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Home My WebLink AboutCFR-07.17.2017-JonroweCANDIDATE / OFFICEHOLDER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 1 1 Filer ID (Ethics Commission Filers) 2 Total pages filed: The C/OH Instruction Guide explains how to complete this form. MS / MRS / MR FIRST MI 17 3 CANDIDATE/ OFFICEHOLDER OFFICE USE ONLY NAME Ms. Rachael Greulich _ _ _ Date Received NICKNAME LAST SUFFIX RECEIVED Jonrowe JUL 17 2017 4 CANDIDATE/ ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE OFFICEHOLDER MAILING 308 S. Church Street Georgetown, TX 78626 ADDRESS CITY SEC. ❑ Change of Address r V 5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION OFFICEHOLDER 512 627-9596 Date Hand -delivered or Date Postmarked PHONE 6 CAMPAIGN MS / MRS / MR FIRST MI Receipt # Amount $ TREASURER Mari Date Processed NAME . . . . . . . . . . . . . . . NICKNAME LAST SUFFIX Date Imaged Ramirez 7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE TREASURER 407 W University Ave Suite 120 ADDRESS Georgetown, TX 78626 (Residence or Business) 8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER 512 )695-7226 PHONE 9 REPORT TYPE El January 15 E-1 30th day before election � Runoff � 15th day after campaign treasurer appointment (Officeholder Only) X❑ July 15 ❑ 8th day before election ❑ Exceeded $500 limit El Final Report (Attach C(OH - FR) 10 PERIOD Month Day Year Month Day Year COVERED 64 / 27 / 2017 06 / 30 f 2017 THROUGH f 11 ELECTION ELECTION DATE ELECTION TYPE ❑ Primary ❑ Runoff ❑ Other Month Day Year Description 05 f 06 / 2017 X❑ General OFFICE HELD (if any) ❑ Special 13 OFFICE SOUGHT (if known) 12 OFFICE Georgetown City Council, Georgetown City Council, District 6 District 6 GO TO PAGE 2 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 PG 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. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDER's COMMITTEE(S) KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES. COMMITTEE TYPE COMMITTE.EE N','AME ;/GENERAL"" ENERAL PA C - COMMITTEE ADDRESS SPECIFIC ?. 0. 6o X as q (A Am . k 770� -� 8 —? (0 COMMITTEE CAMPAIGN TREASURER NAME F—I Additional Pages COMMITTEE CAMPAIGN TREASURER ADDRESS 01 ce 17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIO OF $50 OR LESS (OTHER THAN TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $ 50. 00 2. TOTAL POLITICAL CONTRIBUTIONS $ 1, 050.00 (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) TOTALS EXPENDITURE 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, $ 238 .48 UNLESS ITEMIZED 4. TOTAL POLITICAL EXPENDITURES $ 3,545.85 CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY BALANCE $ 12,023 .75 OF REPORTING PERIOD OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LOAN TOTALS LAST DAY OF THE REPORTING PERIOD 0 18 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the accompanying report is MICME MMMKIN true and correct and includes all information required to be reported by me Notary IDN 129233532 undo I 15, Election Code. My Commission Expire Deoemlber 13, 2020 AFFIX NOTARY STAMP I SEALABOVE Sworn to and subscribed before me, by the said '\ �4A ✓ om-Owe.' V day of u l WS, , 20 , l ., to certify which, witness my hand and seal of office. Signature §f OfficbZ administering it ��4LJ1sw Printed name oLoffic administering oath or this the SC-- u Title of offitoAaministarina oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 Forms provided by Texas Ethics Commission www. ethics. state. tx.us Revised 9/8/2015 SUBTOTALS - C/OH FORM C/OH COVER SHEET PG 3 19 FILER NAME 20 Filer ID (Ethics Commission Filers) Rachael Jonrowe 21 SCHEDULE SUBTOTALS SUBTOTAL NAME OF SCHEDULE AMOUNT 1• IX SCHEDULEAI: MONETARY POLITICAL CONTRIBUTIONS $ 1000.00 2. ❑ SCHEDULEA2: NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS $ 3• El SCHEDULE B: PLEDGED CONTRIBUTIONS $ 4. El SCHEDULE E: LOANS $ 5. SCHEDULE Fl: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ 3,307.37 $ $ 6. SCHEDULE F2: UNPAID INCURRED OBLIGATIONS 7. SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS 8• SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $ 9• SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS $ 10. SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $ 11. El SCHEDULE I: NON -POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ 12. ❑SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS $ RETURNED TO FILER Forms provided by Texas Ethics Commission www. ethics. state. tx.us Revised 9/8/2015 MONETARY POLITICAL CONTRIBUTIONS Al SCHEDULE _ ........... The Instruction Guide explains how to complete this form. 1 Total pages Schedule Al. 1 2 FILER NAME 3 Filer ID (Ethics Commission Filers) Rachael Jonrowe 4 Date 5 Full name of contributor ❑ out-of-state PAC (ID#: I 7 Amount of contribution ($) 4-28-17 Jerry & Sharon Harris $250.00 6 Contributor address; City; State; Zip Code 111 Congress Ave Ste 1400, Austin, TX 78704 8 Principal occupation / Job title (See Instructions) 9 