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Home My WebLink AboutKeith Self 01132015Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1-800-325-8506 .. CANDIDATE I OFFICEHOLDER ZJORIGIN FORM C/OH CAMPAIGN FINANCE REPORT L COVER SHEET PG 1 1 ACCOUNT # 2 Total pages ~ The C/OH Instruction Guide explains how to complete this form. (Ethics Commission filets) 3 CANDIDATE I IoIS/IoIRS/e; ARST loll ""~ '~OFFICEHOLDER .Kal7l. t ......_.. ~;Y NAME ~;,.~~.~.. ,..~~ . . . . . . . . . . .. -....... . -.. . .. ". ~ NICl<NAME o~j~ SUFAX " ~ ....\;~!~( ~~l : = #/4 CANDIDATE I ~1bi ;~£~?=6Y;;~:~ s '. .........../ ~jOFFICEHOLDER %~. MAILING ~.......... ........~ ~.. ADDRESS D~"", •...-~,\\\•. arked D Change of Address Tl '1607/ 'Iff....,.. ([p~5 CANDIDATE! AREA CODE PHONE NUMBER EXTENSION OFFICEHOLDER c;J..1/j ) YS/f-607~ Receipt " IAmount PHONE ...-.. Date pr7sed I 6 CAMPAIGN loIS IMRS 16J ARST loll . :3 '/~} TREASURER t/lH'etV~ (lj Dale Imaged/I NAME . . . . . -.. . . . . . . . . . . . ... • r~ ./-;-._ NICKNAME ~lYTA SUFAX '~7 7 CAMPAIGN ST63~L;~~rc~~/~~ ;;et;;;;qJ '79-73P70TREASURER ADDRESS (Residence or business) 8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER (1/tfI) h;L8-/~7PHONE 9 REPORT TYPE [ff"Janualy 15 D D D 15th day after ca~ign treasurer30th day before election Runoff appointment (officehOkIer only) o Jutf 15 0 8111 day before eledion 0 Exceeded $500 IimiI 0 Filial ffillO<l (Atlach CIOH • FR) 10 PERIOD loIonlh Day Yea-Monlh Day Yeac COVERED o7/tJ/ /~/,/ THROUGH };L /3/ /~/f 11 ELECTION ElECTION DATE El.ECllON TYPE Mon1tJ Day Year LK~/1 / 0 '!/1#;1 '! o PJimary DRunoIf Dspedal 12 OFFICE OfFICE HElD (if any) 0~e-13 OFFICE SOUGHT rlfknown) tOMJIY 14 NOTICE ,/ OF DIRECT .. Direct campaign expenditures are campaign expenditures made by others wilhou1 the candidate's prior consent or approval. CAMPAIGN Candidates are required to dlsdose this Information only if they receive noliflcallon of the direct campaign expenditure. •• EXPENDCTURE -.a.; BY OTHER Name <.n r.. INDMDUALS <::r:o~- Addmss IPO Box; ApLl Suite#; Cily; Slate; Zip Code -~-:...:> 0 ad<ilional pages -0 j I I::x ~. ~---.GO TO PAGE 2 0 -.J Revised 0612712008 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989) FORM C/OH COVER SHEET PG 2 15 ACCOUNT # (Ethics Corrrnission Fliers) THIS BOX IS Fm NOTJ(;E OF POU11CAI. CON1RIBU1lONS ACCEPle> ~ POUllCAl EXPENOlTIJRES MAO!: BY POllllCAL COMMITTEES TO __T THE C/lNDlOATE I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE wrTHOUT THE CANDIDATE'S OR OffiCEHOLDER'S ICIIOWLEDGE OR CONSENT. ~TES AM) OFF1CEHOlDERS AilE. REQlJIRB) TO R£PORT 1HIS 1Nf0000llOH ONI.Y IF '!HEY R£CEII/E NOTICE OF SUCH EXPENllIl\JRES. CANDIDATE IOFFICEHOLDER REPORT: SUPPORT & TOTALS 14 CIOH NAME 16 NOTICE FROM POLITICAL COMMITTEE(S) COMMITTEE NAME COMMITTEE TYPE ~EHERAL Ke. r DSPECIFK: C07~;;RESS~~~67:~/~/II~K7J 75CJ7/ o additional pages 17 CONTRIBUTION TOTALS 1. 2. TOTAL POLITICAL CONTRIBUTIONS 0 $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS). UNLESS ITEMIZED TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) $ $0: EXPENDITURE TOTALS 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS. UNLESS ITEMIZED $ 4. TOTAL POLITICAL EXPENDITURES CONTRIBUTION BAlANCE 5, TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF REPORTING PERIOD OUTSTANDING LOAN TOTALS 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORTING PERIOD $ 18 AFFIDAVIT AFFIX NOTARY STAMP I SEAL ABOVE Sworn to and subscribed by the said -----F---+C-:...J.-I-...Ja"""':::::..J.,_<:.L...-4-I-------. this the ,." -fI.-.., day of ~=f..J.