This document is a correction/amendment affidavit for a Texas candidate/officeholder campaign finance report. It contains information about the original report being corrected, including the time period covered, an explanation of the correction, and an affidavit signed by the candidate swearing that the corrected report is true and accurate. The affidavit corrects errors or omissions in a previously filed July 2015 campaign finance report.
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2015 05-01 yvonne (ty) lake - correction amendment affidavit for 04-09-15 report
1. Texas Ethics Comr-nission P.0 Box 12070 Austin Texas 73711- 2070 ( 512) 463- 5800 ( TDD 1- 800- 735- 2989)
FORM COR- C/ OH
CORRECTION/AMENDMENT AFFIDAVIT
FOR CANDIDATE/OFFICEHOLDER
1 ACCOtA T; y 2 Total pages filed:
OFFICE USE ONLY
3 CANPIDAI F V 1, 1 R',, MR C E I
i F I C F H 0 1 T) E I Z
11, 14/ 2-01, vo/iii C
MAY 0 12015
4 ORK; INAt RFPORT Runoff Other ( SPeC- fy)
CITY-SECRETARY_lannary
7 yrr
luiy 15 Exceeded$ 500 limit
Oth 0-,
y:) P.fore eicrainn 15th day after treasurer
appOiri( officehldei only) Receipt 0 Amount
81h day before election Final report
L
Dale Processed
5 ORIGINAL PERIOD den=r Day Ycar mcnitl D y Year
COVERED
THR(DUGH Late Imaged
6 EXPLANATION OF CORRECTION
t--A- A d Jul< V42 r - 7-714 0 a'ez
C_
y Hoµ/ 4 tj tl c-c4 R-Aiiae6 Bcli u 4-rd-0/- 7' W'4 7'L/ P11 16 off
c2e7
I swear, or affirm, under penalty of perjury, that this corrected
7 AFFIDAVIT report is true and correct.
Check ONLY if applicable
Semiannual reports: This report is an amendment/correction to a
semiannual report due on or after September 1, 2011. If amend-
ment/ correction is filed on or after the eighth day after the original
report was filed, I swear, or affirm, that the original report was made
in good faith and without an intent to mislead or to misrepresent the
information contained in the report.
Other reports ( excluding semiannual reports due an or after
SANDRA MAU
September 1, 2011): I swear, or affirm, that I am filing this corrected
report not later than the 14th business day after the date I learned
icNotwy PuN
that the report as originally filed is inaccurate or incomplete. I swear.
STATE OF TEXAS or affirm, that any error or 0 iss. n in he report as originally filed
u"
y It X19My Com. Exp Janwry It X19 was made in good faith. :
MWSig,. i: 41 of Candidate or Officeholder
AFFIX NOTARY STAMP , SEAL 4, 130VE
Sworn to and subscribed before me. by the said qiJd A 60-
this the day of ZM
21)—
to ce ify which witness my hand and se I of offi e.
signature of officer administering oath Printed name of officer administering oath itle of offifir administering oath
Remember To Attach Any Part Of The Campaign Finance Report Form
Needed To Report And Explain Corrections
WWW. e1hiGs. state. fX. i Revised 09/ 01/ 2011
2. CANDIDATE / OFFICEHOLDER FORM C/ OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 Filer ID lEthicliCommissior Filers) 2 Total pages filed
The C101H Instruction Guide explains how to complete this form.
OFFICE USE ONLY
INICII I, A5T SUFFIX
OFFICE110L.DER.
A Wk A,
ADDRESS
C-
MAY 0 12015
Change of Address
CITY SECRETARY
jVQ . M 111 114 P- Dale Processed
SUFFIX
Date Imaged
7 CAMF--WCN J-.TiDDRESS ( NOP080K PLEASE), APTiSATF#. CITY, STATE ZIP CODE
TREASURER
ADDRESS
114 C go S s.
TREASURER
Pl
9 REPORTTYF
Rull 15th day after campaign
V-- Otlh day befam election
July 15 8th day I elerifon Exreeded S600 limit Final Report( Attach CYOH- FP)
10 PERIOD Month Day Year Month 03 Year
COVERED
I— THROUGH
y
11 ELECTION El ECTINI DATE Ei- ECTION TYPE
vc th Day Year Primary L Ruli .- Other
Description
12 OFFICE OFFICE HELD
ill
any) 13 OFFICESOUGHT ( ifknown)
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics. stall us Revised 0212712015
3. SUBTOTALS - COH FORM C/ OH
COVER SHEET PG 3
I FILER NAME 20 Filer ID( Ethics Commission Filers)
vo^'!` r -. '7y, LAxe
21 SCHEDULESUSTOTALS SUBTOIAL
NAME OF SCHEDULE AMOUNT
I--.........................
YSCHEDULE All: MONETARY POLITICAL CONTRIBUTIONS
2.
1-9-- SCHEE) ULE A2: NON- MONETARY( IN- KIND) POLITICAL CONTRIBUTIONS
3 FZ?- SCHEDULE B: PLEDGED CONTRIBUTIONS
4 SCHEDULE E LOANS
5. SCHEDULE Fi: POLITICAL EXPENDITURES FROM POLITICAL CONTRIBUTIONS
6 SCHEDULE F2 UNPAID INCURRED OBLIGATIONS
7. SCHEDULE F3: PURCHASE OF INVESTMENTS FROM POLITICAL CONTRIBUTIONS
L..9— SCHEDULE G: POLITICAL EXPENDITURES FROM PERSONAL FUNDS
SCHEDULE H: PAYMENT FROM POLITICAL CONTRIBUTIONS TO BUSINESS OF C/OH
SCHEDULE i: NON- POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
I................
