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HomeMy WebLinkAboutKeith Self 01122016 r CANDIDATE/OFFICEHOLDER ° °- FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 1 1 Filer ID(mics Commission Filers) 2 Total pages tiled: The C/OH Instruction Guide explile how to complete this form. (7 3 CANDIDATE/ MS/ -„ FPST OFFICEHOLDER `%�/ MI OFFICE USE ONLY NAME / /� Date Received NKXQ1At LAST SUFFIX ``,, ``�E/7 -2.9C/161 ' ``,```` '',,',, Se/F 4 CANDIDATE/ ADDRESS r PO BOX; APTS. LDER SUITE t CITY; STATE; IP CODE OFFtGEHO6AAILING 7 /‘)/ �r /"/c-t /l� 7 ` . ADDRESS �a/l S3\ ,:i '.. `" ❑ Change of Address i NIA EXTENSION ', a 5 CANDIDATE/ AREA CODE PHONE yi TEM ���� OFFICEHOLDER ( 19 ) Date�t l to Posimariced PHONE Ji/5-v_.... .,7)_.., l 11 6 CAMPAIGN Ms!MAS Fg�T/1 7fV M) Receipt* Amount 5 TREASURER . NAME !� wDate Processed NICKNAMELAST '/,2'/� Date Imaged i ./2-/6 7 CAMPAIGN STREET ADDRESS (NO PO 00 APT i th CITY: STATE/�,,��/Z PP CODE TREASURER j 3©C ��C.��i1't K1� C�'►✓'Gl�" 1 �1�'//rel/[i 75 7��7D (Residence or Business) �� 8 CAMPAIGN AREACODECODE / PHONE NUMBER E TREASURER t/ (�2 ./ 7 9 REPORT TYPE January 15 n 30th clay before election a Runoff n 15t1 day atter treasurer appointment (Officeholder Orly) nJuly 15 n 86 day bye aim:gm n Exceeded woo Bak Q Final Report(flash CaOH-FR) 10 PERIOD Month Day Year Month Day year C COVERED D 7/0/ /i�„/ . THROUGH /"2/ .5` /./�.J 11 ELECTION ELECTION DATE ELECTION TYPE Month � year ❑ wry ❑ Runoff ❑ Other :Description .r I, / / ❑ General ❑ species - 12 OFFICE OFFICE HELD (d ally) 13 OFFICE SOU( IT (9 Mown} CJ GO TO PAGE 2 Forms provided by Texas Ethics Commission www ethics_siate_ix_us Revised 9/8/2015 CANDIDATE/OFFICEHOLDER CAMPAIGN FINANCE REPORT FORM C COVER SHEET PG 2 2 14 CJOH NAME15 Filer ID (Ethics Commission Filers) r� 5e / r 16 NOTICE FROM nags aPTT Is FOR soma OF POURCAL COIMIIINYITOMS ACCEPT®OR POLRICAL EXP IUITIRIES MADE BY POLITICAL COMMITTEES 10 POLITICAL SUPPORT UM CAMPMATE I amcwounin. now EXPENINOWLES ow new sem Woe mnmur THE CAaPaUEES on O DER', COMMITTEE(S) KNOWLEDGE OR CONSENT. CAN RMIES ANO ORECEcoLOEAs ARE REWIRED TO REPORT TATS MORRanoe ONLY F TREY RM VE NOTICE OF 5001 EaPENEURES. COMMITTEE TYPE COMMITTEE NAME WI-GENERAL r/e,/t1. 0S" 0 Ye,77 5dc COMMITTEE ADDRESS d r) SPECIFIC 77,.• /( � U I/�,,/Cr 5-7" _... ' lf--- 74/ � 7. 07/ .. > COMMITTEE CAMPAIGN TREASURER °�3 :1 2 62)i 0 Additional Pages /�NCr�G<l COMMITTEE ms/ ON /l �D��R I ref e_ ~ d c) /me it/4/9/, /,< 7. c'2l 17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF$50 OR LESS(OTHER THAN TOTALS PLEDGES,LOANS,OR GUARANTEES OF LOANS),UNLESS ITEMIZED $ 2. TOTAL POLITICAL CONTRIBUTIONS � (OTHER THAN PLEDGES,LOANS,OR GUARANTEES OF LOANS) $ E G , 0 0 EXPENDITURE 3. TOTAL POLITICAL EXPENDITURES OF$100 OR LESS. TOTALSUNLESS ITEMIZED $ 4. TOTAL POLITICAL EXPENDITURES $ 5-- 7 CONTRIBUTION BALANCE 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY $ p.3 / j 7� OF REPORTING PERIOD OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ 18 AFFIDAVIT ------ __._ —� 1 swear,Or affirm,udder .