~t..:----, 20 is 'to certit! which, witness my hand and seal of office. www.elhics.slale.lx.us Revised 09/28/2011 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989) POLITICAL CONTRIBUTIONS fl SCHEDULE AOTHER THAN PLEDGES OR LOANS I IGINAL 2 4 9 The Instruction Guide explains how to complete this form. FILER NAME Ke;7716~Jf' 5 Full name of contributor o out-aI-state PACQO#: )Date .f<q.II,/ 'FOt.::L- Contributor address; City; Stale; Zip Code ~~ ~r' 6 1 Total pages Schedule A: 3 ACCOUNT It (Ethics Commission Filers) 7 Amount of 18 In-kind contribution contribution ($) I description (if applicable) jOe; -pD I I I (If travel outside of Texas, complete Schedule T) Principal occupation I Job tille (See Instructions) 10 Employer (See Instructions) 1 Dale Full name of contributor o out-of-state PAC (10#: ) Amount of I In-kind contribution contribution ($) I description (if applicable) .~fJS~tT;;;',J "ffctrri6~1;;'7/#W Contributor address; City; State; Zip Code ~I V~ 5c.a?~1/~{;1()/j ./ IPO fic>x ;2-':2-f6//t~ 79 7qt.t; I (If trallel outside of Texas, complete Schedule T) Principal occupation I Job title (See Instructions) Employer (See Instructions) I Full name of contributor o out-of-state PAC QD#: ) Amount of I In-kind contribution contribution ($) description (if applicable) Dale I Contributor address; City; State; Zip Code I I I (If trallel outside of Texas, complete Schedule T) Principal occupation I Job title (See Instructions) Employer (See Instructions) I Full name of contributor o out-of-state PAC (10#: ) Amount of I I n-kind contribution contribution ($) I description (if applicable) Date Contributor address; City; Stale; Zip Code I I I (If trallel outside of Texas complete Schedule T) Principal occupation I Job tille (See Instructions) Employer (See Instructions) -'" UlI Full name of contributor o out-of-state PAC QD#: ) Amount of I In-kind eO!\lributia contribution ($) description (irapplicable I V.) • Dale Contributor address; City; State; Zip Code I ""D :::':I !rr1I r-. -:r- Clf trallel outside of Texas, COmole~edJe n' , Principal occupation I Job title (See Instructions) Employer (See Instructions) -.J "~' I ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED If contributor is out-of-state PAC, please see instruction guide foradditional reporting requirements. www.elhics.slale.lx.us Revised 09/28/2011 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989) SCHEDULEFPOLITICAL EXPENDITURES INAL EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense GlftlAwanlsIMemoriala Expense SalarieslWagesiContract Labor Loan RepaymentlReimbultl8ment AccounlinglBanking Legal Services SolicltationiFundraising Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Travel In District COntributions/Donations Made By Event Expense Pomng Expense Travel Out Of District CandidatelOflk;eholder/Political Committee Fees Printing Expense Office OvemeadlRentaJ Expense OTHER (enter a category not listed above) The Instruction Guide explailUl how to complete this form. 1 Total pages Schedule F: 2 ALER NAME / / 4 Dale 6 Amount (S) /()()~ 8 PURPOSE OF EXPENDITURE 9 Complete QNLY if direct 3 ACCOUNT # (Ethics CornrrUsIon Fliers) (b) Description IIl_lllIlslde ofTexas. mmplele 5d1eduIeT)--.--:,/ expenditure to benefit C10H PURPOSE OF EXPENDITURE Complete Qm If direct expenditure to benefit C/OH w Description (II nV8I 0Uhlde al T_. tamplele S Office sought category (See cat"llOOes 11st8d at the top of this a:hecIule)PURPOSE PURPOSE OF EXPeNDITURE Dale Amount ( Complete QNLY if direct expenditure to benefit C/OH OF /'""'EXPENDITURE e-vtJ ICe-C-~ e- Complete mu.Y if direct Candidate I Officeholdef name Office held expenditure to benefit C10H ATTACH ADDITIONAL COPIES OF THI5 SCHEOULEAS NEEDED www.Qlhics.8IQle.llt.us Revised 0912812011