Employer (See Instructions) Lawyer Date Full name of contributor ❑ out-of-state PAC (ID#: I Amount of contribution ($) 4-28-17 Husch Blackwell LLP $750.00 Contributor address; City; State; Zip Code 190 Carondelet Plaza, STe 600, St Louis, MO 63105 Principal occupation / Job title (See Instructions) Employer (See Instructions) Law firm Date Full name of contributor ❑ out-of-state PAC (ID#: I Amount of contribution ($) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor ❑ out-of-state PAC (I047 I Amount of contribution ($) Contributor address; i City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Business Owner ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission www. ethics. state. tx.us Revised 9/8/2015 PLEDGED CONTRIBUTIONS SCHEDULE B The Instruction Guide explains how to complete this form. 1 Total pages Schedule B; 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 TOTAL OF UNITEMIZED PLEDGES 5 Date 6 Full name of pledgor ❑ out-of-state PAC (ID#: ) a Amount 9 In-kind contribution of Pledge $ description 7 Pledgor address; City; State; Zip Code ❑ Check if travel outside of Texas. Complete Schedule T. 10 Principal occupation / Job title (See Instructions) 11 Employer (See Instructions) Date Full name of pledgor ❑ out-of-state PAC (ID#: ) Amount In-kind contribution of Pledge $ description Pledgor address; City; State; Zip Code ❑ Check if travel outside of Texas. Complete Schedule T. Principal occupation / Job title (See Instructions) -[:::Employer (See Instructions) Date .................. .... ---------- ---- ----- Full name of pledgor ❑ out-of-state PAC tiIL)n I Amount of In-kind contribution Pledge $ description ........ Pledgor address; City; State; Zip Code ❑Check if travel outside of Texas. Complete Schedule T. Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of pledgor ❑ out-of-state PAC (ID#:) Amount of In-kind contribution Pledge $ description Pledgor address; City; State; Zip Code ❑Check if travel outside of Texas. 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 for additional reporting requirements. Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 LOANS SCHEDULE E The Instruction Guide explains how to complete this form. 1 Total pages Schedule E: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 TOTAL OF UNITEMIZED LOANS $ 5 Date of loan 7 Name of lender ❑ out-of-state PAC'{IGii ) 9 Loan Amount ($) 6 Is lender 8 Lender address; City; State; Zip Code 10 Interest rate a financial Institution? 11 Maturity date Y N 12 Principal occupation / Job title (See Instructions) 13 Employer (See Instructions) 14 Description of Collateral 15 Check if personal funds were deposited into political account (See Instructions) ❑ none ❑ 76 GUARANTOR 17 Name of guarantor 19 Amount Guaranteed ($) INFORMATION 18 Guarantor address; City; State; Zip Code ❑ not applicable 20 Principal Occupation (See Instructions) 21 Employer (See Instructions) Date of loan Name of lender ❑ out-of-state PAC (ID#: ) Loan Amount ($) .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Is lender Lender address; City; State; Zip Code Interest rate a financial Institution? Maturity date Y N ................. Principal occupation / Job title (See Instructions) Employer (See Instructions) Description of Collateral Check if personal funds were deposited into political account (See Instructions) ❑ none ❑ GUARANTOR Name of guarantor Amount Guaranteed ($) INFORMATION Guarantor address: City; State; Zip Code . ❑ not applicable I Principal Occupation (See Instructions) Employer (See Instructions) ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED If lender is out-of-state PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F1 EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/FundraisingExpense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In District Contributions/Donations Made By Gift/Awards/Memodals Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above) Credit Card Payment The Instruction Guide explains how to complete this form. 1 Total pages Schedule Fl. 2 FILER NAME 3 Filer ID (Ethics Commission Filers) Rachael Jonrowe 4 Date 5 Payee name 5-16-2017 E1 Monumento 6 Amount ($) 7 Payee address; City; State; Zip Code 205 2nd Street, Georgetown, TX 78626 301.68 8 (a) Category (See Categories listed at the top of this schedule) (b) Description Volunteer Event ❑ Check if travel outside of Texas.CompleteScheduleT. PURPOSE OF ❑ Check if Austin. TX, officeholder living expense EXPENDITURE 9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Williamson County Sun 5-3-2017 Amount ($) Payee address; City; State; Zip Code 866.25 707 S. Main St, Georgetown, TX 78626 Category (See Categories listed at the top of this schedule) Description ❑ Check if travel outside of Texas.CompleteScheduleT. PURPOSE OF Advertising ❑ Check if Austin, TX, officeholder living expense EXPENDITURE Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Office Depot 5-1-2017 Amount ($) Payee address; City; State; Zip