HomeMy WebLinkAboutCFR-12.31.2015-EbyTexas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 i
ii!11 iiipp ij�
DROMMM-W-3,TMIUM
www.emics.stal:e.11x.us Revised 0712812014
I ACCOUNT# 2 Total pages filed:
The CIOH Instruction Guide explains how to complete this form.
(Ethics Commission Filers)
3 CANDIDATE d
MSIMRSIMR FIRST Ml OFFICE USE ONLY
OFFICEHOLDER
NAME
DateR
•
NICKNAME LAST SUFFIX
JAN 15 2016
ADDRESS / PO BOX; APTISUITEM, crm, STATE; ZIP CODE City Secretan
4 CANDIDATE
OFFICEHOLDER
MAILING
Date Hand -delivered or Postmarked
ADDRESS
change of address
Receipt Amount
AREA CODE PHONE NUMBER EXTENSION
Processed
6 CAMPAIGN
TREASURER
MS/MRS/MR FIRST MI Date Imaged
. A
NAME
. . . . . . . . . . ..
NICKNAME SUFFIX
fT
7 CAMPAIGN
STREETADDRESS (NO PO BOX PLEASE); APTISUITE#; CITY" STATE; ZIPCODE
TREASURER
ADDRESS
business)jJ
(residence or
8 CAMPAIGN
TREASURER
AREA CODE PHONE NUMBER EXTENSION
PHONE
9 REPORT TYPE
W/J.uary 15 F-1 0 E-1 15th day after campaign
n30th day before election Runoff
treasurer appointment
(officeholder orgy)
F-1 July 15 F-1 8th day before election ❑ Exceeded $500 ❑ Final report (Attach CIOH - FR)
limit
10 PERIOD . 4'
COVERED
Month Month Owl Year
THROUGH
11 ELEC�TION
ELECTION DATE
ELECTION TYPE
Month Day year
F-1 Primsy ❑ Runoff ED General D Special
12 OFFICE
OFFICEHELD litany)
13 OFFICE SOUGHT (if known)
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www.emics.stal:e.11x.us Revised 0712812014
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) X163-5800 (TDD 1-800-735-2989)
CANDIDATE/ OFFICEHOLDER REPORT: FORMCIOH
SUPPORT
& TOTALS OVER SHEET PG2
14 CION NAME
15 ACCOUNT# (Ethics Commission Filers)
---I k) 1 f
16 NOTICE FROM
THIS BOX IS FORCEbFPOL41iCALCONiRtiHU�TiONSACCEPTEDORpOLttiCALEXPENDITURES AAADEBYPOLtTHCALCOl9&9TTiEESTOSUPPOR7THE
POLITICAL
CANDIDATE I OFFI EHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE MTHOUT THE CANDIDATE'S OR OFFICEHOLDER's ICNOH&EDGE OR
COMMITTEE(S)
CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO RFPORTTHIS INFORMATION 014LY IF THEY RECEIVE N013CEOF SUCH EXPENDITURES.
COMMITTEE NAME
COMMITTEETYPE
RECEIVED
GENERAL
COMMITTEE ADDRESS
® SPECIFIC
�
City SecretaD
COMMITTEE CAMPAIGN TREASURER NAME
additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
TOTALS
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
p
$
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
EXPENDITURE
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS; UNLESS ITEMIZED
TOTALS
4. TOTAL POLITICAL: EXPENDITURES
...........
CONTRIBUTION
BALANCE
S. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
t�
OF REPORTING PERIOD
`l'
OUTSTANDING
LOAN TOTALS
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$ `--
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 aH information required to be reported by
me under Ti 15,
rElec'ode.
a
Signature of Candidate or -ificeholder
AFFIX NOTAi2Y STAMP ! SEAL ABOVE
Sworn to and subscribed
before me, by the said o-- this the
IS day of 20 tito certify which, witness my hand and seal of office.
cue
Signature of officer administering oath Printed name ofofficer administering oath Ttie of tficer administering oath
www.etnicS.State.tx.us
Revised 07J28f201-t