___---- Pw DEBORAH JOY pINA the accompanying report is ALA,:', true and correct ! q" �to be me sr° y public under T,, 5,17/ 2 ,/ bySign»of :. . ... _ or Officeholder AFFIX NOTARY STA MP i SEALABOV E Sworn to and subscribed before me,by the said • KQ l 5i,k. ,this the41/244±)t--- day of , -4 / _ = certify which,witness my hand and seal of office. 1 0 YilitiArA )j -• /tOj officer ; r 4111 , oath Printed name of officer administering oath Forms provided by Texas Ethics Commission www evlics.state.tx.us Revised 9/8/2015 SUBTOTALS - C/OH FORM C/OH COVER SHEET PG 3 19 FILER NAME 20 Filer ID(Ethics Commission Filers) 21 SCHEDULE SUBTOTALS SUBTOTAL NAME OF SCHEDULE AMOUNT 1- yr SCHEDULE Al: MONETARY POLITICAL CONTRIBUTIONS $ C)0*70 2. FK SCHEDULE A2: NON-MONETARY(IN-KIND)POLITICAL CONTRIBUTIONS $ 52)0 CO 3. n SCHEDULE B: PLEDGED CONTRIBUTIONS $ 4. [] SCHEDULE E: LOANS $ 5 SCHEDULE Fl: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ Wil + 6. SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $ 7. ( ( SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $ 8. u SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $ 9 [] SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS $ 10. n SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF ClOH $ 11. pi SCHEDULE 1:NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ 12. n RETUSCHEDULE KO FILER: INTEREST,CREDITS,GAINS,REFUNDS,AND CONTRIBUTIONSRNED $ C, c=:• Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al The instruction Guide explains how to coinpete this form. 1 Total pages Schedule Al: 2 FILER NAME L/ 3 Filer III (Ethics Commission Filers) 4 Date 5 Full name of contributor o out-of-state Mc pita 17 Amount of contritxdion ($) /9.5"-c., -//9-/16 e," &4- irlt;15.&77C/91/90/0/1Q:**4 5/ 00 o9016 contributor address City; . State; Zip Code Po /30)( /9-‘16)/4), 7X -22‘ . 8 Principal occupation/Job title(See Instnartions) 9 Employer(See Instructions) Date Full name of contributor 0 out-of-state PAC KW Amount of contribution ($) Contributor address; City; State; Zip Code Principal occupation I Job title(See Instructions) Employer(See Instructions) Date Full name of contributor 0 out-of-state MC(101: 1 Amount of contribution ($) Contributor address; City; State; Zip Code Principal occupation/Job title(See Instructions) Employer(See Instructions) Date Full name of contributor 0 out-of-state MC Amount of contribution ($) Contributor address; City; Slate; Zip Code Principal occupation I Job title(See Instructions) Employer(See Instructions) _ ; cz) • 4 ATTACH ADDMONAL COPIES OF THIS SCHEDULE AS HEEDED If conhibutor is out-of-state PAC,please sae instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission vnver.ethics.statelx.us Revised 9/8/2015 • Lick NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS SCHEDULE A2 1 Total pages Schedule A2: The Instruction Guide explains how to complete this tome. 2 FILER NAME 3 Rim ID (Ethics Commission Filers) 4 TOTAL OF UNITEM1ZED 1N-KIND POLITICAL CONTRIBUTIONS $ 5 Date 6 Full name of contributor 0 out-of-state PAC(ID& ) 8 Amount of 9 In-kind contribution .. d/ ri79 1//6 Contrbution$ . description 4-520 /7/k;AF:r, 7 Contributor address; City; State; Zip Code I Rd - 15- 4,00 gwrn-y. f?Hrvica), --5-( S a 61 nChect N travel outside ri Texas.Complete Schedule T. 10 