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CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 Filer ID (Ethics Commission Filorsl 2 Total pages filed:
The C;OH Instruction Guide explains how to complete this form.
3 CANDIDATE' MS MRS MR FIRST MI
OFFICEHOLDER p 1r� OFFICE USE ONLY
NAME Xi' 1ereM7 Date Received
NICKNAME LAST SUFFIX
' , p4"5 ■ IgliW T
4 CANDIDATE! ADDRESS PO BOX. APT SUITE A. CITY, STATE. ZIP CODE
OFFICEHOLDER MAILINGrr_ �] n {� JAN 0 3 2018 .I
ADDRESS /( 0 ! 5c?,I e IL s>(/Ae �'�J-' �!�
E Change of Address 1(Q°VO CITY OF EULESS
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION 4
OFFICEHOLDER rr r 1 1 7{. (p I Date Hand-delivered or Date Postmarked
PHONE l g r 7 1 „}
6 CAMPAIGN MS MRS•MR FIRST r Ml Receipt ai Amount 5
TREASURER
NAME ' r5' i_br; Date Processed
NICKNAME LAST SUFFIX
f; 1 p h Date Imaged
7 CAMPAIGN STREET ADDRESS rNO PO BOX PLEASE/: APT SUITE#: CITY- STATE ZIP CODE
TREASURER ADDRESS 5, 78 ` 0r,fie c, (off, 1 2(polio'7 0
!Residence or Business) /6°7 8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
PHONE TREASURER ( e]r] ) a 33.. /(0
9 REPORT TYPE
January 15 n 30th day before election n Runalf � 151h day after campaign
treasurer appointment
;Officeholder Only.
July 15 n 8th day before election E Exceeded 5500 limit n Final Report;Attach GOH•FR1
10 PERIOD Month Day Year Month Day Year
COVERED S n (// Gbl 7
b'7 / Q r/ ,26/ r THROUGH /2
11 ELECTION ELECTION DATE ELECTION TYPE
Month Day Year E Primary ❑ Runotl n Other
Description
General ❑ Special
/
12 OFFICE OFFICE HELD lit any) 13 OFFICE SOUGHT Id known;
Et,t(eit C147 (oR4< ( e/a-e z
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9r8.'2015
1
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 DOH NAME 15 Filer ID (Ethics Commission Filers}
erem y bpti p ;,ts
16 NOTICE FROM THIS BOX IS FOR NOTICE Of POLITICAL CONTRIBUTIONS ACCEPTED OR POLmCAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICAL SUPPORT THE CANDIDATE 1 OFFICEHOLDER. THESE EXPENDITURES MAY NAVE BEEN MADE WITHOUT THE CANCSDATE'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 COMMITTEE NAME
❑GENERAL
COMMITTEE ADDRESS
❑SPECIFIC
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)
TDTANDITURE 3 TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
UNLESS ITEMIZED
4, TOTAL POLITICAL EXPENDITURES /25
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
BALANCE OF REPORTING PERIOD -
•
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ PJ
18 AFFIDAVIT F�
!swear.or affirm,under penalty of perjury.that the accompanying report is
true and correct d includes all information required to be reported by me
i `�t lPeoi� J O H N BUSH
�`�!!?be under Titl .El ction Code.
;j=z :6'Notary Public,State of Texaa
„ 3, 4E Comm.Expires 01.18-2021
.I -.9ei;•...•��
1 rfi��l0y«y Notary ID 130967426 17fF);1---71
Signature of Candidate or Officeholder
AFFIX NOTARY STAMP,SEAL ABOVE
pp � 1 I♦n
Sworn t and subscribed befor me, by the said tfefly ! ti3+� 1.1l`� , this the
day of� ,20 ` LJ ,to cerlify whictt,witness my hand and seal of office.
Signatur. of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms prov••d by Texas Ethics Commission www.ethics.state.tx.us Revised 9,8.+2015