HomeMy WebLinkAbout2015 Tompkins semi Jan Texas Ethics Commission P.D.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
4.
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 ACCOUNT# 2 Total pages filed
The CIOH Instruction Guide explains how to complete this form. (Ethics Commission Fiiers)
3 CANDIDATE 1 MSIMRS1MR FPS- MI OFFICE USE ONLY
OFFICEHOLDER xier{e►N
NAME NICKNAME LAST LFFIC "1
D
4 CANDIDATE / ADDRESS I RO BOX. C.PT:SUITE e. CM'. STATE; ZIF con-X JAN - 2 2015 J
OFFICEHOLDER
MAILING : 30 r'
ADDRESS J t(1 7 ffie74 C-14 C SS 1 7(.Ar-a Date Hand-delivered d Fostmarned
n change of address 7 / CO OF EULESS 1
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION i
OFFICEHOLDER Date Processed
PHONE ( 7 (21( - LP-
ok:,2
6 CAMPAIGN MSIMRS/MP FIRST MI Date Imaged
TREASURER
NAME II1II 4r• l
NICKNAME LAST SUFFIX
7 CAMPAIGN STREET ADDRESS(ND POBOX PLEASE), APT I SUITE M, CITY, STATE. ZIP CODE
TREASURER r'''',ADDRESS 7 �4�/, r,e �C►d 7 u�
{residence or business) it/0 ,1yne7°ri lm'
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE ( gl-7 ) p2 3 3- ..cc
9 REPORT TYPE January 15 I 1 30th day before election n Runoff nday campaign
V�J 15th after cam al n
treasurer appointment
IoffmholderortlYI
n July 15 n 8th day before election n Exceeded S500 n Final report(Attach C/OH-FR)
limit
-10 PERIOD month Day Year Mortht Cey vaar —
COVERED 7 / / /Zoly THROUGH /z /,I/zo/y
11 ELECTION ELECTION DATE ELECTION TYPE
Montn Oat Year I Pnrrar n Runoff n General Speaal
/ /
12 OFFICE OFFICE HELD(early) 13 OFFICE SOUGHT if known)
u less erg 4kIIN 1 ?/4 ee z
GO TO PAGE 2
www.ethics.state.tx.us Revised 07/28/2014
Texas Ethics Commission P.O-Box 12070 Austin,Texas 78711-2070 (512)4F3-5800 (TDD 1-800-735-2989)
r
CANDIDATE / OFFICEHOLDER REPORT: FORM C/OH
SUPPORT & TOTALS COVER SHEET PG 2
14 C/OH NAME 15 ACCOUNT# (Ethics Commission Filers)
i-efenti A. Tots ]ki t
16 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE
POLITICAL CASOGATE/OFFICEHOLDER. THESE EYPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDER'S KNOWLEDGE OR
COMMITTEE(S) CONSENT.CAMNDATES AHD OFFICEHOLDERS APE REQUIRED TO REPORT'DISINFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEE NAME
COMMITTEE TYPE
n GENERAL
COMMITTEE ADDRESS
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
I I additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF$50 OR LESS(OTHER THAN pp /]
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $ f�
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 $ pJ
CBALANCE OF
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY �v OF REPORTING PERIOD ` ��
^
OUTSTANDING 6 TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS $
LAST DAY OF THE REPORTING PERIOD k
18 AFFIDAVIT
I swear. or affirm.under penalty of perjury,that the accompanying report
is true and co and includes all information required to be reported by
4�Y,+aae U DSAY WELLS �]
1 a° �l me under I 15, Election Code.
' 8 i Hoary Public 1
'on I STATE OF TEXAS 11 \ dal Commission Expires Ofe02101 b j
N.N. o
Signature of Candidate or Officeholder
AFFIX NOTARY STAMP 1 SEAL ABOVE
Sworn fit❑ and subscribed before me, by the said Z�r--01\ 1 �11,5 , this the
ci day of 3&M trli , 20 4 5 , to certify Mich, witness my hand and seal of office
i kV ,---t-6,\5 1
Lr.,064
Lrejn 11 :Inir.,Ig-r-41,,re.._
Signature of. =dministering oath Printed name f❑ ICer administenng oath Title of officer administering oath
www.ethics.state.tx.us Revised 07/28l2014