HomeMy WebLinkAboutMark Wiggins 01152014FORM C/OH
GINA OVER SHEET PG 1
2 Total pages filed:
(Ethics Commission Filers) \2
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0 15th day after campaign
treasurer appointment
(officeholder only)
Exceeded $500 ~al report (Attach CrOH -FR)
Month Dl>{ Year
/ /
D General D Speaal
OFFICE SOUGHT (if kn~n)
CO'-~/N (2. utJ"i C""""""$~'...-:.......1
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ACCOUNT #
STATE;
EXTENSION
CITY.
EXTENSION
Runoff
limit
Runoff
Texas Ethics Commission PO Box12070 Austin Texas 78711-2070,
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13
CA OIDATE I OFFICEHOLDER
CAMPAIGN FI ANCE REPORT
The C/OH Instruction Guide explains how to complete this form.
3 CANDIDATE / MS/MRS/MR FIRST
OFFICEHOLDER fv1A-~~NAME
NICKNAME LAST
WIG-(=dNS
4 CANDIDATE / ADDRESS I PO BOX, APT I SUITE #; CrTY;
OFFICEHOLDER
MAILING Ll~J1-8eHDIN~ O~Il.."Ti:) ;c..~Tk.ADDRESS
o change of address
5 CANDIDATE/ AREA CODE PHONE NUMBER
OFFICEHOLDER
PHONE ( )
6 CAMPAIGN MS/MRS/MR FIRST
TREASURER Muli..NAME
NICKNAME LAST
VJ 1G2,"/~5
7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT I SU ITE #;
TREASURER
ADDRESS
q '-Il-BeNb/N!-OA.~ -ri". J P(residence or business)
8 CAMPAIGN AREA CODE PHONE NUMBER
TREASURER ( )PHONE
9 REPORT TYPE 0 January 15 0 30th day before election
0 July 15 0 8th day before election
10 PERIOD Month Dl>{ Year
COVERED / / THROUGH
11 ELECTION ELECTION DATI: ELECTION TYPE
MonlI1 Dl>{ Year D Pnmary
/ /
/
12 OFFICE OFFICE HELD (if any)
GO TO PAGE 2
(512) 463-5800 (TOO 1-800-735-2989)
www.ethics.state.tx.us ReVised 04/19/2013
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
CANDIDATE I OFFICEHOLDER EPO T: FORM C/OH
SUPPO T & TOTALS n OVER SHEET PG 2
14 C/OH NAME 15 ACCOUNT # (Ethics Commission Filers)
16 NOTICE FROM
POLITICAL
COMMITTEE(S)
o additional pages
17 CONTRIBUTION
TOTALS
EXPENDITURE
TOTALS
CONTRIBUTION
BALANCE
OUTSTANDING
LOAN TOTALS
THIS BOX IS FOR NOTICE OF POUTICAL CON1Rl6UllONS ACCEPTED OR POU11CAJ.. EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE
CANDIDATE I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE DR
CDNSENT. CANOtDATl"S AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENOtlURES.
COMMITTEE TYPE
D GENERAL
D SPECIFIC
COMMITTEE NAME
COMMITTEE ADDRESS
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
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 LOANS AS OF THE
LAST DAY OF THE REPORTING PERIOD
of
<.. -...-
C...t1
.r
~
a
c..n a
$
$d
$ ,R)
$ ~
$ /J
$ /ff
18 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the accompanying report
is true and correct and includes all info 10 required to be reported by
me under Tit 15, Election Cod
DEBORAH JOy PIMA
NatIry NlIic
STAlE OF TEXAS ..,e-. ~1"2Ot.
AFFIX NOTARY STAMP I SEAL ABOVE
__/Y)L....L--fJ"a:no....L.L,,~~I---'o!.A.<.>...J..a..iqLf-;j,.........,.o..J-..!'O..-c---' th i s th e
, to certify which, witness tdy hand and seal of office.
Revised 04/19/2013www.ethics.state.tx.us
9
Texas Ethics Commission PO. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-80Q..735-2989)
POLITICAL CONTRI UTIONS L SCHEDULE AOT ER THAN PLEDGES OR LOANS
The Instruction Guide explai s how to complete this form. 1 Total pages Schedule A:
2 FILER NAME 3 ACCOUNT # (Ethics Commission Filers)
4 Date 5
6
Full name of contributor 0 out-at-stale PAC (10#:.
