Texas Ethics Commission RO. Box 12070 Austin, Texas ‘81Q7 __th1246 .5800 (TDD 1-800-735-2989)w-i—iaii. KUKU

CANDIDATE I OFFICEHOLDER CITY SECRETARY FORM CIOHCAMPAIGN FINANCE REPORT Ft WORTH TX CovER SHEET PG 1

j I ACCOUNT # 2 Total pages fltedThe CIOH Instruction Guide explains how to complete this form. (EthComm0nF)

OFFICEHOLDER

‘:

. OFFICE USEONLYNAME

3 CANDIDATE I MS/MRS/MR F ST MI

NICKNAME SUFFIX

STATE; ZIP CODE4 CANDIDATE I ADDR SS/P0BO APT/SUITEsOFFICEHOLDERMAILINGADDRESS

change of address)/;_w, 77 7’i7

5 CAN DIDATE/ AREA CODE PHONE NUMBER EXTENSIONOFFICEHOLDERPHONE

6 CAMPAIGN M I RSIMR

TREASURER.

.NAMENICKNAME SUFFIX

7 CAMPAIGN STREETADDRESS (NO P0 BOX PLTREASU R ER

A/SUITE#, CIT’r STATE; ZIP CODE

ADDRESS(residence or business) 4>

8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSIONTREASURER ($f) 999 7(f7PHONE

9 REPORT TYPEJanua 15 Oth day before eledion Runoff ‘‘ 15th day after campaignL__...i treasurer appointment

(cfficetmiderory)

July 15 8th day before election Exceeded $50D Final report (Attach C/OH - FR)limit

10 PERIOD y ve fy YeCOVERED

t5/ ,/ // THROUGH // ‘/311 ELECTION ELECTIONDATE ELECTIONTh’PE

El Pnmary El Ruff [‘erai El Speaal

12 OFFICE OFFICE HELD (if any ) 13 OFFICE SOUGHT (if known)

GOTO PAGE 2

www ethics state ix USRevised 09/28/2011

Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)

CANDIDATE I OFFICEHOLDER REPORT: FORM C/OHSUPPORT & TOTALS CovER SHEET PG 2

15 ACCOUNT # (Ethics Commission Filers)14 CIOH NAM_,

UTIONS ACCEPTED OR16 NOTICE FROM ThIseOXISFOR’i11CEOFPOU11CAt. POliTICAL EXPENDITURES MADE BY POLII1CAL COMMITTEES TO SuPPORT THEPOLITICAL CANDIDATE I OFFICEHOlDER. THESE EXPENDfTURES MAY HAVE BEEN MADE WITHOUT THE CANDIOAT&S OR OFRCEHOLDERS KNOWLEDGE ORCOMMITTEE (S) CONSENT. CANDIDEiTES AM) OFFICEHOlDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF ThEY RECEIVE NOTICE OF SUCH EXPENDITURES.

COMMITTEE NAMECOMMITTEE TYPE

fl GENERAL

COMMITTEE ADDRESS

SPECIFIC

COMMITTEE CAMPAIGN TREASURER NAME

J additional pages

COMMITTEE CAMPAIGN TREASURER ADDRESS

17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THANTOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $ 9’t.5i2. TOTAL POLITICAL CONTRIBUTIONS

(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) $ OZEXPENDITURETOTALS 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED $

, 9’4. TOTAL POLITICAL EXPENDITURES $ / / /.4/gc5lJ

CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAYBALANCE OF REPORTING PERIOD $ :7 1:O- 4’2OUTSTANDING

6. TOTALPRINCIPALAMOUNTOFALLOUTSTANDING LOANSASOFTHE $LOAN TOTALS LAST DAY OF THE REPORTING PERIOD

18 AFFIDAVIT

I swear, ,pt1Tmi, under penalty of perjury, that the accompanying reportis truyd cqrect and inCIudeaII information required to be reported by

unde e 1 e tio e.

;/2,

Signature of Canlate or Officeholder

AFFIX NOTARY STAMP / SEAL ABOVE

Sworn t a ubscrubed f re by the s this the

/0 ‘ay of 20 to cei4hIch witness my hand and seal of office.4

‘

gnature of officer adminustenng oath Pnnted name of officer admunustenng oath - Title of ofradrnunustenng oath

www ethics state Ix usRevised 09/28/2011

Texas Ethics Commission RO. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)

POLITICAL CONTRIBUTIONSSCHEDULE AOTHER THAN PLEDGES OR LOANS

I

Tot/’s

Schedule A:The Instruction Guide explains how to complete this form./ g

2

(7 ‘t’

3 AC OUNT # (Ethics Commission Filers)

F II narri of contributor / out-of-state PAC j 7 Amount of I 8 In-kind contribution4 Date

,4/7,t::::4:contribution ($) description (if applicable)

/ 6 Contributor address City State; Zip Code.

.

