Humphrey, Tish, semi-annual, 1-17-17Texas Ethics Commission
P.O. Box 12070
Austin, Texas 78711-2070
(512) 463-5800
DD 1-800-735-2989
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
The C/OH Instruction Guide explains how to complete this form.
1 ACCOUNT #
(Ethics Commission Filers)
j 2 Total pages filed.
3 CANDIDATE /
OFFICEHOLDER
NAME
MSS, R FIRST ( MI
—I-f'a
/
OFFICE USE ONLY
` e
NICKNAME HLAum .ST. SoFAX J
bre
Date Re ved
f'sh
4 CANDIDATE 1
OFFICEHOLDER
MAILING
ADDRESS
change of address
ADDRESS /PO BOX APT/SUITES STATE ZIP CODE
rO T �.--ail�
3o5- re s
1'e T K
Dajj d> livered or ostmuked
'
13 � �
u Ak V t 77 3rd
Receipt + -
Amount
5 CANDIDATE/
OFFICEHOLDER
PHONE
AREA CODE PHONE NUMBER EXTENSION
n �7
� �13�� 57 I aOOy
=�7�c:ssed
6 CAMPAIGN
TREASURER
NAME
7 CAMPAIGN
TREASURER
ADDRESS
(residence or business)
MS/MRS/MR FIRST Mt
-Th ereso,
11311)-)
-'d
`' i3 17
NICKNAME LAST SUFFIX
/qlelcand er
STREET ADDRESS (NO PO BOX PLEASE; APT/SUITES CITY STATE ZIP CODE
Pia 3 b 73 ra Z os r
kAO n ---S NAke TX -7 7 3YO
8 CAMPAIGN
TREASURER
PHONE
AREA CODE PHONE NUMBER EXTENSION
( 93d aq (_36 03
9 REPORT TYPE
�{ January 15 30th day before election I I Runoff 15th day after campaign
y� treasurer appointment
(officeholder only)
Li July 15 I 1 8th day before election L i Exceeded $500 Final report (Attach C/OH - FR)
limit
10 PERIOD
COVERED
Month fay Year Month tray Year
1.7�D/, THROUGH , 3l 42-011P
11 ELECTION
Et. ECTION DATE
Month Day Year'
// 3 'ao/5-
ELECTION TYPE
Prmary
;._.......: Runoff Pcieneral ri Speaal
12 OFFICE
OFFICE HELD (if any)
CO till eTL. Member'
ward Z
13 OFFICE SOUGHT TIknown}
GO TO PAGE 2
www.ethics.state.tx.us
Revised 09/28/2011
Texas Ethics Commission
P.O. Box 12070
Austin. Texas 78711-2070
(512) 463-5800
(TDD 1-800-735-2989)
CANDIDATE / OFFICEHOLDER REPORT: FORM C/OH
SUPPORT & TOTALS COVER SHEET PG 2
14 C/OH NAME/ ��
L--_��j` 4if a.
t t
I T i s\,.. 1-4 tiviweV r
15 ACCOUNT # (Ethics Commission Filers)
16 NOTICE FROM
POLITICAL
COMMITTEE (S) i
I
Pi additional pages
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLIThAL EXPENDITURES MADE
CANDIDATE I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES
CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY
BY POLITICAL
IF THEY RECEIVE
COMMITTEES TO SUPPORT THE
OR OFFICEHOLDERS KNOWLEDGE OR
NOTICE OF SUCH EXPENDITURES.
—
COMMITTEE TYPE
_...._..1 GENERAL I
r-1 SPECIFIC
COMMITTEE NAME
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
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE OF REPORTING PERIOD
$ / 00.0 0
$ /O O G t7
$ )
S�,^
�V
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD
18 AFFIDAVIT
Irpoke,
.
+!( io.N.
FRANCES LEE WOODWARD
Notary Public
STATE OF TEXAS
COMM. EXP. FEB.
NOTARY ID 12681012-9
/ SEAL ABOVE
before
111L,
I swear, or affirm, under penalty of perjury, that the accompanying report
is true and correct and includes all information required to be reported by
me under Title 15, Election Code.
�J
/�(/
Ci
19, 2017 - /l
AFFIX NOTARY STAMP
Sworn • : nd subscribed
day
Signature of Candidate
or holder
this the
me, by the said 14- k -A
L, 20 1-\ , to certify which witness
my han and seal of office.
c
\ ,
I 0 t. / *AN ..� a. 0
Si. n-ture of offic. _dministering oath `" Printed name of officer administering oath life of officer administering ath
www. ethics state.tx.us
Revised 09/28/2011
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
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAME OF SCHEDULE
SUBTOTAL
AMOUNT
1.
n SCHEDULE A1: MONETARY POLITICAL CONTRIBUTIONS
$ 0
2.
SCHEDULE A2: NON -MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS
$ Pr
3.
SCHEDULE B: PLEDGED CONTRIBUTIONS
,/
$ !/1
4.
n SCHEDULE E: LOANS
$
0
5.
SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
gr
6.
I J SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
$
/%r
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 C/OH
$
P/
11.
SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$ /�
12
— SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS
— RETURNED TO FILER
$ (JC/
4
Forms provided by Texas Ethics Commission
www.ethics.state.tx.us
Revised 9/8/2015