Contributor address; City; State; Zip Code
-1) 7 Amount of I 8 In-kind contribution
contribution ($) I description (if applicable)
I
I
I
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor o aUI-af-slate PAC (10# -'1 Amount of
contribution ($)
II In-kind contribution
description (if applicable)
Contributor address; City; State; Zip Code I
I
I
(If travel outside of Texas, complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
I
Date Full name of contributor o aUI-af-slata PAC (10#.: ---') Amount of
contribution ($)
I
I
In-kind contribution
description (if applicable)
Contributor address; City; State; Zip Code I
I
I
(If travel outside of Texas, complete Schedule n
Principal occupation / Job title (See Instructions)
Date Full name of contributor o aut-of-stale PAC (10#:
I
Employer (See Instructions)
....) Amount of
contribution ($)
II In-kind contribution
description (if applicable)
Contributor address; City; State; Zip Code I
I
I
(If travel outside of Texas complete Schedule T)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
I -\
Amount of I In-kind lCQPtributionl
contribution ($) I descriptio":_ app.l.l ble
Full name of contributor 0 oul-af-sIBlePAC(IO# -')Date
Contributor address; City; State; Zip Code I (.J1 •
I .r:-1"[:x II -" ' (If travel outside of Texas, compl@Sche.d le.1\
Principal occupation / Job title (See Instructions) Employer (See Instructions) (J1
I C) •
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide foradditional reporting requirements.
www.elhicsslale.lx.us Revised 04/19/2013
2
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
.~PLEDGED CO TRIBUTIO 5 SCHEDULE B-L
1 Total pages Schedule B: The Instruction Guide explains how to complete this form.
FILER NAME
3 ACCOUNT # (Ethics Commission Filers)
TOTAL OF UNITEMIZED PLEDGES: c:> c:> ~ c:> ~ 94 1$
5 Date 6 Full name of pledgor D OUI-of-stale PA (IDtt ) 8 Amount of
pledge ($)
19
I
In-kind description
(if applicable)
7 Pledgor address; City; State; Zip Code I
I
I
(If travel outside of Texas, complete Schedule T)
10 Principal occupation I Job title (See Instructions) 11 Employer (See Instructions)
1
Amountof In-kind descriptionDate FUll name of pledgor D OUI-of-stete PAC (10# ) I pledge ($) (if applicable)
I
Pledgor address; City; State; Zip Code I
I
I
(If travel outside of Texas, complete Schedule T)
Principal occupation I Job title (See Instructions) Employer (See Instructions)
I
Date Amountof In-kind descriptionFull name of pledgor D oul-of-stale PAC (10#' ) I
pledge ($) (if applicable)
I
I
I
I
Pledgor address; City; State; Zip Code
(If travel outside of Texas, complete Schedule T)
Principal occupation I Job title (See Instructions) Employer (See Instructions)I
Date Amount of I In-kind description
pledge ($) (if applicable)
Full name of pledgor D out-ol·stale PAC(IOIt )
I
I
I
Pledgor address; City; State; Zip Code
I -(If travel outside of Texas, complet~chedule i)1
~ Principal occupation I Job title (See Instructions) Employer (See Instructions) :::
I ~
Date Full name of pledgor D out-of-Slale PAC (IDIt ) Amountof I In-kind tUlcription
Pledgor address; City; State; Zip Code
pledge ($) I
I
I
(if applicableJ
~ ::z
9 .
<.J1
I c::> > .f·"
(If travel outside of Texas, complete Schedule T)
Principal occupation I Job title (See Instructions) Employer (See Instructions)
I
ATIACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
www.elhics.state.lx.us Revised 04/19/2013
Texas Ethics Commission PO Box 12070 Austin Texas 78711-2070 (512) 46:>-5800 (TDD 1-800-735-2989)
LOANS
2 FILER NAME
4
OTAL OF UNITEMIZE D LOANS:
5 Date of loan 7 Name of lender
6 Is lender 8 Lender address;
a financial
Institution?
y N
12 Principal occupation / Job title (See Instructions)
14 Description of Collateral
o none
16 GUARANTOR 17 Name of guarantor
INFORMATION
18 Guarantor address;
o not applicable
20 Principal Occupation (See Instructions)
Date of loan Name of lender
Is lender Lender address;
a financial
Institution?
y N
Principal occupation / Job title (See Instructions)
Description of Collateral
0 none
GUARANTOR Name of guarantor'
INFORMATION
Guarantor address;
o not applicable
Principal Occupation (See Instructions)
....'
