HomeMy WebLinkAboutJay Bender 01142015 Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT D ORIGINAL COVER SHEET PG 1
1 ACCOUNT# 2 Total pages filed:
The C/OH Instruction Guide explains how to complete this form. (Ethics commission Filers) t i
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4 CANDIDATE / ADDRESS/PO BOX; APT/SUITE#: CITY; STATE: ZIP CODE _ 1
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ADDRESS ��,,o�`' ••�
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5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDERDate Processed
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6 CAMPAIGN MS/MRS/MR FIRST MI Date Imaged
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Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
CANDIDATE / OFFICEHOLDER REPORT: FORM C/OH
SUPPORT & TOTALS ORIGINAL COVER SHEET PG 2
14 C/OH NAME15 ACCOUNT# (Ethics Commission Filers)
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16 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT THE
POLITICAL CANDIDATE/OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
COMMITTEE(S) CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEE NAME
COMMITTEE TYPE
RECEIVED JAN 14 2015
F-7 GENERAL
COMMITTEE ADDRESS
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
Ell additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF$50 OR LESS(OTHER THAN f
�(
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $ Y .'
2. TOTAL POLITICAL CONTRIBUTIONS $ �`
(OTHER THAN PLEDGES,LOANS,OR GUARANTEES OF LOANS)
EXPENDITURE it 0
TOTALS 3. TOTAL POLITICAL EXPENDITURES OF$100 OR LESS, UNLESS ITEMIZED $ f 3
4. TOTAL POLITICAL EXPENDITURES $
i 3C)
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY 3
BALANCE OF REPORTING PERIOD $ �� ��/
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE ���111 D j
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ l`C
18 AFFIDAVIT
"4,d STEPHANIE JEAN ARLES I swear,or affirm, under penalty of perjury,that the accompanying report
♦,"� is true and correct and'�cludes all information required to be reported by
,9; :1 Notary Public
�• •• me under Title` 5, Electi�, Code.
.4.44;:',
•� •�. STATE OF TEXAS
►i a N* ate comm.Exp AO I2.I013 f
C 7 _
c-.1
Signaturle of Candidate or Officeholder
AFFIX NOTARY STAMP/SEAL ABOVE I/,i
Sworn to and subscribed before me, by the said '�Jc1 . A . , this the
\-54L day of g ^ I t.l , 20 , to certify which, witness my hand and seal of office.
' . r - /et
erin oath Title of officer adr�inisterin oath
o- *i-ti ne,lir) 49e5 noria
Sign- ure of officer admini enng oath Printed name of officer administering rJ g
www.ethics.state.tx.us Revised 07/28/2014
' I
Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
POLITICAL CONTRIBUTIONS
OTHER THAN PLEDGES OR LOANS SCHEDULE A
nORIGINAL
The Instruction Guide explains how to complete this form. 1 Total pages Schedule A:
2 FILER NAME i •-rte 3 ACCOUNT# (Ethics Commission Filers)
4 Date 5 Full name of contributor ❑out-of-state PAC(11:# ) 7 Amount of 18 In-kind contribution
contribution ($) description (if applicable)
6 Contributor address; City; State; Zip Code
(If travel outside of Texas,complete Schedule T)
9 Principal occupation/Job title(See Instructions) 10 Employer(See Instructions)
Date Full name of contributor ❑ out-of-statePAC(ID#: ) Amount of I In-kind contribution
contribution ($) description (if applicable)
Contributor address; City; State; Zip Code I
(If travel outside of Texas,complete Schedule T)
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of contributor 0 out-of-state PAC(ID#: ) Amount of In-kind contribution
contribution ($) description (if applicable)
Contributor address; City; State; Zip Code I
(
(If travel outside of Texas,complete Schedule T)
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of contributor 0 out-of-state PAC(ID#. Amount of I In-kind contribution
contribution ($) description (if applicable)
Contributor address; City; State; Zip Code
(If travel outside of Texas,complete Schedule T)
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of contributor 0 out-of-state PAC(ID* Amount of I In-kind contribution
contribution ($) description (if applicable)
Contributor address; City; State; Zip Code
(
(If travel outside of Texas,complete Schedule T)
Principal occupation/Job title(See Instructions) Employer(See Instructions)
RECEIVED JAN 14 2015
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide foradditional reporting requirements.
Revised 07/28/2014
www.ethics.state.tx.us
ail
Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
PLEDGED CONTRIBUTIONS SCHEDULE B
ORIGINAL
1 Total pages Schedule B:
The Instruction Guide explains how to complete this form.