Code 117.18 1013 W. University, Georgetown, TX 78626 Category (See Categories listed at the top of this schedule) Description ❑ PURPOSE Check if travel outside of Texas. Complete Schedule T. OF Printing ❑ Check if Austin, TX, officeholder living expense EXPENDITURE Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F1 EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/FundraisingExpense Accounting/Banking Fees Office Overhead/Rental Expense Trans Transportation Equipment &Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In n District Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above) Credit Card Payment The Instruction Guide explains how to complete this form. 1 Total pages Schedule F1: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) Rachael Jonrowe 4 Date 5 Payee name 5-6-2017 Graphismo 6 Amount ($) 7 Payee address; City; State; Zip Code 407 E 4th Street, Georgetown, TX 78626 750.00 8 (a) Category (See Categories listed at the top of this schedule) (b) Description Graphic Design ❑ Check iftravel outside ofTexas. Complete Schedule T. PURPOSE OF ❑ Check if Austin, Tx, officeholder living expense EXPENDITURE 9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Ink Images 5-1-2017 Amount ($) Payee address; City; State; Zip Code 1272.26 2544 Shell Road, Georgetown, TX 78628 Category (See Categories listed at the top of this schedule) Description ❑ Check if travel outside of Texas Complete Schedule T. PURPOSE printing OF ❑ Check if Austin, TX, officeholder living expense EXPENDITURE Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Amount ($) Payee address; City; State; Zip Code Category (See Categories listed at the top of this schedule) Description ❑ PURPOSE Check iftravel outside ofTexas.Complete ScheduleT. OF ❑ Check it Austin, TX, officeholder living expense EXPENDITURE .......... . Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH ............ ........................... _....... ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 UNPAID INCURRED OBLIGATIONS SCHEDULE F2 EXPENDITURE CATEGORIES FOR BOX 10(a) Advertising Expense Event Expense Loan Repaymenf/Reimbursement Solicitation/Fundraising Expense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In District Contributions/Donations Made By Gift/AWards/Memodals Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services SalariesNdages/Contract Labor Other (enter a category not listed above) The Instruction Guide explains how to complete this form. 1 Total pages Schedule F2: f 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS $ 5 Date 6 Payee name 7 Amount ($) 8 Payee address; City; State; Zip Code 9 TYPE OF EXPENDITURE ❑ Political ❑ Non -Political 10 (a) Category (See Categories listed at the top of this schedule) (b) Description PURPOSE ❑ Check if travel outside of Texas. Complete Schedule T. OF EXPENDITURE ❑Check if Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Amount ($) Payee address; City; State; Zip Code 1 ❑ Political L Non -Political TYPE OF EXPENDITURE Category (See Categories listed at the top of this schedule) Description [--] Check if travel outside of Texas Complete Schedule T. PURPOSE OF ❑ Check if Austin, TX, officeholder living expense EXPENDITURE Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS The Instruction Guide explains how to complete this form. 2 FILER NAME 4 Date g Name of person from whom investment is purchased SCHEDULE F3 1 Total pages Schedule F3: $ Filer ID (Ethics Commission Filers) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - - . . . . . . . . . . . . . . . . . . . 6 Address of person from whom investment is purchased; City; State; Zip Code 7 Description of investment 8 Amount of investment ($) Date IName of person from whom investment is purchased Address of person from whom investment is purchased; City; State; Zip Code Description of investment Amount of investment ($) ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www. ethics. state.tx. us Revised 9/8/2015 EXPENDITURES MADE BY CREDIT CARD SCHEDULE F4 ---------------- EXPENDITURE CATEGORIES FOR BOX 10(a) Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In District Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above) The Instruction Guide explains how to complete this form. 1 Total pages Schedule F4: 2 .............. FILER NAME 3 Filer ID (Ethics Commission Filers) 4 TOTAL OF UNITEM IZED EXPENDITURES CHARGED TO A CREDIT CARD $ 5 Date 6 8 ------------------------------------------------------------------------- Payee name Payee address; City; State; Zip Code 7 Amount ($) 9 TYPE OF EXPENDITURE (a) Political ❑ Non -Political Category (See Categories listed at the top of this schedule) (b) Description 10 PURPOSE ❑ Check if travel outside of Texas. Complete Schedule T. OF EXPENDITURE ❑Check it Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Amount ($) Payee address; City; State; Zip Code TYPE OF EXPENDITURE Political Non Political Category (See Categories listed at the top of