
Dat a
E] change of address
AREA CODE PHONE NUMBER
Receipt # Amount
EXTENSION
Date Processed
6 CANDIDATE/
OFFICEHOLDER
PHONE
6 CAMPAIGN
MSIMRSIMR FIRST
MI Date Imaged
TREASURER
NAME
. . . . . . 0
. . . . . . . . . ---------
. . .
NICKNAME LAST
SUFRX
a
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT1SUrrE#;
CITY. STATE, ZIP CODE
TREASURER
ADDRESS
(residence or business)
8 CAMPAIGN
TREASURER
AREA CODE PHONE NUMBER
-
—
9 REPORT TYPE®
15 30th day before election
El to
Runoff 15th day after campaign
F] El treasurer appointment
(officeholderonly)
July 15 8th day before election
❑ Exceeded $500 El Final report (Attach CIOH - FR)
limit
10 PERIOD
COVERED
Month Day Year
THROUGH
Month Day year
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day YearPmmey
Runoff General Special
o5F
12 OFFICE
OFFICE HELD (if any)
13 OFFICESOLIGHT (ftnawn)
C-
ce, 7
GO TO PAGE 2
www.ethics.state.tx.us Revised 07128/2014
CANDIDATE/ OFFICEHOLDER REPORT: FORM G10H
SUPPORT & TOTALS COVER SHEET PG 2
14 C/01-1 NAME
,4/-/ j 61
16 ACCOUNT# (Ethics Cominission 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 CANDIDATES 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
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
$
4. TOTAL POLITICAL EXPENDITURES
$
CONTRIBUTION
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE
OF REPORTING PERIOD
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 Ind de all information required to be reported by
me under T' 1 Elect' ode.
DENISE PUTNAM
My Commission Expires
May 21;:2017
Signature ofCandidate arr ceholder
AFFIX NOTARY STAMP SEAL ABOVE
Sworn to and subscribed before me, by the said this the
day o 4 20 to certify which, witness my hand and seal of office.
-V
re of officer administering oath Printed name ofwrier adrininistering oath' Title of officer adminii-ring oath
www.ethics.state.tx.us Revised 07128/2014-,
POLITICAL CONTRIBUTIONS
SCHEDULE A
L
OTHER THAN PLEDGES OR OANS
The Instruction Guide explains how to complete this form.
1 Total pages Schedule A: A
2 FILER NAMEA)4_
3 ACCOUNT # (Ethics Commission Filers)
4 Date
5 Full name of contributor ❑ out-of-state PAC(1D#:
7 Amountof 8 In-kind contribution
contribution description (if applicable)
6' Contribu r address; City; State; Zip Code
//
(If travel outside of Texas, complete Schedule T)
9 Principal occMation / Job title (See Ins)tructions)
WC 77S
10 Employer (See Instructions)
Date
Full name of contributor ❑ out-of-state PAC (ID#:
Amountof In-kind contribution
contribution description (if applicable)
Contributor address; City; State; Zip Code
_X
%7
If travel outsideof Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) T
Employer (See Instructions)
Date
Full name of contributor ❑ out-of-statePAC(lo#:
Amountof I In-kind contribution
contribution description (if applicable)
City; State; Zip Code
(if travel outside ...... complete Schedule T)
Principal;qpation / Job title (See Instructions)
rZZ4-A)Z-_�'V1
Employer (See Instructions)
I
Date
Full name contributor E] out-of-state PAC (IM
/1
4.
Amountof In-kind contribution
contribution description (if applicable)
/5
ontributor address; City; State; Zip Code
-
(if tra-1 outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor n out-of-state PAC (ID#:
Amountof In-kind contribution
contribution description (if applicable)
Cont'rib*utor'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