I7oo/B%d6 5AS2’/1’5 (If travel outside of Texas, complete Schedule 0

9 Principal occupation I Job title (See Instructions) 10 Employer (See Instructions)

Date Full name of ontributor LI out-of-state PAC(iO ) Amount of In-kind contribution

,ç,/,,,// contribution ($) description (if applicable)

Contributor address City; State; Zip Code

J//YS*26/?Zá/d-, 4.L 7/€Z (If travel outside of Texas, complete Schedule T)

Principal occupation I Job title (See Instructions) Employer (See Instructions)

Date Full name of contributor LI out-of-state PAC(IO# Amount of I In-kind contribution

/.

contribution ($) description (if applicable)

State; Zip CodeContributor address

4aMç (If_travel outside of_Texas,_complete_Schedule_T)Principal occupation I Job title (See Instructions) Employer (See Instructions)

Date Fu name of contributor LI out-of-state PAC i Amount of I In-kind contribution

...‘contribution ($) description (if applicable)

Contributor address, City

//Zip Code

/.d2 i

lè’ti%, ?,k’ 2Zk2( (If travel outside of Texas, complete Schedule T)Principal occupation / Job title (See Instructions) Employer (See Instwctions)

ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDEDIf contributor is out-of-state PAC, please see instruction guide foradditional reporting requirements.

Date

//3

FtjlI nam of conibutor LI out-of-state PAC (ID#. I

?4%74.c5&ntributor addr; ty; State; Zip Cod

6/srIfrà%-, 72 7/,/,(5-

Principal occupation I Job title (See Instructions) Employer (See Instructions)

Amount of In-kind contributioncontribution description (if applicable)

/4.d2(If travel outside of Texas. complete Schedule T)

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Texas Ethics Commission PC. Box 12070 Austin, Texas 78711-2070 (512)463-5800 TDD 1-800-735-2989)

POLITICAL EXPENDITURES SCHEDULE F

EXPENDITURE CATEGORIES FOR BOX 8(a)Advertising Expense Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/ReimbursementAccounting/Banking Legal Services Solicitation/Furidraising Expense Transportation Equipment & Related ExpenseConsulting Expense Food/Beverage Expense Travel In District Contributions/Donations Made ByEvent Expense Polling Expense Travel Out Of District Candidate/Officeholder/Political CommitteeFees Printing Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)

I Total pa Schedule F

The Instruction Guide explains how to complete this form.

3 ACCOUNT # (Ethics Commission Filers)

4Dq(e/ I &—Ryee came

1/3D /13 c/3q Lmd frc/rrss; City State; Zip Code6 4rnountfr)

icq25 1 7 /18 PURPOSE (a) Category (See categories listed at the top of this schedule) (b Description lIt travel outside of Texas, complete Schedule T)

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expenditure to benefit C/OH

De

,/

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4iount Payee addre s

il

PURPOSE Category ( ee categones listed at the top of this schedule) I Description (If travel outside of Texas, complete Schedule T)OF

name Office sought Office held

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Complete QNLX if direct Candidate! Office oexpenditure to benefit C/OH

Data

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(j) ayee addrass, City Stte; Zip Code

bo f%,11 2.34PURPOSE -5tego lSee categories listed at the top of this schedule)

jDescription If travel outside of Texas complete Schedule TI

OFEXPENDITURE ,-..i rL:,

b1er name — - - - Office sought- Office heldComplete Qfy 1 direct Candidate /

expenditure to benefit C On

ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED

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Category )See categories listed at the top of this schedule) Description (If travel outside of Texas, complete Scl,eduleT)v44-Complete if direct Candidate / Officeholder name Office sought Office heldexpediture to benefit C/OH

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Texas Ethics Commission RO. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)

POLITICAL EXPENDITURES SCHEDULE F

EXPENDITURE CATEGORIES FOR BOX 8(a)Gift/Awards/Memorials Expense Salaries/Wages/Contract Labor Loan Repayment/ReimbursementLegal Services Solicitation/Fundraising Expense Transportation Equipment & Related ExpenseFood/Beverage Expense Travel In District Contributions/Donations Made ByPolling Expense Travel Out Of District Candidate/Officeholder/Political CommitteePrinting Expense Office Overhead/Rental Expense OTHER (enter a category not listed above)

The Instruction Guide explains how to complete this fonn.

Advertising ExpenseAccounting/BankingConsulting ExpenseEvent ExpenseFees

/

7 Pa ee address

/2oq’

3 ACCOUNT # (Ethics Commission Filers)

City; State; Zip Code

a ruos (a) Category eecategLiesisted at the top of this schedule) Description (If travel outside of Texas, complete Schedule T)

EXPENOfFURE

9 Complete if direct Ca didate I Offlce)6lder Q&cle Office sought Office heldexpenditure 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 13OF

EXPENDITURE

Complete QfjJ if direct Candidate I Officeholder name Office sought Office heldexpenditure to benefit C/OH

Date Payee name

Amount ($) Payee address; City; State; Zip Code

puipos Category (See categories listed at the top of this schedule) Description (If travel outside of Texas, complete Schedule 13

OFEXPENDITURE

Complete Qf!(( 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 (It travel outside of Texas, complete Schedule 13

OFEXPENDITURE

Complete Qfjjy if direct Candidate / Officeholder name Office sought Office heldexpenditure to benefit C/OH

ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED

wwwethics.statetx.us Revised 0912812011