this schedule) Description ❑ Check if travel outside of Texas. Complete Schedule T. PURPOSE OF EXPENDITURE Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS SCHEDULE G EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan Re paymenUReimbursement Solicitation/Fundraising Expense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In District Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services SalariesANages/Contract Labor Other (entera category not listed above) Credit Card Payment The Instruction Guide explains how to complete this form. 1 Total pages Schedule G: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 Date 5 Payee name 6 Amount ($) 7 Payee address; City; State; Zip Code Reimbursementfrom political contributions intended 8 (a) Category (See Categories listed at the top of this schedule) (b) Description PURPOSE ❑ Check if [ravel outside of Texas. Complete Schedule T. OF EXPENDITURE ❑ Check if Austin, TX, officeholder living expense 9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Amount ($) Payee address; City; State; Zip Code F7Reimbursement from political contributions intended Category (See Categories listed at the top of this schedule) (b) Description PURPOSE ❑ Check if travel outside of Texas. Complete Schedule T. OF EXPENDITURE ❑ Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Amount ($) Payee address; City; State; Zip Code ❑Reimbursement from political contributions intended Category (See Categories listed at the top of this schedule) (b) Description PURPOSE � El Check if travel outside of Texas. Complete Schedule T. OF EXPENDITURE ❑ Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www. ethics. state. tx.us Revised 9/8/2015 PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH SCHEDULE H EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In District Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services Salarier(Wages/Contract Labor Other (enter a category not listed above) Credit Card Payment The Instruction Guide explains how to complete this form. 1 Total pages Schedule H: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 Date 5 Business name 6 Amount ($) 7 Business address; City; State; Zip Code 8 (a) Category (See Categories listed at the top of this schedule) (b) Description PURPOSE ❑ Check if travel outside of Texas. Complete Schedule T. OF EXPENDITURE ❑ Check if Austin, TX, officeholder living expense 9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Business name Business address; City; State; Zip Code Amount ($) Category (See Categories listed at the top of this schedule) Description PURPOSE ❑ Check if travel outside of Texas. Complete Schedule T. OF ❑ EXPENDITURE Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Business name Amount ($) Business address; City; State; Zip Code Category (See Categories listed at the top of this schedule) Description ❑ PURPOSE Check if [ravel outside of Texas. Complete Schedule T. OF ❑ Check if Austin, TX, officeholder living expense EXPENDITURE Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE The Instruction Guide explains how to complete this form. 1 Total pages Schedule I; 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 Date 5 Payee name 6 Amount ($) 7 Payee address; City; State; Zip Code 8 (a) Category (See instructions for examples of acceptable (b) Description (See instructions regarding type of information PURPOSE categories.) required.) OF EXPENDITURE Date Payee name Amount ($) Payee address; City; State; Zip Code PURPOSE Category (See instructions for examples of acceptable Description (See instructions regarding type of information OF categories.) required.) EXPENDITURE Date Payee name Amount ($) Payee address; City; State; Zip Code PURPOSE Category (See instructions for examples of acceptable Description (See instructions regarding type of information OF categories.) required.) EXPENDITURE Date Payee name Amount ($) Payee address; City; State; Zip Code Category (See instructions for examples of acceptable Description (See instructions regarding type of information PURPOSE categories.) required.) OF EXPENDITURE ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www. ethics. state.tx.us Revised 9/8/2015 INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED TO FILER SCHEDULE K The Instruction Guide explains how to complete this form. 1 Total pages Schedule K: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) ..................... 