HomeMy WebLinkAboutKeith Self 07152014Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
SUFFIX
MI
{IJ ..
EXTENSION
CITY;
N .r:
ZIP CODE STATE;
CANDIDATE I OFFICEHOLDER
CAMPAIGN FINANCE REPORT DORIGIN
1 ACCOUNT#
The C/OH Instruction Guide explains how to complete this form.
(ElhicsCommission Filers)
3 CANDIDATE I MS/MRS MR FIRST MI
OFFICEHOLDER
NAME Ke ltll . . . ..., .
NICKNAME lAST SUFFIX
6~
ADDRESS I PO BOX.: APT ISUITEII; CITY; STATE; ZIP CODE 4 CANDIDATE I
OFFICEHOLDER
MAILING /fdrl;1P ~ sT/llcjf/v/J/CV :z;<ADDRESS
, / .--7 /.
[ifchange of address
AREA CODE PHONE NUMBER 5 CANDIDATEI
OFFICEHOLDER
PHONE
6 CAMPAIGN
TREASURER
NAME
MS/MRS
.{;/~~r:;.
NICKNAME lAST
STREET ADDRESS (NO PO BOX PLEASE); APT I SUITE #;7 CAMPAIGN
TREASURER
ADDRESS S305 h-Jch tAJOoj1 CJ fMe
(residence or business) 1YlC-/< /lvAlo/.J ./,;J( ?,5d2?
8 CAMPAIGN
TREASURER
PHONE
9 REPORT TYPE
FORMC/OH
COVER SHEET PG 1
2 Total pages filed: -" - - • -...~,
AREA CODE PHONE NUMBER EXTENSION
(1£1 )
15th day after campaign o January 15 o 30th day before election o Runoff o treasurer appoinlment
(officeholder only)
~'Y15 o 8th day before election o Exceeded 5500 o Final report (Attach CIOH -FR)
limil
10 PERIOD
COVERED
Mon1h Cla'f Year
()//O//~/r THROUGH
Monlh Cla'f Year
cJ6' /30 /~/-y
11 ELECTION
Mon1h
ELECTION DATE
Cla'f
/ /
Year
ELECTION TYPE o Pnmary DR<roOfI D General o Special
12 OFFICE OFFICE HELD (~any) 13 OFFICESOUGHT (~known)
GO TO PAGE 2
www.elhics.slale.lx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 (TDD 1-800-735-2989)
CANDIDATE t OFFICEHOLDER REP FORM CtOH
SUPPORT & TOTALS AM II :~~VER SHEET PG 214 JUL -7
14 C/OH NAME 15 ACCOUNT # (Ethics Commission Filers) ORIGINAL
16 NOTICE FROM lltiS BOX IS FOR NDllCE OF POUllCAL CONlRIBU1TONS ACCS'lEll OR POU11CAL EXPENDlnJRES MADE BY POLlllCAL COMMITTEES TO SUPPORT THE
POLITICAL CANDIDATE I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WTTHOifT THE CANDIDATE'S OR OffiCEHOLDER'S KNOWLEDGE OR
COMMITTEE(S) CONSENT. CANDIDATES AM:> OFACEHOLDERS ARE REQUIRED TO REPORT THIS INFDRMAllON ONLY IF THEY RECEIVE NOtiCE OF SUCH EXPENDITURES.
COMMITTEE TYPE
o GENERI\L
o SPECIFIC
o additional pages
17 CONTRIBUTION
TOTALS
EXPENDITURE
TOTALS
CONTRIBUTION
BALANCE
OUTSTANDING
LOAN TOTALS
18 AFFIDAVIT
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
.5 3C5 ~~;p"~1e/ /7110J<;41JeJ!:.7l.