Principal occupation/Job title(FOR NON-JUDICIAL)(See Instructions) 11 Employer(FOR NON-JUDICIAL)(See Instructions) 12 Contristdoes principal occupation(FOR JUDICIAL) 13 Contributor's job Me(FOR JUDICIAL)(See Instructions) 14 Contributors employer/law firm(FOR JUDICIAL) is Law firm of contributor's spouse(if any)(FOR JUDICIAL) 16 If contributor is a child,law firm of parent(s)(If any)(FOR JUDICIAL) Date Full name of contributor 0 out-of-state PAC(01: ) Amount of In-kind contribution Contribution $ . description Contributor address; City; State; Zip Code FICheck If travel outside of Texas Complete Schedule T. Principal occupation/Job title(FOR NON-JUDICIAL)(See Instructions) Employer(FOR NON-JUDICIAL)(See Instructions) Contributor's principal occupation(FOR JUDICIAL) Contributor's job title(FOR JUDICIAL)(See Instructions) Contributor's employer/law firm(FOR JUDICIAL) Law firm of contributor's spouse(if any)(FOR JUDICIAL) If contributor is a child,law firm of parent(s)(If any)(FOR JUDICIAL) _ 2 ATTACH ADDITIONAL COPES OFTIS SCHEDULE AS NEEDED If contributor Is out-of-state PAC, please see instruction guide for additional reporting requirements. Forms provided by Texas Ethics Commission vivay.ethics.state.lx.us Revised 9/8/2015 POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE Fl EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan g Expense AccoundinglEffinicing Fees OrmeOverhead:RenfaI Expense Trans an Equipment&Related Expense Consulting Expense Polling Expense Travel In District By Food/Beverage Prinfing Expense Travel Out Of District CandiclatefOlacehaidenPornicalOommatee Legal Services Labor Other CredtCadPayirerx The Instruction Guide• xplutins how to complete this form. 1 Total pages Schedule Fl: 2 FILER NAME / /, ,p� 3 Filer ID (Ethics Commission Filers) 4 Gate jev''/ ` e 5 Payee name /D 6C6 4� r /..5-0••frolffr-56,1 p ice--71, 0,4-72.;,,L) 6 (S 7 Payee addresss- City; - Zip /,` /- pd, g 20c) 5-t /G 4 4)-3a/ 8 (as)CategOty(See Categories listed the top of tiffs sc edule) (b)Description PURPOSE �pr!%—,,-,6.TC✓�I ON,I'%vu5 ❑C iltrebetai&aeotTexas.CompleteSchedule r OF ❑Check if Austin,TX,officeholder living expense c. EXPENDITUREti 9 Complete ONLY if direct Candidate/Officeholder name Office sought Office heli expenditure to benefit C/OH Tr- a Date Payee name.. /� 07, /,5`. Cir/�- Cry'►'' -- r: c Amount ($) O Payee address; State; Zip Code e / IJ_ ‘3P'.5/9.r a T 9.r Cy(See Categories tried at the top of this schedule) Description PURPOSE ,,,,//�� n Check if travel OI da of Texas.Complete S T. OF Ca i� p)(letAJ3C ❑Check if Austin,TX,officeholder Wing expense EXPENDrR/RE Complete ONLY if direct Candidate/Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name — MAII-1 /5 ,0/(1/1/- el4-/gr-,044//C/Pj Amount (5) Payee address; City: • Zip Code i^ Category(See Categories kited at t, a this top schedule) Description PURPOSE /9-10co-p j ❑Check itrarelautddeof Texas.Connate Schedule T. OF ❑Check It Austin.TX.officeholder Hying expense El TIME Complete ONLY if direct Candidate/Officeholder name Office sought Office held expenditure to benefit C/OH ATFACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/812015 -,- . • POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE Fl EXPEPAIDIRJRE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan Repaymentneirnbursement Solicitation/Fundralshig Expense AccourstIngeanking Fees Office Overhead/Rental Expense Transportation EquiPment&Related Expense Consulting Expense Foodffiteverage Expense Polling Expense Travel hi Meld CoranbutionstOonation s MadeBy GNI/AvraiderAleniorials Expense Printing Expense Travel Out Ot District Candidate/Officeholder/Political Commelee Legal Services SakwieslWageslContract Labor Other(order a category not Wed above) Cres*Cad Payment The instruction Guide explains how to complete this form - 1 Total pages Schedule Fl: 2 FILER NAME .. eKi .-3-i-f/fs 3 Filer ID (Ethics Commission Filers) I; 4 Date 5 Payee name - A / l /0 g /5 Ale/0/0/91 eleti71/‘ /";fl- 41ey/ynettysr_s 6 Amount ( 7 Payee address; City; State; Zip Code ff.- 8 (4 CategorxiSee Categories listed al the top ot this'checker') (b)Description PURPOSE n Check it!restate:dile ofTexas.Compete Sdiedute T. OF e.01///f r6 -""-/-2)-11/Po/li,9-.)-1tw D Check*Austin,TX,officeholder bring expense EXPENDITURE 9 Complete gwy if direct Candidate/Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name 11/041-6/..0 C frytri ce-ty Amount ($) Payee address; City; State; Zip Co , 00 373g- 4/9y-77 _c_77. ,L)/,,v,//,- ,,v, i',/__ 302- 5`5( 409 ' Category(See Categories rated at the top of this schedule) Description PURPOSE n Medal travel outside otTexas.Complete Sdredulet OF 00/1).514a-- eyiuse- EXPENDITURE 0 Check it Austin.TX,officeholder living expense Complete Of if direct Candidate/Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name . ... cr Amount ($) Payee address; City: State; pp Code 00 373 by -fr?..6._ .e7.-1--y/yAiON/eiti, _..... Category(See Categories kited at the top otthis schedule) Description PURPOSE . n Dadra travel outside of Texas.Complete Schedukt T. EXPEINNTURE OF ,CiVia.,<64/777 fl Check it Austin.,TX.officeholder lying expense CD . Complete ONLY if direct Candidate/Officeholder name Office sought Office held expenditure to benefit C/OH ATTACH ADDITIONAL COPES OF THIS SCHEDULE AS HEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE Fl EXPEIWITURE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan Repaymerekteirnixasament Expense Ao tiglBsYdrg Fees Oboe Or+erheedMRentalExpense Transportation Equipment&Related Expense Constiting Expense FoodSe erage Expense Polling Expense Travel In District MadeBy GilliAwanis&Asmodals Expense Printing Expense Travel Dula District CancidatatOfficeholdedPolitical Committee Legal Services SalanesANageetCordract Labor Other(enter a category net hoed above) CredtCand Paymati The instruction Guide expiable how to complete this form. 1 Total pages Schedule F1: 2 FILER NAME.. / ����� 3 Filer ID (Ethics Commission Filers) 4 Al ID 4.-58 Payee name r f fli (/I d 6 / ) 7 Payee address State;ae: ZP Code i- ,co -2,*7 S'7' rix G f r e.Mtn , /�C .777 b 300 8 W Category_ r(See Categories raRad,the top of this �7e) (b)Description PUCE (Q�/Y /!f ,�Iev�y v�'"a�l/(}44) ❑Check Hhaveloutside ofTexas.Complete Schedule T. EXPENDITURE rYi/ `17.14, /eG ~CI�"G"."OF ❑Check if Austin,TX,officeholder Wing expense 9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name /,2/a-/0.110 ' 'DD _5/711/71' Z' /✓5u - -- Amount ($) Payee addres% City: Starve: ZP Code 0:614 . / :6 /4 /" / fJ7 75iC25:2 7 /Oa og -,-r. s 1 , 150-�e59` Category(See Categories listed at the top of this schedule) Description c..