SCHEDULE K: INTEREST, CREDITS. GAINS REFUNDS. AND CONTRIBUTIONS
RETURNED TO FILER
Forms provided by Texas Ethics Commission www. eIhics. state. tx. us Revised 02i27/ 2015
4. CANDIDATE / OFFICEHOLDER FORM C/ OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C/ 01- 1 NAML 15 Filer ID ( Ethics Commission Filers)
o ., , - Ty L ei III
16 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL comMiTTEEs TO
POLITICAL SUPPORT THE CANDIDATE/ OFFICEHOLDER, THESE EXPENDITURES MAY HAVE BEEN MADE MTHOUT THE CANDIDATES OR OFFICEHOLDER' S
COMMITTEE( S) KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SIJGH EXPENDITURES.
COMMITTEE TYPE COMMITTEE NAME
17 GENERAL
CQMMITTF' E ADDRESS
F– I$PECIPIC
COMMITTEE CAMPAIGN TREASURER NAME
Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF $ 50 OR LESS ( OTHER THAN
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $
2. TOTAL POLITICAL CONTRIBUTIONS
OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
c:).
f XPENDITURE
3 TOTAL POLITICAL EXPENDITURES OF $ 100 OR LESS.
TOTALS
UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES
CONTRUTION
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE
IB
OF REPORTING PERIOD
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD rJ
18 AFFIDAVIT
I swear, or affirm, under penalty of perjury, that the accompanying report is
irue and correct at J indu all inf ation required to be reported by me
under Title 15, Fle tion o e.
nallInfaflon r/C' U
tion e
0'
SANDRA HART
NWdy Publicj* j
STATE OF TEXAS
iw MY C-. ER 18,'' 019
Signature of Candidate or Officeholder
AFFIX NO iAR4 STAMP ISEALABOVE
Sworn to and Subscribed before me, by the said & M4' z Ak—,this the
day of 20 to certify which, witness my hand and seat of office.
m
V
7-...................
Sign re or offific,, administering oath Printed name of officer administering oath Tit] Office,. , n,'. I. nnq;".. 1h
Forms provided by Texas Ethics Commission www.ethics, state. tX. us Revised 02/ 27/2015
5. MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
The Instruction Guide explains how to complete this form.
I ToW pages Schedule At:
II............
2 VIL NAME 3 Filer U ( Ethics Commission Filers)
4 Date 5 Full name of contributor
Fj out- of- state PAC( IDA 7 Amount of contribution
A1-0>
6 Contributor agre6si City: State. Zip Code
C let
8 Principal occupation I Job title ( See Instructions) 9 Employer ( See Instructions)
Date Fufl name Of Contributor
F1- 11- of- slate PAC W4
Amount of contribution
Contributor address,
City. Slate; Zip Code
Principal occupation I Job title( See Instructions) Employer( See Instructions)
Date Full name of contributor out- of- State PAC( 104 Amount of contribution
Contributor address: city; State; Zip Code
Principal occupation I Job title ( See Instructions) Employer ( See Instructions)
r.......................
Date Full name of contributor 0u0- 01- state PAC, Amount of contribution ($)
Contributor address: City, State: Zip Code
PrInGtpat occupation / Job title ( See Instructions) Employer ( See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC. please see instruction guide for additional reporting requirements.
ori) r pwvjdrrd thy 1,., xa, Lthics Commission www ethics state tx. us Revised 0 212712 01 5
6. UNPAID INCURRED OBLIGATIONS SCHEDULE F2
EXPENDITURE CATEGORIES FOR BOX Ill
Advedlsir€g Expense Event Expense Loan Repayrnent/Reimburserrnent Solicitat€on/ Fundra€sing Expense
Accounting/ Banking Fees Office Overhead/ Rental Expense Transportation Equipment R Related Expense
Consulting Fxpense Food/ Deveraae Expense Polling Expense Travel In District
Gcninbut€enslDonations Made By G f/ Awards/ Momorals Expense Print€nq Expense Travel Out Of District
CandrdatelOfceholderlPontical Committee Legal Services Salanes WageslContract Labor Other( enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F2 Z FILERNAME
i 3 Filer ID ( Ethics Commission Filers)
J o
4 TOTAL OF UNITENIIZED UNPAID INCURRED OBLIGATIONS
5 Date 6 / Payee name
3...- I C o M t H N rY -7m PAIL-r l s A wn
7 Amount ($) a Payee address; City; State; Zip Code
A
9 TYPE OF
EXPENDITURE f' olitical
J
l Non-Political
10 a)
Category ( See categories listed at the top of ihis schedule) ( b) Description
P U R P O SE Check it travel outside of Texas, complete Schedule T
EXPENDITURE
v-1rZ x`°} J
S I Check if Aust€n, Tx, officeholder having expense
P Z_e fj CA 4 / b V*?Z rU// J 4$
11 Co€replete 91`,L_Y if direct Candidate / Officeholder name Office sought Office hold
expenditure to bent€t C/OH
Date Payee name
Arnount { yt Payee address, Coy: State. Zip Code
TYPE OF
EXPENDITURE
L— 1
Political a Non-Political
Category ( See categories listed at the top of this schedule) Description
PURPOSE
Check if travel outside of Texas, complete Schedule T
OF
Check if Austin, TX, Officeholder hving expense
EXPENDITURE
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit CIOH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by lex85 i_ lhlcs Commissin WWW el State. tx.us Revised0 212712 01 5