HomeMy WebLinkAboutDavid Smith 01152014Texas Ethics coLJJ~RIGl~aX~2070 (TOO 1-800-735-2989)Austin, Texas .'l:i:\Z11
CANDIDATE I OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT 14 JAN 13 PM ~: 27 COVER SHEET PG 1
1 ACCOUNT # 2 Total pages filed:
(Ethics Commission Filers)The C/OH Instruction Guide explains how to complete this form.
3 CANDIDATE 1
OFFICEHOLDER
NAME
4 CANDIDATE I
OFFICEHOLDER
MAILING
ADDRESS
D change of address
5 CANDIDATEI
OFFICEHOLDER
PHONE
6 CAMPAIGN
TREASURER
NAME
7 CAMPAIGN
TREASURER
ADDRESS
(residence or business)
8 CAMPAIGN
TREASURER
PHONE
9 REPORT TYPE
10 PERIOD
COVERED
11 ELECTION
12 OFFICE
NICKNAME LAST SUFFIX
ADDRESS I PO BOX: APT I SUITE#; CITY; STATE; ZIP CODE
IOl C. pc-<rk ~lvcL" s.+e. 000
~ l C-(V\O , (e..)£:..,,,-.$. 7 SO 7 -4
AREA CODE PHONE NUMBER EXTENSION
MS/MRS/MR FIRST MI
A.V\V' M.
NICKNAME LAST SUFFIX
Lo
STREET ADDRESS (NO PO BOX PLEASE); APT I SUITE #; CITY; STATE; ZIP CODE
7S07~
AREA CODE PHONE NUMBER EXTENSION
15th day afler campaignG2l oJanuary 15 30th day before election Runoffo o treasurer appointment
(officeholder only) o July 15 D 8th day before election Exceeded $500 Final report (Atlach C/OH . FR)D limit
Month Day Year Month Day Year
THROUGH
67/0'/;2...013
ELEcnON TYPEELECTION DATE
Month Day Year
o Primary D Runoff G2f General D Spedal
/0;2./;<010
13 OFFICE SOUGHT (ff known)OFFICE HELD (if any)
MS/MRS/MR FIRST MI
GO TO PAGE 2
www.ethics.state.tx.us Revised 09/28/2011
D ORIGIINA L J . U
1512~J'00 ; (TOO 1-800-735-2989)Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 ~ c__• ,,-.
CANDIDATE t OFFICEHOLDER REP~J~N 3 PM ~80t FORM CtOH
SUPPORT & TOTALS ER SHEET PG 2
14~.NAM,Ed M. S """ i +h
115 ACCOUNT # (Ethics Commission Filers)
_ o.:v I
16 NOTICE FROM 111IS BOX IS FOR NOTICE OF POumCAL CONTRlBUTIONS ACCEPTED OR poumCAL EXPENOITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE
POLITICAL CANDIDATE 1OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
COMMITTEE(S) CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED 110 REPORT THIS INFORMATION ONLY IF THEY RECBVE NOTICE OF SUCH EXPENDITURES;
COMMITTEE NAME
COMMITIEE TYPE
o GENERAL
COMMITIEE ADDRESS o SPECIFIC
COMMITIEE CAMPAIGN TREASURER NAME
o additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN ~ 0-TOTALS PLEDGES, LOANS, QR GUARANTEES OF LOANS), UNLESS ITEMIZED $
2. TOTAL POLITICAL CONTRIBUTIONS $ or8t.~8'(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
EXPENDITURE $TOTALS 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED \7::2.l7
4. TOTAL POLITICAL EXPENDITURES $ \/'::<.17
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE OF REPORTING PERIOD $ -0-
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE $ -0-LOAN TOTALS LAST DAY OF THE REPORTING PERIOD
18 AFFIDAVIT
I swear, or affirm, under penalty of pe~ury, that the accompanying report
is true and correct and includes all information required to be reported by
~~ ] me under Title 15, Election Code.
