CORRECTION/AMENDMENT AFFIDAVIT FOR CANDIDATE/OFFICEHOLDER 1 Filer ID
(Ethics Commission Filers)
2 Total pages filed:
00080553 3 CANDIDATE / OFFICEHOLDER NAME
FORM
OFFICE USE ONLY
7 MS / MRS / MR
FIRST
Mr.
Benjamin
NICKNAME
LAST
Date Received
MI
ELECTRONICALLY FILED 01/26/2016
SUFFIX
Kissling 4 ORIGINAL REPORT TYPE
Date Hand-delivered or Date Postmarked
January 15
Runoff
July 15
Exceeded $500 limit
Receipt #
15th day after campaign treasurer appointment (officeholder only) Final Report (Attach C/OH-FR)
Date Processed
X 30th day before election 8th day before election
5 ORIGINAL PERIOD Month COVERED
Day
Other (specify)
Year
01/01/2016
COR-C/OH
Month THROUGH
Day
Year
Amount
Date Imaged
01/21/2016
6 EXPLANATION OF CORRECTION One expense was a credit card expense that was previously reported as a loan and political expense from political funds. The descriptions of expenses were also made more specific.
7 AFFIDAVIT I swear, or affirm, under penalty of perjury, that this corrected report is true and correct. Check the box next to any and all applicable statements: Semiannual reports: 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. X
Other reports: I swear, or affirm, that I am filing this corrected report not later than the 14th business day after the date I learned that the report as originally filed is inaccurate or incomplete. I swear, or affirm, that any error or omission in the report as originally filed was made in good faith.
Mr. Benjamin Kissling Signature of Candidate or Officeholder AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said _________________________________________, this the ___________________ day of___________________, 20________, to certify which, witness my hand and seal of office.
Signature of officer administering oath
Printed name of officer administering oath
Title of officer administering oath
Remember To Attach Any Part Of The Campaign Finance Report Form Needed To Report And Explain Corrections Forms provided by Texas Ethics Commission
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CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT
FORM
COVER SHEET PG 1 1
The C/OH Instruction Guide explains how to complete this form.
Filer ID
2
Total pages filed:
(Ethics Commission Filers)
7
00080553 3
CANDIDATE / OFFICEHOLDER NAME
C/OH
MS / MRS / MR
FIRST
MI
Mr.
Benjamin
OFFICE USE ONLY Date Received
ELECTRONICALLY FILED NICKNAME
LAST
SUFFIX
01/26/2016
Kissling 4
CANDIDATE / OFFICEHOLDER MAILING ADDRESS Change of Address
ADDRESS / PO BOX;
APT / SUITE #;
CITY;
ZIP CODE
Date Hand-delivered or Date Postmarked
Receipt #
Lewisville, TX 75057
Amount
Date Processed
Date Imaged
5
CAMPAIGN TREASURER NAME
MS / MRS / MR
FIRST
MI
Mr.
Benjamin D.
NICKNAME
LAST
SUFFIX
Kissling 6
CAMPAIGN TREASURER ADDRESS
STREET ADDRESS (NO PO BOX PLEASE);
APT / SUITE #;
CITY;
STATE;
ZIP CODE
(Residence or Business)
Lewisville, TX 75057
7
CAMPAIGN TREASURER PHONE
8
REPORT TYPE
AREA CODE
PHONE NUMBER
January 15
X
July 15
9
PERIOD COVERED
Month
Day
Month
ELECTION DATE Day Year
03/01/2016
11 OFFICE
30th day before election
Runoff
15th day after campaign treasurer appointment (officeholder only)
8th day before election
Exceeded $500 limit
Final Report (Attach C/OH-FR)
Year
01/01/2016
10 ELECTION
EXTENSION
Month THROUGH
Day
Year
01/21/2016 ELECTION TYPE
X Primary General
OFFICE HELD (if any)
Runoff
Other
Special
12 OFFICE SOUGHT (if known)
State Representative District 65
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Version V1.0.34538
FORM
CANDIDATE / OFFICEHOLDER REPORT: SUPPORT & TOTALS 13 C / OH NAME
C/OH
COVER SHEET PG 2 3 of 7 14 Filer ID
Kissling, Benjamin (Mr.)
(Ethics Commission Filers)
00080553 15 NOTICE FROM POLITICAL COMMITTEE(S) 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
COMMITTEE ADDRESS SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
16 CONTRIBUTION TOTALS
1.
TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
$
0.00
2.
TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
$
0.00
3.
TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED
$
0.00
4.
TOTAL POLITICAL EXPENDITURES
$
16.22
CONTRIBUTION BALANCE
5.
TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF THE REPORTING PERIOD
$
0.00
OUTSTANDING LOAN TOTALS
6.
TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORTING PERIOD
$
751.07
EXPENDITURE TOTALS
17 AFFADAVIT
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.
Mr. Benjamin Kissling Signature of Candidate or Officeholder AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said _________________________________________, this the ___________________ day of___________________, 20________, to certify which, witness my hand and seal of office.
