Montgomery, Lydia, 1-10-17CANDIDATE I OFFICEHOLDER
CAMPAIGN FINANCE REPORT
FORM C/OH
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
3 CANDIDATE /
OFFICEHOLDER
NAME
MS/ MRS / MR FIRST
(I�
NICKNAME / LAST
K! ,nr-
MI
SUFFIX
OFFICE USE ONLY
Date Received
lc:Sup' g 1 ((Dlr.?
4 CANDIDATE /
OFFICEHOLDER
MAILING
ADDRESS
❑ Change of Address
ADDRESS / PO 90X; APT / SUITE #; CITY; STATE; ZIP CODE
9 56 `EtKt 'n C e
�Y l�
-["\- , �, Z5V 1,( e 77( t773
5 CANDIDATE/
OFFICEHOLDER
PHONE
AREA CODE PHONE NUMBER EXTENSION
(`�y 3
� ) (99, I 06'Li— — �
_, d -d _ Dal Postmarked
nd r
'
6 CAMPAIGN
TREASURER
NAME
MS 1 MRS MR FIRST
(4t3 0. Y
NICKNAME LAST
I
MI
! Amount d
v'
SUFFIX
r
) b) I-�/
l
D. �it aed
Q I Ic�/1�
7 CAMPAIGN
TREASURER
ADDRESS
(Residence or Bus ness)
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE it; CITY; STATE; ZIP r r
cis -1,, g_i,s / Y ''713t6
8 CAMPAIGN
TREAS
PHO EURER
AREA CODE PHONE
(n3f-) l _
NUMBER
9!_`[,
�
EXTENSION
9 REPORT TYKE
'January 15 ❑ 30th day before election ❑
❑ July 15 ❑ 8th day before election ❑
Runoff ❑ 15th day aftcampaign
treasuer appointment
(Officeholder Only)
Exceeded $500 limit ❑ Final Report (Attach C/OH - FR)
10 PERIOD
COVERED
Month Day Year
011/01 / �V l V 1 THROUGH
Month Day Year
V /
IV 3 ( /00vc,
11 ELECTION
ELECTION DATE
Month Day Year
/ /Description
❑ P^ma y ❑ Runoff
Geneal Special r ❑
4
ELECTION TYPE
❑ Other
12 OFFICE kid Ct
U -h -M 11 /1/144(b
OFFICE HELD (d any) _
,i,,,65v1 (bA Co,,,,,c -
13 OFFICE SOUGHT (d known)
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/O NAME
15 Filer ID (Ethics Commission Filers)
16 NOTI FROM
POLITICAL
COMMITTEE(S)
THIS BOX IS FOR NO • l • • CAL CONTRI : , . ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
SUPPORT THE CANDIDATE / OFFICEHOLDER. . - .* • z , - - MAY HAVE BEEN MADE WITHOUT TIM CANDIDATE'S OR OFFICEHOLDER'S
IrCgNtEDOE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH
COMMITTEE TYPE
GENERAL
COMMITTEE NAME
SPECIFIC
COMMITTEE ADDRESS
Additional Pages
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
$ �J LJ n t
V
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
$ 1
/)�� 0 '" —
VV d
EXPENDITURE
TOTALS
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
UNLESS ITEMIZED
$
4. TOTAL POLITICAL EXPENDITURES
$ `V
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
OF REPORTING PERIOD
/_ 4
$ to l V , ,..,sr?„,
OUTSTANDING
LOAN TOTALS
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LAST DAY OF THE REPORTING PERIOD
$
18 AFFIDAVIT
I swe , • affirm d = pen . ty of • - rjury, that the accompanying report is
FRANCES LEE WOODWARD
\ Notary Public
STATE OF TEXAS
COMM. EXP. FEB. 19, 2017
NOTARY ID 12681012-9
true nd co • and i cl
u • 3 Title 1 ledn C•17-ii
it la
: I info ation required to be reported by me
1
t — I�Ito, i /
AFFIX NOTARY STAMP / SEALABOVE
Sworn/�to and subscribed before me, by the said
Si. net Ire of Candid , - • r Officeholder
}
1%^ V,- rn , this the b
dar `�
f _ .ei� —
r 20 � 1 to certify which, fitness my hand seal of ffic
ii-
0
, .
Lu Lu)rQD 0 i A- \ice--+ A
ignature of o Icer administering oath Printed name of officer administering oath Title of officer administ ring oath
orms provided by Te)Cas Ethics Commission
www.ethics.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)
efeyvt_cia-c/
-
21 SCHEDULE SUBTOTALS
NAME OF SCHEDULE
SUBTOTAL
AMOUNT
1. SCHEDULE Al: MONETARY POLITICAL CONTRIBUTIONS
$ (�
t�Q//
2. SCHEDULE A2: NON -MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS
$
3• [] SCHEDULE B: PLEDGED CONTRIBUTIONS
$ V
4. SCHEDULE E: LOANS
$ Q
5. fl SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$ 0
6. I I SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
$ Cl
7. D SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$ V
8. U SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD
$ C)
9. U SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
$
0
10. 0 SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH
$ 0
11. I I SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$ C)
12. ❑SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS
RETURNED TO FILER
$
Fnrrnc nrrnv:.4e.l h,. T ..• •
s Ethics Commission
.eth,cs.state.tx.us
Revised 9/8/2015