• I A CHEDULE E
1 Total pages Schedule E:
The Instruction Guide explains how to complete this form.
3 ACCOUNT # (Ethics Commission Filers)
q q q q q $
9 LoanAmount ($)o out-of-state PAC (10#. )
10 Interest rate
11 Maturity date
13 Employer (See Instructions)
Check if personal funds were deposited into political account
0
19 Amount Guaranteed ($)
Zip Code
Employer (See Instructions)
Loan Amount ($)o out-of-state PAC (10#: )
Interest rate
Maturity date
Employer (See Instructions)
Check if personal funds were deposited into political aC29.lJnt
-r
~ •0 (-,
-
Amount G~nt~J<-
"""
CJ1 .J
oJ
Zip Code ~
::J:
a ~ i
~~
U1 :Employer (See Instructions)
0
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If lender is out-of-state PAC, please see Instruction guide for additional reporting requirements.
q
City; State; Zip Code
15
City; State;
21
City; State; Zip Code
City; State;
www.ethics.state.tx.us Revised 04/19/2013
--
Texas Ethics Commission PO Box 12070 Austin Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
POLITICAL EXPENDITURES n SCHEDULE FGIN L
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense GifUAwards/Memorials Expense SalarieslWages/Contract Labor Loan RepaymenUReimbursement
Accounting/BanKing Legal Services
Solicilalion/Fundraising Expense Transportalion Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District ContributionslDonations Made By
Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F: 2 FILER NAME 13 ACCOUNT # (Ethics Commission Filers)
4 Date 5 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
(a) Category (See ca.egories listod al the top of this schedule) (b) Description (If travel outside of Texas, campi eta Schedule T)8 PURPOSE
OF
EXPENDITURE
9 Complete QNLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Payee nameDate
Amount ($) Payee address; City; State; Zip Code
Category (See calegories IIstad at the top of this schedule) Description (If travel outSide of Texas. complete Schadule T)PURPOSE
OF
EXPENDITURE
Complete ~ if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Payee nameDate
Amount ($) Payee address; City; State; Zip Code
Description (If travel outSide at Texas, complete Schedule T)Category (See categories lisled at the top of thiS schedule)PURPOSE
OF
EXPENDITURE
Candidate / Officeholder name Office sought Office heldComplete ~ if direct
expenditure to benefit C/OH
--I.
-l .Payee nameDate {-..~,"""---,,'-..Amount ($) Payee address; City; State; Zip Code J1
"
it
z:::r -Description (If travel outside of Texas, complata Scfiiiiifule T)Category (See catagorieslisted at the top of this schedule)PURPOSE .OF en
EXPENDITURE 0 -,...
Candidate 1 Officeholder name Office sought Office heldComplete ~ If direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 04/19/2013
Texas Ethics Commission P.O. Box 12070
Austin Texas 78711-2070
(TDD 1-800-735-2989)(512) 463-5800
POLITICAL EXPENDITURES
IN CHEDULE GMADE FROM PERSONAL FUNDS •
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan RepaymenUReimbursementAccounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment & Related Expense IConsulting Expense Food/Beverage Expense Travel In District ContributionslDonations Made ByEvent Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Tolal pages Schedule G: 2 FILER NAME 3 ACCOUNT # (Ethics Commission Filers)
4 Date 5 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
0 Reimbursement from
political contnbutions
intended
8 PURPOSE (a) Category (See categories listed allhelop Of this schedule) (11) Description (If Iravel oulside of Texas, complele Schedule T)
OF
EXPENDITURE
Date Payee name
Amount ($) Payee address; City; State; Zip Code
0 Reimbursement from
poliliCBI contnbutions
intended
PURPOSE Category (See ca'egories lisled atlhe top of this schedula) Description (If Iravel oUlside of Texas, complete Scheduie T)
OF
EXPENDITURE
Date Payee name
Amount ($) Payee address; City; State; Zip Code
D Reimbursement from
political contributions
Inter\ded
PURPOSE Category (See categories listed at the top of lhis schedule) Description (If Ira vel outside of Texas, complele Schedule T)
OF
EXPENDITURE -.