---) PURPOSE —/��.- ���} I 1 Check*tavelousideoTexas.CompleleSdradrieT. OF &$$U I J - / e 1$& ❑Check i Austr.TX,officeholder Vying _. , , EXPENMTURE ✓ Complete ONLY if direct Candidate/Officeholder name Office sought Office tie* i"'''-, expenditure to benefit C/OH C L,../ 4 Date*7'91124°/ Payee name err/ car Amount ($) Payee address; _ City; State; pp Code 100 f 3732- 14-Y7 r?- e" < hli f es, P Z 32 fry' Category(See Categories listed at the top of VOs adxhee) Description PURPOSE ❑Check Miami outside of Texas.CompkbSchedule T_ OF a Check if Austin.TX,oficetwWer living expense EXPENDITURE Complete ONLY if direct Candidate/Officeholder name Office sought Office held expenditure to benefit C/OH ATTACH ADDIT ONAL COPES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015 POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE Fl EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan RePrilirnerffiRairlialsement SolicitationlFundraisingfxpense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense Consisting Expense Food rage Expense Poling Expense Travel in District Made By Cail/Avranisffifiernorixds Expense Printing Expense Travel Out Of District Committee Legal Labor Other(enter acgory not bated above) CndtCaNPayrnarrt The instruction Guide explains how to complete this form. 1 Total pages Schedule Fl- 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 �0 46- K i _-5G//f) 6 Amount ) 7 Payee address; City;gay. r� State;�sem, rr�% i,v6y� 5 7sa-7/ 8 (a)Category(sea Categories Fisted at the top of this fie) (b)Description PIXTPOSE le/A'46.1/(z/�1Gf►/r/-o(- n(xsdcilraveloseideafTex�CompleleScheduleL OF ��/ ❑Check if Austin.TX, icing expense EXPENDITURE eaoTr/fp r%/o/U/Dem/R'To4i 9 Complete ONLY if direct Candidate1Officeholder Candidate/Officeholdername Office sought Office held expenditure to benefit C/OH Date Payee name - 649 d/i,,o/j- -/.9---r r/e' °-"9-r Amount ($) Payee address; City; State; Zip Code �3 �' ,/� �3 2 �!'y /'ems- % ,�y �= �vti 1JCA1, r 3�-��/ 00 Category(See Categories listed at the tap of this schedule) Description PURPOSE 4,441-car/A/5" nCheck iaaelesideefTexas_ComplelesdredrieT. O LtL/ /N/ ���� rl ❑Check it Austin,TX,officeholder living expense EXPENDITURE Complete ONLY if direct Candidate/Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name ICCIAy /5 f/, -,ii eimivi Lev- of C®rr1 e__ . cri Amount ($) Payee address; CityState- Zgo Code G/ i. " 0`, / r i,5Tff . T p/09/1)e) �a7 / v.w Category(see Categories&tied at the top of this schedule) Description a PURPOW Con/rri ba-)/04)5/404 S n CheckitaiataaesideafTeokas Complete sdhedkieL z nCheck if Austin.TX,officeholder Erving expensed r-:-.:-,:s, EXPENDITURE O Complete ONLY if direct Candidate/Officeholder name Office sought Office held expenditure to benefit C/OH ATTACH ADDI"t1ONAL COIFS OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015