2 FILER NAME 3 ACCOUNT# (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED PLEDGES: a * *
5 Date
6 Full name of pledgor 0 out-of-state PAC(ID#: ) 8 Amount of I g In-kind description
pledge ($) ( (if applicable)
7 Pledgor address; City; State; Zip Code I
I I
(If travel outside of Texas,complete Schedule T)
10 Principal occupation/Job title(See Instructions) 11 Employer(See Instructions)
Date Full name of pledgor 0 out-of-state PAC(IDtt: ) Amount of I In-kind description
pledge ($) (if applicable)
Pledgor address; City; State; Zip Code I
(If travel outside of Texas,complete Schedule T)
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of pledgor 0 out-of-state PAC(ID#: Amount of I In-kind description
pledge ($) I (if applicable)
Pledgor address; City; State; Zip Code I
(
(If travel outside of Texas,complete Schedule T)
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of pledgor Ei out-of-state PAC(ID#: ) Amount of I In-kind description
pledge ($) (if applicable)
Pledgor address; City; State; Zip Code I
(If travel outside of Texas,complete Schedule T)
Principal occupation/Job title(See Instructions) Employer (See Instructions)
Date Full name of pledgor 0 out-of-state PAC(ID#: Amount of I In-kind description
pledge ($) (if applicable)
Pledgor address; City; State; Zip Code I
(If travel outside of Texas,complete Schedule T)
Principal occupation/Job title (See Instructions) Employer(See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements.
www.ethics.state.tx.us Revised 07/28/2014
RECEIVED JAN 141015
II
Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
LOANS SCHEDULE E
1J ORIGINAL
1 Total pages Schedule E:
The Instruction Guide explains how to complete this form.
2 FILER NAME 3 ACCOUNT# (Ethics Commission Filers)
4
TOTAL OF UN ITEMIZED LOANS: * b v r b $
SII
5 Date of loan 7 Name of lender 0 out-of-state PAC(l ) 9 Loan Amount($)
6 Is lender 8 Lender address; City; State; Zip Code 10 Interest rate
a financial
Institution?
11 Maturity date
Y N
12 Principal occupation / Job title (See Instructions) 13 Employer (See Instructions)
14 Description of Collateral 15 Check if personal funds were deposited into political account
❑ none ❑
16 GUARANTOR 17 Name of guarantor 19 Amount Guaranteed($)
INFORMATION
18 Guarantor address; City; State; Zip Code
❑ not applicable
20 Principal Occupation (See Instructions) 21 Employer (See Instructions)
Date of loan Name of lenderout-of-state PAC(ID# ) Loan Amount($)
Is lender Lender address; City; State; Zip Code Interest rate
a financial
Institution?
Maturity date
Y N
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Description of Collateral Check if personal funds were deposited into political account
❑ none ❑
GUARANTOR Name of guarantor Amount Guaranteed($)
INFORMATION
Guarantor address; City; State; Zip Code
fl not applicable
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.
www.ethics.state.tx.us Revised 07/28/2014
RECEIVED JAN 14 2015
Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
POLITICAL EXPENDITURES SCHEDULE F
ORIGINAL
EXPENDITURE CATEGORIES BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations 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 FILEy.NAME / 3 ACCOUNT#(Ethics Commission Filers)
4 Date 5 Payee nark — '
/`L) -- 13 i1v' L �tcl �i( c
6 Amount ($) 7 Payee add s5; City; State; Zip Code .�
8 PURPOSE (a) Category (See categories listed at the top of this schedule) (b) Description (If travel outside of Texas,complete Schedule T)
OF -.0
EXPENDITURE L VCA I (:_-_-_-(1 p{.L't c--t-
Check ifAustin,TX,officeholder living expense
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
PURPOSE Category (See categories listed at the top of this schedule) Description (If travel outside of Texas,complete Schedule T)
OF
EXPENDITURE
❑ Check if Austin,TX,officeholder living expense
Complete CN..Y if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/O-I
Date Payee name
Amount ($) Payee address; City; State; Zip Code
PURPOSE Category (See categories listed at the top of this schedule) Description (If travel outside of Texas,complete Schedule T)
OF
EXPENDITURE 0 Check if Austin,TX,officeholder living expense
Complete ON-Y if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Category (See categories listed at the top of this schedule) Description (If travel outside of Texas,complete Schedule T)
PURPOSE
OF
EXPENDITURE 0 Check if Austin,TX,officeholder living expense
Complete ONLY 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 07/28/2014
RECEIVED JAN 14 2015
Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
POLITICAL EXPENDITURES SCHEDULE G
MADE FROM PERSONAL FUNDS ORIGINAL
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations 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 G: 2 FILER,NAME —1 3 ACCOUNT# (Ethics Commission Filers)
4 Date 5 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
8 PURPOSE (a)Category (See categories listed at the top of this schedule) (b) Description (If travel outside of Texas,complete Schedule T)
OF
EXPENDITURE
Check if Austin,TX,officeholder living expense
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Reimbursement from
political contributions
irtended
PURPOSE Category (See categories listed at the top of this schedule) Description (If travel outside of Texas,complete Schedule T)
OF
EXPENDITURE
Check if Austin,TX,officeholder living expense
Date Payee name
Amount ($) Payee address; City; State; Zip Code
1-7 Reimbursement from
I I
political contributions
intended