L-Date Payee name boo ::.--., -.:'~
..... . Amount ($) Payee address; City; State; Zip Code
b0rn---
D Reimbursement from C3 I
political contribuhons
CJ1inlended
Category (See calagories lisled allhe top of Ih,s schedule) Description (If travel au lsi de or Texes, complele SJ;;}ul T)PURPOSE
OF
EXPENDITURE
ATIACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.elhics.slale.lx.us Revised 04/19/2013
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
PAYMENT FROM POL TICAL CONTRI UTIONS , SCHEDULE H TO A BUSINESS OF C/OH
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense SalarieslWages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Fund raising Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Travel In District ContributionslDonations Made By
Event Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political Committee
Fees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
,
1 Total pages Schedule H: 2 FILER NAME 13 ACCOUNT # (Ethics Commission Filers)
4 Date 5 Business name
6 Amount ($) 7 Business address; City; State; Zip Code
8 PURPOSE (a) Category (See ""legories IISled allhe lop ollhis schedule)
OF
EXPENDITURE
9 Complete ~ if direct Candidate / Officeholder name
expenditure to benefit C/OH
(b) Description (If lravel outsida of Texas, complele Schedule T)
Office sought Office held
Date Business name
Amount ($) Business address; City; State; Zip Code
PURPOSE
OF
EXPENDITURE
Complete ONLY if direct
expenditure to benefit C/OH
Category (See ""Iegories Iisled allhe top of this schedule)
Candidate / Officeholder name
Description (If lravel outside of Texas, complele Schedule T)
Office sought Office held
Date Business name
Amount ($) Business address; City; State; Zip Code
PURPOSE
OF
EXPENDmJRE
Complete QtlU if direct
expenditure to benefit C/OH
Category (See categories listed allha top of tnlS schedule)
Candidate / Officeholder name
Description (If Iravel oulside of Texes. complele Schedule T)
Office sought Office 1ltd
'-. . ~ Business name -Date -
CJl
Amount ($) Business address; City; State; Zip Code
a
.::. fl1::r
, ... ----='r .Category (See c"tegories listed at Ihe top of Ihis schedule) Description (If travel outside of Texas, complete S~le T)PURPOSE
OF
EXPENDITURE
Complete Q.ti1:i if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 04/19/2013
-----
Texas Ethics Commission p.o. Box 12070 Austin Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
NON-POLITICAL EXPENDITURES SCHEDULE I
MADE FROM POLITICAL CONT IBUTIONS ,,... L
The Instruction Guide explains how to complete this form.
3 ACCOUNT # (Ethics Commission Filers)1 Total pages Schedule I: 2 FILER NAME
5 Payee name4 Date
6 Amount ($) 7 Payee address; City; Slate; Zip Code
8 PURPOSE (a) Category (See In,tructions for examples of acceplable (b) Description (See instructIons regarding type of information
categories)OF required.)
EXPENDITURE
Date Payee name
Amount ($) Payee address; City; State; Zip Code
PURPOSE (a) Category (See Ins!ructions for examples of acceplable (b) Description (See instructions regarding type of information
categories)OF required.)
EXPENDITURE
Payee nameDate
Amount ($) Payee address; City; State; Zip Code
PURPOSE (a) Category (See instructions for examples of acceptable (b) Description (See instructions regarding type of information
categolles)OF reqUired.)