Signature of officer administering
Forms provided by Texas Ethics Commission
Printed name of officer administering
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Title of officer administering oath
Version V1.0.34538
FORM
SUBTOTALS - C/OH
C/OH
COVER SHEET PG 3 4 of 7 18 FILER NAME
19 Filer ID
Kissling, Benjamin (Mr.)
(Ethics Commission Filers)
00080553
20 SCHEDULE SUBTOTALS SUBTOTAL AMOUNT
NAME OF SCHEDULE 1.
SCHEDULE A1: MONETARY POLITICAL CONTRIBUTIONS
$
2.
SCHEDULE A2: NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS
$
3.
SCHEDULE B: PLEDGED CONTRIBUTIONS
$
4.
X
SCHEDULE E: LOANS
$
1.07
5.
X
SCHEDULE F1: POLITICAL EXPENDITURES FROM POLITICAL CONTRIBUTIONS
$
1.07
6.
SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
$
7.
SCHEDULE F3: PURCHASE OF INVESTMENTS FROM POLITICAL CONTRIBUTIONS
$
SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD
$
9.
SCHEDULE G: POLITICAL EXPENDITURES FROM PERSONAL FUNDS
$
10.
SCHEDULE H: PAYMENT FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH
$
11.
SCHEDULE I: NON-POLITICAL EXPENDITURES FROM POLITICAL CONTRIBUTIONS
$
12.
SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED TO FILER
$
8.
X
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Version V1.0.34538
LOANS
SCHEDULE
The Instruction Guide explains how to complete this form. 2 FILER NAME
1 Total pages Schedule E:
Sch: 1/1 Rpt: 5/7 3 Filer ID
Kissling, Benjamin (Mr.) 4
$
7 Name of lender
01/19/2016 6 Is lender a financial institution?
(Ethics Commission Filers)
00080553
TOTAL OF UNITEMIZED LOANS
5 Date of loan
out-of-state PAC (ID#:_________________________________) 9
Loan Amount ($)
Kissling, Benjamin 8 Lender address;
E
$1.07 City;
State;
Zip Code
10 Interest Rate
11 Maturity Date
No Lewisville, TX 75057 12 Principal occupation / Job title (See Instructions)
13 Employer (See Instructions)
Clinical Laboratory Specialist III
Creative Testing Solutions
14 Description of Collateral
15 Check if personal funds were deposited into political account (See Instructions)
X None 16 GUARANTOR INFORMATION
17 Name of guarantor
X not applicable
18 Guarantor address;
19 Amount Guaranteed ($)
City;
20 Principal occupation
Forms provided by Texas Ethics Commission
State;
Zip Code
21 Employer (See Instructions)
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Version V1.0.34538
POLITICAL EXPENDITURES FROM POLITICAL CONTRIBUTIONS
SCHEDULE
F1
EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Accounting/Banking Consulting Expense Contributions/ Donations Made By Candidate/Officeholder/Political Committee Credit Card Payment
Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services
Loan Repayment/Reimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1: 2 FILER NAME
Sch: 1/1 Rpt: 6/7 4 Date
Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel in District Travel Out of District OTHER (enter a category not listed above)
3 Filer ID
Kissling, Benjamin (Mr.)
(Ethics Commission Filers)
00080553
5 Payee name
01/19/2016
The UPS Store
6 Amount ($)
7 Payee address;
$1.07
City;
State; Zip Code
1565 W. Main St. Suite 208 Lewisville, TX 75067
8
PURPOSE OF EXPENDITURE
(a) Category
(See Categories listed at the top of this schedule)
(b) Description Check if travel outside of Texas. Complete Schedule T.
Fax
Check if Austin, TX, officeholder living expense
Fax document to TEC 9 Complete ONLY if direct Candidate/Officeholder name expenditure to benefit C/OH
Forms provided by Texas Ethics Commission
Office sought
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Office held
Version V1.0.34538
EXPENDITURES MADE BY CREDIT CARD
SCHEDULE
F4
EXPENDITURE CATEGORIES FOR BOX 10(a) Advertising Expense Accounting/Banking Consulting Expense Contributions/ Donations Made By Candidate/Officeholder/Political Committee
Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services
Loan Repayment/Reimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor
Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel in District Travel Out of District OTHER (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F4: 2 FILER NAME
Sch: 1/1 Rpt: 7/7 4
3 Filer ID
Kissling, Benjamin (Mr.)
00080553
TOTAL OF UNITEMIZED EXPENDITURES CHARGED TO A CREDIT CARD
5 Date
The UPS Store
7 Amount ($)
8 Payee address;
$15.15
TYPE OF EXPENDITURE
10
PURPOSE OF EXPENDITURE
$
6 Payee name
01/19/2016
9
(Ethics Commission Filers)
City;
State; Zip Code
1565 W. Main St. Suite 208 Lewisville, TX 75067 X (a) Category
Political
Non-Political
(See Categories listed at the top of this schedule)
(b) Description Check if travel outside of Texas. Complete Schedule T.
Postage
Check if Austin, TX, officeholder living expense
Postage for documents sent to TEC 11 Complete ONLY if direct Candidate/Officeholder name expenditure to benefit C/OH
Forms provided by Texas Ethics Commission
Office sought
www.ethics.state.tx.us
Office held
Version V1.0.34538