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CANDIDATE / OFFICEHOLDER FORM CIOH
CAMPAIGN FINANCE REPORT COVER SHEET PG 7
1 Fier ID pries Commission F ri 2 TIal pages tiled'
The CIOH Instruction Guide explains how to complete this form.
4
3 CANDIDATE/ e MRS r 61R FiRsr / all
OFFICE USE ONLY
FI OFCEHOLDER )IN)..DA -)r
NAME
Date Received
IdC DMIME - - - - - -LAST SLMFS
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4 CANDIDATE/ ADDRESS 1 PC BOX, APT J SUREfi CITY, STATE; 2.CODE I(
OFFICEHOLDER 1 11yp
MAULING
ADDRESS ; o d5 LA R.I, LAN P .v L.. E- 7W L��61
0 Orange of Address
5 CANDIDATE( AREA CODE EAT CMSION
OFFICEHOLDER Dale Hart-delrrered or Date Postmarked
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6 CAMF UGN ailriA MR �t r - MI Recerpt s Ammar!I
TREASURER 1
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NAME r D r' A i< Date Processed
NICKNAME BAST SIAM _
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7 CAMPAIGN 1 trowirk I ADDRESS (NO PO Box PiEA ; APT 1 some ir, IYTr, STATE. ZIP CODE
TREASURER
ADDRESS may �y+�7 /+ �r �J [�(Residence or Business) 'C 4 1 i J 4 Ur• i�i5-r �1` +6 a3 I
I CAMPAIGN AREA CODE PROW NUNIEffli EXTENSION
ONE TREASURER
P (e)`"T ) i'i3 - 4.)rT
9 REPORT TYPE
,bray 15 ❑ 30fh day fathom demon ❑ Runoff in 151h day after campaign
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(Officeholder Oriyy
-bay 15 [ Bth day Ltekxe eleclio i ❑ EAC eded$500 limirl 7 Fab Report Mach UCH FR)
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10 PERIOD (Burial Day Lear - Month Day Year
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11 ELECTION EL CTiON DATE fnLkc,tvrr iw1
i Month Diu year ❑ Primary ❑ Runoff ❑ Other
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u OFFICE f OFFICE!KEW Of at 13 OFFICE soucifT (1f ki 1)
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Forms provided by Texas Ethics C,amrritssirxv ie wrr-ethics-state-tx-u5 Revised 0212712015
CANDIDATE./OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C10FL NAME 15 Fier E (Eirres Commission Filers)
NPA ).1'r/7 / T1
16 NOTICE FROM THIS IIOX Is FOR NOTICE OF POLrncAL COIITtMB massy ACCEPTED OR!'CAM cw.EXPENDITURES MADE BY POLITICAL CCO MITTEES TO
POl1TICN_ SUPPORT THE GI,ImRTE 1 OFFICEHOLDER. TFESE EXPeroMMES NNW NAVE MEW MADE NI1741JT 7#C*NOrDATF'S OR OFFICEHOLDER'S
COMMITTEE(S) /[MOMLEDGE OR COI/MEN7. CANI17ATES AMD OFFICEHOLDERS ARE REQUIRED TO REPORT TINS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENrTDRES.
EO*INJTTEE TYPE COMMITTLE NAME
0GETIERAL
�� COIRYITTEE ADDRESS
J_J SPEOFIC
COMMITTEE CAMPAIGN TREASURER NAME
Li Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION 1_ TOTAL POLITICAL CONTRIBUTIONS OF$50 OR LESS<OTHE.R THAN
TOTALS PLEDGES, LOANS.OR GUARANTEES OF LOo.UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES. LOANS, DR GUARANTEES OF LOANS)
EX
TflTALS� 3. TOTAL POLITICAL EXPENDITURES OF Stop OR LESS, i f�
1mide ESS ITEMIZED j [�1
" f
4 TOTAL POLITICAL EXPENDITURES $
CONTRIBUTION
BALANCE 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
OF REPORTING PERIOD $ r]
OUTSTANDING 6_ TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ p
118 AFFIDAVIT
I swear,or affirm,under penalty of perjury.that the accompanying report rs
true and correct and inckidex all inkormation required 7D be reported by me
KM SUTTER under Tile 15,Beckon Code.
‘41•• My Commission Expires
August 25,2017
7,41167," • _ k JC L
Signature of Candilfale or
AFT iX NOTARY STAMP 1 SEAL ABOVE
Sworn to and subscribed before me,by the said I—r`I of ("id iq f`a L) !t!
{Z .this e /-
day of' ,20 1 < ,to oerUfy which,witness my hand and seal of office_
irW
� o�A RJ Pt)13 a c-
aIure of olbcer administering°ads F'rxlled rH$mne of or6aer Ong oath Tide of officer DOITNI iMering oath
Forms provided by Texas Ethics Commission www.eencs.state_tt.us Resit/erg 02TZ7f1015