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)
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
OF REPORTING PERIOD
6, TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING
LAST DAY OF THE REPORTING PERIOD
LOANS AS OF THE
CJ
$
$
$
$
$
00.-
$.~
e accompanying report
uired to be reported by
AFFIX NOTARY STAMP I SEAL ABOVE
~ ~,~,
to a~~~subscribed before me, by the said ~\Ar-I~'e..:_\"-~~b'--\;....~'...:-",,,~,J.·· -->-e--,~, this the
~~.~~>'t'ItJay of:rv..-\::; • 20 \.L-4;~'to certify which, witness my hand and seal of office.r--,
inistering oath
www.ethics.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
PENDITURE CATEGORIES FOR BOX 8(a)
POLITICAL EXPENDITURES
Advertising Expense
Accounting/Banking
Consulting Expense
Event Expense
Fees
SCHEDULE F
GifUAwards/Memorials Expense Salaries/Wages/Contract Labor Loan RepaymenVReimbursemenl
Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related Expense
Food/Beverage Expense Travel In District Contributions/Donations Made By
Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F: 2 3 ACCOUNT # (Ethics Commission Filers)
Payee a dress; CitY· State· Zip Code .-.--:-
()tJ /? ::5Z9cY ;fcfl..J ;50lC-/tJQ I /146-)(;/t/M:3)/; I)C
8 PURPOSE
OF
EXPENDITURE
(a) Category (See categories listed attne top 01 this schedule) (b) .Description (If travel outside of Texas. complete Schedule T)
9 Complete Q.lliY if direct
expenditure to benefit C/OH
Candidate / Officeholder name Office sought Office held
PURPOSE
OF
EXPENDITURE
Complete Qtlh:( if direct
expenditure to benefit C/OH
Category (See categories listed at the top of this schedule) -,j::"I/i
Candidate / Officeholder name
Description (If travel outside of Texas. complete Schedule T) -~
Amount ($)
.,/ qf].-~JOoe'
Payee name
Office heldOffice sought
Description (If travel outside of Texas, complete Schedule T)
-J{eAJ H7XbA! {'~r,_
Candidate / Officeholder name
Category (l3ee categories listed at the top of this schedule)
CO (l)T('i btLT/o,/tJ
PURPOSE
OF
EXPENDITURE
Complete ONLY if direct
expenditure to benefit C/OH
PURPOSE
OF
EXPENDITURE
Complete ONLY if direct
Category (See colegories listed at the top of this schedule)
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 09/28/2011
8
(rOD 1-800-735-2989)Texas Ethics Commission P.O. Box 12070
POLITICAL EXPENDITURES SCHEDULE F
Advertising Expense
Accounting/Banking
Consulting Expense
Event Expense
Fees
1 Total pages Schedule F:
6 Amount ($)
2
2~
EXPENDITURE CATEGORIES FOR BOX 8(a) '0/",
Gift/Awards/Memorials Expense Salaries/Wages/C~ntrac1Labor Loan RepaymenlJReimburs'J..~!U111'"1
Legal Services SOllctlatlOn/Fundralsmg Expense Transportation Equipment & Related {xY~
Food/Beverage Expense Travel In District Contributions/Donations Made By
Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
3 ACCOUNT # (Ethics Commission Filers)
Payee address; City; State; Zip Code
~;;J-..;;L0 '/C/J/ ci..fJxJE; .L4-t/04./ JX /'6/&?
PURPOSE (a) Category (See categories listed at the top of this schedule) (b) Description (If Iravel oulside of Texas. complete Schedule T)
EXPENDITURE
OF CD NT((b~l17w
9 Complete ONLY if direct Candidate I Officeholder name Office sought Office held
expenditure to benefit e/OH
L1¥V,J)or
Amount ($) Payee address; City; Slate; Zip Code .~
3 ej'.7-CZ' 0417#r J-11-/Ve / P;h-/Vi); /50,23
Category (See categories listed at the top of Ihis schedule) Description (It travel outside at Texas, complete Schedule T)PURPOSE
OF
EXPENDITURE Sf/S1V:f()rSc1iC. /l/T!"/btu-rtirAJ
Complete Qlli.Y if direc1 Candidate I Officeholder name Office sought Office held
expenditure to benefit C/OH
PURPOSE
OF
EXPENDITURE
Complete ONLY if direct
Description (If travel outside of Texas. complete Schedule T)
I..,
expenditure to benefit C/OH
Payee name rc /1-5 I?J.(
Amount ($) Payee address; City; State; Zip Code
{!O. f3.~ 70/5351; j)Vjf!M'/ 7.J -;.)379
Category (See calegorieslisted althe lop of this schedule) Description (If travel outside of Texas. complete Schedule T)PURPOSE
OF '" EXPENDITURE
Candidate I Officeholder name Office sought Office heldComplete ONLY if direct
expenditure to benefit e/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.slale.lx.us Revised 09/2812011