Patton Semi Jan 2021CANDIDATE / 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/
MS / MR MR FIRST MI
OFFICEHOLDER
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OFFICE USE ONLY
NAME......................................................
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NICKNAME LAST SUFFIX
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RECEIVED e!
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4 CANDIDATE/
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
OFFICEHOLDER
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MAILING
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JAN 1 3 2021
ADDRESS
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❑ Change of Address
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5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER
PHONE
6 CAMPAIGN
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Ms /MRs �rvin � / FIRST MI
Receipt #
Amount $
TREASURER
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Date Processed
NAME.................................................................................
NICKNAME LAST SUFFIX
Date Imaged
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7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
TREASURER
S (O (P t4, Cl!!:\ —\O-L\-
ADDRESS
(Residence or Business)
�� l 7(o69-4-
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8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
9 REPORT TYPE
�anuary 15 30th day before election Runoff 15th day after campaign
II �JI �"
treasurer appointment
(Officeholder Only)
El July 15 F-1 8th day before election Exceeded Modified Final Report (Attach C/OH - FR)
Reporting Limit
10 PERIOD
Month Day Year Month Day Year
COVERED
THROUGH
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day '; "Year
❑ Primary ❑ Runoff ❑ Other
.. _
Description
--
�,.
S.�tio'i
General ❑ Special
9
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (if known)
G 10,A^(-Z L
14 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL
THE CANDIDATE I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
COMMITTEE(S)
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
F-1 Additional Pages
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
GO TO PAGE 2
Forms provided by Texas Ethics Commission www. ethics. state. tx.us Revised 8/17/2020
IRY
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
15 C/OH NAME
16 Filer ID (Ethics Commission Filers)
17 CONTRIBUTION
1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
TOTALS
PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR
CONTRIBUTIONS MADE ELECTRONICALLY)
2. TOTAL POLITICAL CONTRIBUTIONS
...................
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
EXPENDITURE
TOTALS
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE,
4. TOTAL POLITICAL EXPENDITURES
$ �{
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$O
..................
OF REPORTING PERIOD
OUTSTANDING
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$
LOAN TOTALS
LAST DAY OF THE REPORTING PERIOD
(�j5
18 SIGNATURE 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.
Signature of Candidate or Officeholder
Please complete either option below:
(1) Affidavit
N YP VERONICA L`OMAS
.
Notary Public, State of Texas
Comm. Expires 06-27-2024
NOTARY STAMP/ SEAL �'�;'F "'•c�}.�
a„Q;,�r� Notary ID 129013128
Sworn to and subscribed before me by 46 P1 this the day of aLu/ ry
which, witness my hand and seal of office. l
20 T4 to cerciv
Mn V 60 /ti CA 40 Att D r!�J
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
• .
(2) Unsworn Declaration
My name is and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
Executed in County, State of on the day of 20
(month) (year)
Signature of Candidate/Officeholder (Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020