EXPENDITURE
--~
r ~
-= Z -~
Payee nameDate -
Ul r
.Do rrAmount ($) Payee address; City; State; Zip Code ::::lr
0.. r=;:-:-.;
~ .-;
PURPOSE (b) Description (See instructions regarding type of information(a) Category (See instructions for examples of accapteble
requIred)OF categories)
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 04/19/2013
Texas Ethics Commission PO Box 12070 Austin Texas 78711-2070, (512) 463-5800 (TDD 1-800-735-2989)
INTEREST EARNED, OTHER CREDITS/GAINS/
EDULE KREFUNDS, A 0 PURCHASE OF INVESTMENTSn
~
The Instruction Guide explains how to complete this form. 1 Total pages Schedule K:
2 FILER NAME 3 ACCOUNT # (Ethics Commission Filers)
4 Date 5 Name of person from whom amount is received 8 Amount
($)
6 Address of person from whom amount is received; City; State; Zip Code
7 Purpose for which amount is received
Date Name of person from whom amount is received Amount
($)
Address of person from whom amount is received; City; State; Zip Code
I
Purpose for which amount is received
Date II Name of person from whom amount is received Amount
($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
Date Name of person from whom amount is received Amount
{$
~ -
<
:;e -Address of person from whom amount is received; City; State; Zip Code --.-U1 "
.z:JT!'::J:: = -.
Purpose for which amount is received c.n
C>
ATIACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.lx.us Revised 04/19/2013
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TOO 1-800-735-2989)
IN-KIND CONTRIBUTION OR POLITICAL EXPENDITURE
FOR TRAVEL OUTSIDE OF TEXAS [J ORIGH ;,L
The Instruction Guide explains how to complete this form. 1 Total pages Schedule T
2 FILER NAME 3 ACCOUNT # (Ethics Commission Filers)
4 Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
5 Contribution / Expenditure reported on:
D Schedule A D Schedule B D Schedule C D Schedule D D Schedule F
D Schedule H D Schedule N D COH-UC D COH-T D PAC-C
6 Dates of travel 7 Name of person(s) traveling
8 Departure city or name of departure location
9 Destination city or name of destination location
10 Means of transportation 11 Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
Contribution / Expenditure reported on:
D Schedule A D Schedule B D Schedule C D Schedule D D Schedule F
D Schedule H D Schedule N D COH-UC D COH-T D PAC-C
Dates of travel Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
Contribution / Expenditure reported on:
D Schedule A D Schedule B D Schedule C D Schedule D D Schedule F
D Schedule H D SChedule N D COH-UC D COH-T D PAC-C
Dates of travel Name of person(s) treveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation Purpose of travel (including name of conference, seminar, or other event)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
SCHEDULE T
D Schedule G
D PAC-E
D Schedule G
D PAC-E
-'
~
-.. ;;:
-; -D S~ndule G
I
D P~-E ff=':T I
C5 -• ! .. , ...
0
www.elhics.slale.lx.us Revised 04/19/2013
Texas Ethics Commission P.O. Box '12070 Austin, Texas 78711-2070 (512)463-5800 (TOO 1-800-735-2989)
CANDIDATE I OFFICEHOLDER REPORT:
DESIGNATION OF FI AL REPORT FORM C/OH FR
The Instruction Guide explains how to complete this form .
•• Complete only if "Report Type" on page 1 Is marked "Final Report"
1 C/OHNA~
ft/IAIt../L D.
2 ACCOUNT # (Ethics Commission Filers)
3 SIG ATURE
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 terminates 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.
4 FILER WHO IS NOT AN OFFICEHOLDER
•• Complete A & B below only If you are not an officeholder.••
Check only one:
~dO not have unexpended contributions or unexpended interest or income earned from political contributions.
~
(
CAMPAIGN FUNDS
P
I have unexpended contributions or unexpended interest or income earned from political contributions. I understand ttmI: I m~y
not convert unexpended political contributions or unexpended interest or income earned on political contributions to~sonaL
use. I also understand that I must file an annual report of unexpended contributions and that I may not retain unemnded
contributions or unexpended interest or income earned on political contributions longer than six years after filing ~ final'
report. Further, I understand that I must dispose of unexpended political contributions and unexpended interest or income
earned on political contributions In accordance with the requirements of Election Code, § 254.204.
D
A.
B. ASSETS
Check only one:
~do not retain assets purchased with political contributions or interest or other income from political contributions.
D I do retain assets purchased with political contributions or interest or other income from political contributions. 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
5 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.txus Revised 04/19/2013