PURPOSE Category (See categories listed at the top of this schedule) Description (If travel outside of Texas,complete Schedule T)
OF
EXPENDITURE
Check if Austin,TX,officeholder living expense
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
PURPOSE Category (See categories listed at the top of this schedule) Description (If travel outside of Texas,complete Schedule T)
OF
EXPENDITURE
❑ Check if Austin,TX,officeholder living expense
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 07/28/2014
RECEIVED JAN 14 2015
Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
PAYMENT FROM POLITICAL CONTRIBUTIONS SCHEDULE H
TOA BUSINESS OF C/OH �- , ORIGINAL
f :.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/Reimbursement
Accounting/Banking Legal Services Solicitation/Fundraising Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Travel In District Contributions/Donations 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 3 ACCOUNT#(Ethics Commission Filers)
C �4 I-NO.4LAA 6-e✓t, _
4 Date 5 Business name
6 Amount ($) 7 Business address; City; State; Zip Code
8 PURPOSE (a) Category (See categories listed at the top of this schedule) (b) Description (If travel outside of Texas,complete Schedule T)
OF
EXPENDITURE
0 Check if Austin,TX,officeholder living expense
g Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Business name
Amount ($) Business address; City; State; Zip Code
PURPOSE Category (See categories listed at the top of this schedule) Description (If travel outside of Texas,complete Schedule T)
OF
EXPENDITURE
❑ Check if Austin,TX,officeholder living expense
Complete fkLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Business name
Amount ($) Business address; City; State; Zip Code
PURPOSE Category (See categories listed at the top of this schedule) Description (If travel outside of Texas,complete Schedule T)
OF
EXPENDITURE
Check ifAustin,TX,officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Business name
Amount ($) Business address; City; State; Zip Code
PURPOSE Category (See categories listed at the top of this schedule) Description (If travel outside of Texas,complete Schedule T)
OF
EXPENDITURE
Check if Austin,TX,officeholder living expense
Complete CLLY 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 07/28/2014
RECEIVED JAN 14 2015
Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
NON-POLITICAL EXPENDITURES SCHEDULE I
MADE FROM POLITICAL CONTRIBUTIONS
,rI!\AL
The Instruction Guide explains how to complete this form.
1 Total pages Schedule I: 2 FILER NAME ___ 3 ACCOUNT# (Ethics Commission Filers)
4 Date 5 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
8 PURPOSE (a)Category (See instructions for examples of acceptable (b)Description (See instructions regarding type of information
O F categories) required.)
EXPENDITURE
Date Payee name
Amount ($) Payee address; City; State; Zip Code
PURPOSE (a)Category (See instructions for examples of acceptable (b)Description (See instructions regarding type of information
O F categories) required.)
EXPENDITURE
Date Payee name
Amount (8) Payee address; City; State; Zip Code
PURPOSE (a)Category (See instructions for examples of acceptable (b)Description (See instructions regarding type of information
O F categories) required.)
EXPENDITURE
Date Payee name
Amount ($) Payee address; City; State; Zip Code
PURPOSE (a)Category (See instructions for examples of acceptable (b) Description (See instructions regarding type of information
O F categories) required.)
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 07/28/2014
RECEIVED JAN 14 2015
Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
INTEREST EARNED, OTHER CREDITS/GAINS/ SCHEDULE K
REFUNDS, AND PURCHASE OF INVESTMENT
ORIGINAL
Total pages Schedule K:
The Instruction Guide explains how to complete this form.
2 FILER NAME 3 ACCOUNT# (Ethics Commission Filers)
t �at /\Gvk ( -ev1
4 Date 5 Name of person from whom amount is received 8 Amount
($)
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
($)
Address of person from whom amount is received;City;State;Zip Code
Purpose for which amount is received
Date Name of person from whom amount is received Amount
($)
Address of person from whom amount is received;City;State;Zip Code
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
Purpose for which amount is received
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 07/28/2014
RECEIVED JAN 142015
Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
IN-KIND CONTRIBUTION OR POLITICAL EXPENDITURE SCHEDULE T
FOR TRAVEL OUTSIDE OF TEXAS
.i ) ORIGINAL
The Instruction Guide explains how to couplets this form pages Schedule T.
Th
2 FILER NAME 3 ACCOUNT# (Ethics Commission Filers)
4 Name of Contributor/Corporation or Labor Organization/Pledgor/Payee
5 Contribution/Expenditure reported on:
n Schedule A I 1 Schedule B n Schedule C I I Schedule D I .1 Schedule F I I Schedule G
Schedule H ( 1 Schedule N fl COH-UC I I COH-T I I PAC-C 11 PAC-E
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:
I I Schedule A I I Schedule B I I Schedule C I ] Schedule D I I Schedule F 1 Schedule G
Schedule H I ] Schedule N fl COH-UC I I COH-T I I PAC-C I I PAC-E
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 I Expenditure reported on:
I Schedule A I I Schedule B I I Schedule C 7 Schedule D I I Schedule F 7 Schedule G
I I Schedule H 1 I Schedule N I-I COH-UC I COH-T
PAC-C I I PAC-E
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)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
www.ethics.state.tx.us Revised 07/28/2014
RECEIVED IAN 142015