JUDICIAL CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT 1 Filer ID The JC/OH Instruction Guide explains how to complete this form. 3 CANDIDATE / OFFICEHOLDER NAME FORM JC/OH COVER SHEET PG 1 2 Total pages filed: (Ethics Commission Filers) MS / MRS / MR FIRST MI OFFICE USE ONLY Date Received NICKNAME LAST SUFFIX 4 CANDIDATE / OFFICEHOLDER MAILING ADDRESS Change of Address ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE 5 CANDIDATE/ OFFICEHOLDER PHONE 6 CAMPAIGN TREASURER NAME AREA CODE PHONE NUMBER EXTENSION Date Hand-delivered or Date Postmarked ( ) FIRST MI MS / MRS / MR NICKNAME LAST SUFFIX Date Imaged 7 CAMPAIGN TREASURER ADDRESS (Residence or Business) STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; 8 CAMPAIGN TREASURER PHONE AREA CODE PHONE NUMBER EXTENSION ( ) 9 REPORT TYPE January 15 30th day before election Runoff July 15 8th day before election Exceeded $500 limit 10 PERIOD COVERED Month Day Year Month Day THROUGH 1 ELECTION 1 Month ELECTION DATE Day ELECTION TYPE Year Primary General Runoff Special Other Description 12 OFFICE OFFICE HELD (if any) 13 OFFICE SOUGHT (if known) GO TO PAGE 2 Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/1/2015 American LegalNet, Inc. www.FormsWorkFlow.com Receipt # Amount $ Date Processed ZIP CODE 15th day after campaign treasurer appointment (Officeholder Only) Final Report (Attach C/OH - FR) Year CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT 14 JC/OH NAME FORM JC/OH COVER SHEET PG 2 15 Filer ID (Ethics Commission Filers) 16 NOTICE FROM POLITICAL COMMITTEE(S) THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE CANDIDATE OF SUCH EXPENDITURES. / OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE COMMITTEE TYPE COMMITTEE NAME GENERAL COMMITTEE ADDRESS SPECIFIC COMMITTEE CAMPAIGN TREASURER NAME Additional Pages COMMITTEE CAMPAIGN TREASURER ADDRESS 17 CONTRIBUTION TOTALS 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $ $ $ $ $ $ 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. CONTRIBUTION BALANCE OUTSTANDING LOAN TOTALS TOTAL POLITICAL EXPENDITURES 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF REPORTING PERIOD TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORTING PERIOD 6. 18 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the accompanying report is true and correct and includes all information required to be reported by me under Title 15, Election Code. Signature of Candidate or Officeholder AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said _____________________________________, this the ___________ day of _____________, 20_______, to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/1/2015 American LegalNet, Inc. www.FormsWorkFlow.com SUBTOTALS - JC/OH 19 FILER NAME 20 FORM JC/OH COVER SHEET PG 3 Filer ID (Ethics Commission Filers) 21 SCHEDULE SUBTOTALS NAME OF SCHEDULE SCHEDULE A(J)1: MONETARY POLITICAL CONTRIBUTIONS (JUDICIAL) SCHEDULE A2 : NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS SCHEDULE B(J): PLEDGED CONTRIBUTIONS (JUDICIAL) SCHEDULE E(J): LOANS (JUDICIAL) SUBTOTAL AMOUNT 1. 2. 3. 4. 5. 6. $ $ $ $ $ $ $ $ $ $ $ SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F2: UNPAID INCURRED OBLIGATIONS SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH 7. 8. 9. 10. 11. SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED TO FILER 12. $ Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/1/2015 American LegalNet, Inc. www.FormsWorkFlow.com MONETARY POLITICAL CONTRIBUTIONS (JUDICIAL) The Instruction Guide explains how to complete this form. 2 FILER NAME SCHEDULE A(J)1 1 Total pages Schedule A(J)1: 3 Filer ID (Ethics Commission Filers) 4 Date 5 Full name of contributor out-of-state PAC ID#:__________________________) 7 Amount of contribution ($) 6 Contributor address; City; State; Zip Code 8 Contributor's principal occupation 9 Contributor's job title 10 Contributor's employer/law firm 1 Law firm of contributor's spouse (if any) 1 12 If contributor is a child, law firm of parent(s) (if any) Date Full name of contributor out-of-state PAC ID#:__________________________) Contributor address; City; State; Zip Code Contributor's principal occupation Contributor's job title Contributor's employer/law firm Law firm of contributor's spouse (if any) If contributor is a child, law firm of parent(s) (if any) Date Full name of contributor out-of-state PAC ID#:__________________________) Contributor address; City; State: Zip Code Contributor's principal occupation Contributor's job title Contributor's employer/law firm Law firm of contributor's spouse (if any) If contributor is a child, law firm of parent(s) (if any) ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission www.ethics.state.tx.us Amount of contribution ($) Amount of contribution ($) Revised 9/1/2015 American LegalNet, Inc. www.FormsWorkFlow.com NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS The Instruction Guide explains how to complete this form. 2 FILER NAME SCHEDULE A2 1 Total pages Schedule A2: 3 Filer ID (Ethics Commission Filers) 4 TOTAL OF UNITEMIZED IN-KIND POLITICAL CONTRIBUTIONS 5 Date 6 Full name of contributor $ 8 Amount of Contribution $ out-of-state PAC (ID#:______________________) 9 In-kind contribution description 7 Contributor address; City; State; Zip Code Check if travel outside of Texas. Complete Schedule T. 10 Principal occupa