,~~~ ~"<. FAWN HENDERSON ~2n~z4(~~.:-~ Notary Public. Slole of Texc 5
~';;'. "'~f Mv CommiSSion EXPires V~'if.:':."? Oclobel 03, 2016
Signature of Candidate or Officeholder
AFFIX NOTARY STAMP I SEAL ABOVE
Sworn to and subscribed before me, by the said bAV\J) r~10 ~\'\~ 1Tl--\ , this the
~1~ \ \/lrNUklZ ~I ,20~ myday of , to certify which, witness hand and seal of office.
I \ I
--1u!l>t ))'k ~
I
F-AluJ +tw~)r-J IX ML'ifAP--U HJ&.1 (,
Signature flicer administering oath Printed name of officer administering oath Title of officel administering oath
www.ethics.state.tx.us Revised 09/28/2011
I Texas .gi12}, 463-5800 1 -800-325-8506Ausfn 78711 2<f70-pbo.T'
I...
POLITICAL CONTRIBUTIONS ~L~, l~) SCHEDULE A
OTHER THAN PLEDGES OR LOANS 14 JMi 13 PH ~: ')7
1 Total pages Schedule A:The Instruction Guide explains how to complete this form.
3 ACCOUNT # (Ethics Commission filers,2 FILER NAME
~..-.....vid (\,-1 .S I"~I+~
4 Date 7 Amount of 18 I" "hid co;,liibutieli
contribution ($) I description (if applicable)~C(.V; d M S \AA ;-\-Lt
Date
5 Full name of contributor o out-of-state PAC (I[)#' )
Ice ~e.C Af-l ~O ~u"c.L.,a~e. .!:
•I c.c. ..v. ~ c.e..'1 VI6 Contributor address; City; State; Zip Code~C)\3 I C4.s:~<2.. *-~101 E. t:>c., k &l",d.,., S.\.J',k roOO
I ~ ( ~ V\ 0, -y;. ')C.. <.L.S; 7SD7~ (If travel outside of Texas, complete Schedule n
9 Principal occupation I Job title (See Instructions) 10 Employer (See Instructions)
~.... i.-.hc_.... ( ~l"\s.\.IJ..-~ .... ~ 1 :se..li:'
Amount of I .. hi-kltid COliliibutiel1
contribution ($) I description (if applicable)
Date Full name of contributor o OUI-of-slate PAC (10#. )
~l ~c.. ~c.e..~,d. M S~',t~ Q3Cf ~~ -t''''''.j·\ve~~.s.2..0 l 3; Contributor address; City; State' Zip Code .I' +
rOI e. 'f::>G.,.k t5 . d .s -'k ~ CO I 0 ~-'''''''F''''~ Vi
'v., .... de-b.+
f>lo< (;to, le~~ 7 S o 7 ~ I (If travel outside ~f Texas, complete Schedule n
Principal occupation I Job title (See Instructions) Employer (See Instructions) ~('> I ;+\~." f c...e lA _<;.: (> 1-4-,. .A-I ~"(~
Full name of contributor o out'Of-state PAC (10#: ) Amount of I In-kind contribution
contribution (S) description (if applicable)
I I
IContributor address; City; State; Zip Code
I
I
(If travel outside of Texas, complete Schedule n
Principal occupation I Job title (See Instructions) Employer (See Instructions)I
Amount of I In-kind contribution
contribution ($) I description (if applicable)
Date Full name of contributor o out·of-stale PAC (10#: )
IContributor address; City; State; Zip Code
I
I
I (If travel outside of Texas, complete Schedule n
Principal occupation I Job title (See Instructions) Employer (See Instructions)
I
Amount of I In-kind contribution
contribution ($) description (if applicable)
Date Full name of contributor o out-o!·state PAC (10#: )
I
IContributor address; City; State; Zip Code
I
I
IIf travel outside of Texas, complete Schedule n
Principal occupation I Job title (See Instructions) Employer (See Instructions)I
ATTACH ADDITIONAL COPIES OF THIS FORMAS NEEDED
If contributor is out-of-state PAC, please see instruction guide foradditional reporting requirements.
Revised 06/27/2008
Texas Ethics Commission P.O. Box 12070 Austin, TexbsJ8~j2070L [fs'1\) 463-5800 (TOO 1-800-735-2989)
SCHEDULE E ~:27
I
~ /rl
LOANS 14 JAN I3 PHOOI~'G'NAL
The Instruction Guide explains how to complete this form.