4 Date 5 Name of person from whom amount is received 8 Amount ($) 6 Address of person from whom amount is received; City; State; Zip Code 7 Purpose for which amount is received Check if political contribution returned to filer Date Name of person from whom amount is received Amount ($) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received Check if political contribution returned to filer Date Name of person from whom amount is received Amount ($) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received ❑ Check if political contribution returned to filer Date Name of person from whom amount is received Amount ($) Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received Check if political contribution returned to filer ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 IN-KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES FOR TRAVEL OUTSIDE OF TEXAS SCHEDULE T The Instruction Guide explains how to complete this form. 1 Total pages Schedule T: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 Name of Contributor / Corporation or Labor Organization / Pledgor / Payee 5 Contribution / Expenditure reported on: ❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1 ❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COH-UC ❑ Schedule B -SS .................. _ 6 Dates of travel 7 Name of person(s) traveling B Departure city or name of departure location --- 9 Destination city or name of destination location ................. ......--.� 10 Means of transportation 11 Purpose of travel (including name of conference, seminar, or other event) Name of Contributor / Corporation or Labor Organization / Pledgor / Payee .......... ........ Contribution / Expenditure reported on: ❑ Schedule A2 [:]Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1 ❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H -------------- ❑ Schedule COH-UC ❑ Schedule B -SS Dates of travel Name of person(s) traveling Departure city or name of departure location ........... Destination city or name of destination location Means of transportation Purpose of travel (including name of conference, seminar, or other event) Name of Contributor / Corporation or Labor Organization / Pledgor / Payee Contribution / Expenditure reported on: ❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule Fi ❑Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COH-UC ❑ Schedule B -SS Dates of travel Name of person(s) traveling Departure city or name of departure location Destination city or name of destination location Means of transportation Purpose of travel (including name of conference, seminar, or other event) ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 CANDIDATE/ OFFICEHOLDER REPORT: DESIGNATION OF FINAL REPORT FORM C/OH - FR The Instruction Guide explains how to complete this form. •• Complete only if "Report Type" on page 1 is marked "Final Report" -- 1 C/OH NAME 1 2 Filer ID (Ethics Commission Filers) 3 SIGNATURE I do not expect any further political contributions or political expenditures in connection with my candidacy. I understand that designat- ing a report as a final report terminates my campaign treasurer appointment. I also understand that I may not accept any campaign contributions or make any campaign expenditures without a campaign treasurer appointment on file. Signature of Candidate /Officeholder 4 FILER WHO IS NOT AN OFFICEHOLDER •• Complete A & B below only if you are not an officeholder. •- A. CAMPAIGN FUNDS Check only one: F-1 I do not have unexpended contributions or unexpended interest or income earned from political contributions. [] I have unexpended contributions or unexpended interest or income earned from political contributions. I understand that I may not convert unexpended political contributions or unexpended interest or income earned on political contributions to personal use. I also understand that I must file an annual report of unexpended contributions and that I may not retain unexpended contributions or unexpended interest or income earned on political contributions longer than six years after filing this final report. Further, I understand that I must dispose of unexpended political contributions and unexpended interest or income earned on political contributions in accordance with the requirements of Election Code, § 254.204. B. ASSETS Check only one: EJ I do not retain assets purchased with political contributions or interest or other income from political contributions - LJ I do retain assets purchased with political contributions or interest or other income from political contributions. I understand that I may not convert assets purchased with political contributions or interest or other income from political contributions to personal use. I also understand that I must dispose of assets purchased with political contributions in accordance with the requirements of Election Code, § 254.204. Signature of Candidate 5 OFFICEHOLDER •• Complete this section only if you are an officeholder •• I am aware that I remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer on file. I am also aware that I will be required to file reports of unexpended contributions if, after filing the last required report as an officeholder, I retain political contributions, interest or other income from political contributions, or assets purchased with o6iti- cal contributions or interest or other income from political contributions. Signature of Officeholder Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015