HomeMy WebLinkAboutCFR-01.09.2013-Gonzalez,TommyTexas Ethics Commission RO.Box 12O70 Austin, Texas 78711-2070
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12) 463-6800 JDD 1-800-
COVER SHEET PG I
www. ethics. state tx.us Revised 04/ 1 w4u I a
The C/OH Instruction Guide explains how to complete this form.
(Ethics Commission Filers)
3 CANDIDATE
MSIMRSIMR FIRST Ml
OFFICE USE ONLY
JAN 0 9 2U113
MGMT. SVCS
4 CANDIDATE
ADDRESS I PO BOX; APTISUITE#: CIW' STATE; ZIPCODE
OFFICEHOLDER
Postmarked
MAILING
Date Hand -delivered or
ADDRESS
Z, C
change of address
Receipt #
Amount
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
__6aie Processed
6 CAMPAIGN
TREASURER
MS/MRS/MR FIRST
4
Date Imaged
NICKNAME LAST SUFFIX
7 CAMPAIGN
STREET ADDRESS (NO Po BOX PLEASE); APT/SUITEM, CITY., STATE;
ZIPCODE
TREASURER
ADDRESS
(residence or business)
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
_ )
9 REPORT TYPE
Runoff
Xi.nuary 15 D 30th day before election F-1
15th day after campaign
F treasurer appointment
July 15 8th day before election ED Exceeded $500
F
F-1 Final report (Attach VOH - FR)
limit
10 PERIOD
Month Day Year Month Day
year
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
El Primary El Runoff F�
General Special
12 OFFICE
OFFICE HELD (if any)
13 OFFICESOUGHT cifknown)
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CANDIDATE / OFFICEHOLDER REPORT: FORM CIOH
SUPPORT & TOTALS COVER SHEET PG 2
14 C/ON NAME
15 ACCOUNT # (Ethics Commission Filers)
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 CANDIDATES OR OFFICEHOLDERS 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
Q GENERAL
COMMITTEE ADDRESS
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
additional pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
2Q
�V
TOTALS
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS
THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
(OTHER
r
EXPENDITURE
TOTALS
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES
CONTRIBUTION
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE
OF REPORTING PERIOD
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
OUTSTANDING
LOAN TOTALS
LAST DAY OF THE REPORTING PERIOD
;er�
18 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the accompanying report
,•'�a,¢Y piJESSICA ERIN SRMLE is true and correct and includes a information required to be reported by
-1
z° NOTARY PUBLIC
*: *e me un r Title 15, Electio d
..0 +Q, State of Teras
!F,
Comm. Exp. 06-01-2015
natur of Candida a Oroe' older
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the ''1`1 &)112- � this the
5said
day of tai 20 1 L to certi hich, witness my hand and seat of office.
Ign ture officer adminis Ing oath Printed name of officer administering oath Title o Icer administe th
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