2
4
FILER NAME
~o...vid M. SIA-\~+l-,
TOTAL OF UNITEMIZED LOANS: q q q
3 ACCOUNT #
q q q $
5 Date of loan 7 Name of lender o out-of-state PAC (10#: ) 9 Loan Amount ($)
6 Is lender
a financial
In sti tu tion?
8 Lender address; City; State; Zip Code 10 Interest rate
11 Maturity date
12
y N
Principal occupation 1 Job title (See Instructions) 13 Employer (See Instructions)
14 Description of Collateral
o none
16 GUARANTOR 17 Name of guarantor
INFORMATION
15 Check If personal funds were deposited into political account
0
19 Amount Guaranteed ($)
o not applicable
18 Guarantor address; City; State; Zip Code
20 Principal Occupation (See Instructions) 21 Employer (See Instructions)
Date of loan Name of lender o out-<:>f-state PAC (10#:
~
) Loan Amount ($)
Is lender
a financial
Institution?
Lender address; City; State; Zip Code Interest rate
Maturity date
y N
Principal ,occupation 1 Job title (See Instructions) Employer (See Instructions)
Description of Collateral
D none
GUARANTOR
INFORMATION
Name of guarantor
Check if personal funds were deposited into political account
D
Amount Guaranteed ($)
o not applicable
Guarantor address; City; State; Zip Code
Principal Occupation (See Instructions) Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If lender is out-of-state PAC, please see instruction gUide for additional reporting requirements.
1 Total pages Schedule E: 1
(Ethics Commission Filers)
100. 00
www.ethics.state.tx.us Revised 09/28/2011
Texas Ethics Commission P.O. Box 12070 Austin Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
CANDIDATE I OFFICEHOLDER REPORT:
FORM CIOH -FRDESIGNATION OF FINAL REPORT n"'-·-~NAL
The Instmction Guide explains how to complete this form .
•• Complete only if "Report Type" on page 1 is marked "Final Report" ••
1 C/OH NAME 2 ACCOUNT # (Ethics Commission Filers)
\
3 SIGNATURE
I do not expect any further political contributions or political expenditures in connection with my candidacy. I understand that designating a
report as a final report tenminates my campaign treasurer appointment. I also understand that I may not accept any campaign contributions
or make any campaign expenditures without a campaign treasurer appointment on file.
Cl:JJ2Vl.~
Signature of Candidate 1 Officeholder
4 FILER WHO IS NOT AN OFFICEHOLDER
•• Complete A & B below only if you are not an officeholder.••
A. CAMPAIGN FUNDS
Check only one:
w
I do not have unexpended contributions or unexpended interest or income earned from political contributions.
D I have unexpended contributions or unexpended interest or income earned from political contributions. I understand th~mayn-.
not convert unexpended political contributions or unexpended interest or income earned on political contributions to pl!/tonar-.
use. I also understand that I must file an annual report of unexpended contributions and that I may not retain unex~ded~
contributions or unexpended interest or income earned on political contributions longer than six years after filing this final
report. Further, I understand that I must dispose of unexpended political contributions and unexpended interest or income
eamed on political contributions in accordance with the requirements of Election Code, § 254.204.
B. ASSETS
Check only one:
I do not retain assets purchased with political contributions or interest or other income from political contributions.
D I do reta in assets purchased with pclitica! cQntributions or interest or other income from political cor.tributions. I understand that
I may not convert assets purchased with political contributions or interest or other income from political contributions to personal
use. I also understand that I must dispose of assets purchased with political contributions in accordance with the requirements
of Election Code, § 254.204.
Signature of Candidate
OFFICEHOLDER
•• Complete this section only if you are an officeholder ••
D I am aware that I remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer on file.
I am also aware that I will be required to file reports of unexpended contributions if, after filing the last required report as an
officeholder, I retain political contributions, interest or other income from political contributions, or assets purchased with political
contributions or interest or other income from political contributions.
Signature of Officeholder
www.ethics.state.tx.us Revised 04/19/2013
5