HomeMy WebLinkAboutCFR-01.17.2017-EbyCANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT
COVER SHEET PG 1
1 Filer ID (Ethics Commission Filers)
2 Total pages filed;
The CIOH Instruction Guide explains how to complete this form.
2
3 CANDIDATE/
MS 1 MRS, MR FIRST MI
OFFICEHOLDER
OFFICE USE ONLY
NAME
AnnaDate
Received
NICKNAME LAST SUFFIX
Eby
�{J/gyp+
REC EI ED
-V
4 CANDIDATE/ ADDRESS 1 PO BOX: APT / SUITE R; CITY; STATE; ZIP CODE
OFFICEHOLDER
MAILINADDR SS
JAN 17 2017
❑ Change of Address
City Secretary
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER
Date Hand-delivered or Dale Postmarked
PHONE
6 CAMPAIGN
MS r MRS r MR FIRST MI
Receipt 9 Amount $
TREASURER
NAME
Rick . . . . . . . . . . . . . . . . .
Date Processed
NICKNAME LAST SUFFIX
Date Imaged
Vasquez
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY: STATE;
ZIP CODE
TREASURER
ADDRESS
{Residence or Business}
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
9 REPORT TYPE
January 15 30th day before election Runoff
t5th day after campaign
treasurer appointment
(Officeholder Only)
July 15 El Bill day before election Exceeded $500 limit
E] Final Report (Attach CIOH - FR)
10 PERIOD
Month Day Year Month
Day Year
COVERED
07 04 2016 12
31' 2046
THROUGH
11 ELECTION
ELECTION DATE ELECTION TYPE
Month Day Year ❑ Primary ❑ Runoff ❑ Other
Description
❑ General Special
12 OFFICE
OFFICE HELD (it any)
13 OFFICE SOUGHT (if known)
Georgetown City Council
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Forms provided by Texas Ethics Commission www. ethics. state. tx.us
Revised 9/8/2015
CANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET FIG 2
14 C/OH NAME
15 Filer ID (Ethics Commission Filers)
16 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICAL
SUPPORT THE CANDIDATE/OFFICEHOLDER. THESEEXPENUMbRES MAY HAVE BEEN MADE WRHOuTTHE CANDIDATES OR OFFICEHOLDERS
COMMITTEE(S)
KNOWLEDGE OR CONSENT CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENDITURES.
COMMITTEE TYPE
COMMITTEE NAME
GENERAL
COMMITTEE ADDRESS
r—ISPECIFIC
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)
D
. . . . . . . . .. . . . .
EXPENDITURE
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
$
TOTALS
UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES
$ D
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$ 725.00
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 include all information required to be reported by me
under Tiitle1 cticn d .
DENISE "PUTNAM
My Colnlgt$sion`Espires
e May 21, 2617 Signature of Candidate or fficeholder
roma rc•F .
AFFIX NOTARY STAMP/ SEALABOVE
r
%}n n a. ELI 15-4
Sworn to and subscribed before me, by the said , this the
day 20/7 , to certify which, witness my hand and seal of office.
=2wamft2r7 5
Signature of officer administering oath Printed name of officer administering oath Title dofficer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.uS Revised 9/8/2015