Olson, Keith D., 8-day prior, 10-31-16CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
The C/OH Instruction Guide explains how to complete this form.
1 Filer ID (Ethics Commission Filers)
2 Total pages filed:
3 CANDIDATE /
OFFICEHOLDER
NAME
MS / MRS/ MR FI T MI
OFFICE USE ONLY
(
NICKNAME LAST I SUFFIX
0 1,-&3.11N--
Date , ceived
/0/3 /At
4 CANDIDATE /
OFFICEHOLDER
MAILING
Change of Address
ADDRESS / PO BOX; APT / SUITE #;CITY; STATE; ZIP CODE
12)'��^1181,S_--ADDRESS
1/44,kikik �i' \-t'r _7 / a S) / W O
1, �
5 CANDIDATE/
OFFICEHOLDER
PHONE
AREA CODE PHONE NUMBER EXTENSION
/ lei3) Zi
A A 9 A
(„1`• (_'617 (';I
I —
': „d -•slivered r�� osstma ed
3/ I
6 CAMPAIGN
TREASURER
NAME
MS / MRS / MR FIRST MI
_6
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A•c-
A ouatt
I Q- .0
NICKNAME LAST SUFFIX
�• sed //,
6 / ✓ �I /Le
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7 CAMPAIGN
TREASURER
ADDRESS
or Business)
STREET ADDRESS (NO PO
(�( ��
l 666
BOX PLEASE); APT / SUITE #; CITY; STAT • P CODE
11i�^M(Residence
��'� `� ��1n� 6t4 -t1)` If .51.l
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I\ �- �"'TT
8 CAMPAIGN
TREASURER
PHONE
AREA CODE PHONE NUMBER EXTENSION
` s_ _ / ,1�J
7%) 22.....
9 REPORT TYPE
January 15 30th day before election Runoff 15th day atter campaign
treasurer appointment
(Officeholder Only)
July 15 8th day before election Exceeded $500 limit Final Report (Attach C/OH - FR)
10 PERIOD
COVERED
Month Day Year Month Day Year
(( /30 /23/10 THROUGH Gi /iit/Zo o
11 ELECTION
ELECTION DATE
Month Day Year
j k / O� j �u/ I I_
ELECTION TYPE
Primary 1 1 Runoff 1 1 Other
Description
Vsfeneral nSpecial
12 OFFICE
OFF
e,,,A,
CE HELD
Vki "-}3
(if any)
CAL AI ... t...etne_
an l C l C
13 OFFICE SOUGHT (if known)
44Ak j-3 C,1 1 t -e I...4--- L4Iy
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GO TO PAGE 2
Forms provided by Texas Ethics Commission
www.ethics.state.tx.us
Revised 9/8/2015
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C/OH NAME ' i k r r\ _ U
1 � .-
15 Filer ID (Ethics Commission Filers)
16 NOTICE FROM
POLITICAL
COMMITTEE(S)
u Additional Pages
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
SUPPORT THE CANDIDATE / OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S
KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENDITURES.
COMMITTEE TYPE
COMMITTEE NAME
GENERAL
SPECIFIC
COMMITTEE ADDRESS
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
TOTALS
1. 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)
$ �
/�/
EXPENDITURE TOTALS
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
UNLESS ITEMIZED
$
4. TOTAL POLITICAL EXPENDITURES
$
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
OF REPORTING PERIOD
$ 3� r ��
OUTSTANDING
LOAN TOTALS
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LAST DAY OF THE REPORTING PERIOD
$--
18 AFFIDAVIT
I swear, or affirm, under penalty of perjur , at t e accompanying report is
MARY E.NEi
STATE OFTEXAS
true and correct and includes all infor ation req ired to be reported by me
under Title 15, Ele. ion • = / or
,.� ,Cowtr E, ani/m1$
4 ����
s
Illir,
Signatu - - - older
AFFIX NOTARY STAMP / SEALABOVE
•
Sworn to and subscribed before me, by the said .P c -,j-L CA,sp►•s , this the 31 IA -
day of be_7. , 20 ' (p , to certify which, witness my hand and seal of office.
; ig\J�` WO. -a..)11 "\by h � ` „ 5 l
Signature of of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission
www.ethics.state.tx.us
Revised 9/8/2015
Forms provided by Texas Ethics Commission
www.ethics.state.tx.us
Revised 9/8/2015
SUBTOTALS - C/OH FORM C/OH
COVER SHEET PG 3
19
FILER NAME•r
(1 CEJ'OLc,,_
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAME OF SCHEDULE
SUBTOTAL
AMOUNT
1.
SCHEDULE A1: MONETARY POLITICAL CONTRIBUTIONS
$
2.
SCHEDULE A2: NON -MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS
$
3.
SCHEDULE B: PLEDGED CONTRIBUTIONS
$
4.
SCHEDULE E: LOANS
$
.4g -"----
4g—
5.
5.
SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
6.
SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
$ 431--
7.
7'
I I SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$ ..61.,....-
�8•
81
I 1 SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD
$
9•
1 I SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
$
l/ef9.-----
10.
SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH
$
11.
SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
12
SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS
RETURNED TO FILER
$ ,y}�
' (�
Forms provided by Texas Ethics Commission
www.ethics.state.tx.us
Revised 9/8/2015