HomeMy WebLinkAboutCFR-05.01.2015-EbyFORMCOR-C/OH
CORRECTION/AMENDM ENT AFFIDAVIT
FOR CAN DIDATE/OFFICEHOLDER
ACCOUNT# -r;�--Tbtal
pages filed:
OFFICE USE ONLY
VIII
3 CANDIDATE/
ow wh
MSIMRSIMR FIRST MI oat
i
� �CEIVED
OFFICEHOLDER
NAME
4ST
NICKNAME SU'FFIX'
C.t
January 15 El Runoff Other (specify) Y Serjre.-t�,tl
F�IIUIpIN��I II II
4 ORIGINAL REPORT—
TYPE
ElJuly 1,5 Exceeded S500 limit I Date Hand-dolivered or Postmarked
30th day before eleEl ction ■15th day after treasurer
appointment (officeholder only)
8th day before election Final report
Date Processed
Month Day Year Month Day Year
THROUGH Date Imaged
- -------
5 ORIGINALPE-RIOD
COVERED
6 EXPLANATION OF CORRECTION
NO W 7 10S " / i7bL N7—�c 7w
sea*
511LI11111FIgill Q
Remember To Attach Any Part Of The Campaign Finance Report Form
Needed To Report And Explain Corrections
www,ethics.statI Revised 09/01/2011
CANDIDATE if OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG I
I ACCOUNT#
Commission Filers)
2 Total pages filed:
The C10H Instruction Guide explains how to complete this form.
(Ethics
3 CANDIDATE /
OFFICEHOLDER
MS/MRSJMR FIRST MI
NAME
Dat 1RWJWJ%9l16air 1 W Lft"
NICKNAME LAST SUFFIX
MAY 0 12015
CIV Secretary
4 CANDIDATE
ADDRESS IPO BOX; APT/SUITE#; CITY; STATE; ZIP CODE
OFFICEHOLDER
MAILINGOs
/,
Date Hand -delivered or Postmarked
ADDRESS
change of address
(,K
Receipt #
Amount
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
Date Processed
OFFICEHOLDER
PHONE
)
6 CAMPAIGN
MS t MRS I MR FIRST MI Date Imaged
TREASURER
NAME
. . . . . . .
NICKNAME LAST SUFFIX
7 CAMPAIGN
TREASURER
7 X
(residence or business)
8 CAMPAIGN
TREASURER
PHONE
AREA CODE PHONE NUMBER EXTENSION
��/ )
9 REPORT TYPE
El January 15 ❑ 30th day before election Runoff ❑15th day after campaign
I�JEl
treasurer appointment
(officeholderonty)
El July 15 8th day before election El Exceeded $500 ❑ Final report (Attach CIOH - FR)
limit
10 PERIOD
COVERED
Month Day Year month COY Year
15 laoTHROUGH 19 , /I ,
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
El Pdmary El Runoff General Special
12 OFFICE
OFFICE HELD litany)
13 OFFICESOUGHT (ifknown)
0
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www. et h i cs state. tx. us Revised 07/28/2014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-736-2989)
CANDIDATE/ OFFICEHOLDER REPORT: FOR/OH
SUPPORT & TOTALS OVER SHEET
14 Cf01-1 NAME 15 ACCOUNT# (Ethics Commission Filers)
16. NOTICE FROM THIS. BOX IS FOR NOTICE OF.POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL. EXPENDITURES MADEBYPOUTICALCOMMITTEES TOSUPPORT THE
.
POLITICAL CANDIDATE IOFFICEHOLDER. THESE EXPEND"VRESMAY HAVE BEEMMADE MT'HOUTTHE CANDIDATE'S OROFFICEHOLDE'R'SKNOWLEDGE OR
COMMITTEE(S) CONSENT. CANDIDATESANOOFFICEHOLDERS ARE REQUIRED MREPORrTHIS IN TION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEE NAME
COMMITTEE TYPE
Q 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 s
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 ail Information required to be reported by
me under Till lection de.
I iWy
DEMISE PUTN�M
My Commission Expires '
May 21, 2017 SIgnajLWbf Candidate or0 ceholder
Ill I
AFFIX NOTARY STAMP lSEAL ABOVE
Sworn to and subscribed before me, by the said (JG this the
Ist day of 20 to certify which, witness my hand and seat of office.
f vY
j Signature of officer administering oath Printed name of officeradrninistering oath Title of officer admil tering oath
www.emics.slaie.ix.us Revised 07/28/2014