Smith Semi Jan 2021CANDIDATE
/ OFFICEHOLDER
FORM C/OH
CAMPAIGN
FINANCE REPORT
explains how to complete this form. 1 Eller ID (Ethics Comuu ,Ion Flare)
COVER SHEET PG 1
2 Total pages riled:
The C/OH Instruction Guide
3 CANDIDATE/
OFFICEHOLDER
MS I MR MR RST MI
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OFFICE USE ONLY
NAME......................
....................,,,.......
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• • • � �
NICKNAME LAST SUFFIX
D¢ le Received
kECEIVED
4 CANDIDATE /
ADDRESS I PO BOX; APT I SUITE u. CITY; STATE, ZIP CODE
OFFICEI MAILING IOLDER
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JAN 1 5
ADDRESS
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2021
Change of Address
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ARFA CODE PHONE N11MRF.R _ FXTENSION
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5 CANDIDATE/
OFFICEHOLDER
PHONE
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Recelpli I Amounts
6 CAMPAIGN
TREASURER
NAME........
.................................. .................... . ....
Date Procossod
NICKNAME LAST SUFFIX
Svc_
ST tFESUOPO X PLEASE��T I SUITE 0; CITY;
\f�\J
Date Imaged
STATE; ZIP CODE
7 CAMPAIGN
TREASURER
ADDRESS
(Residenco or Business)
AREA CODE PHONE NUMBER EXTENSION
8 CAMPAIGN
TREASURER
PHONE
9 MREPORT TYPE --
January 15 301h day before election ❑ Runoff
j—j 15th day after campaign
treasurer appointment
(Offieeholdor Only)
DJuly 15 u 8th day before election E] Exceeded Modified
D Final Report (Attach CiOH - FR)
Reporting Limit
10 PERIOD
Morph Day Year
Year
COVERED
l V THROUGH (�Month
1 (� p�l�
! Or�
-
eDay
^
11 ELECTION
ELECTION DATE ELECTION TYPE
II
Month Day Year L_. Pnrnary Runoll `_-_J Other
Dasnriplinn
IDS OH �ff V i General L Special
12 OFFICE
OFFICE HELD (If any) 13 OFFICE SOUGHT (II known)
� �t-
14 NOTICE FROM
—
THIS BOX IS FOR NOTICE
THE CANDIDATE I OFFICEHOLDER.
OF POLITICAL. CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANOIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
POLITICAL
CONSENT, CANDIDATES
AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY
RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEES)
'COMMITTEE NAME
COMMITTEE TYPE
i�GENERAL
_ COMMITTEE ADDRESS
L � Additional Pages
COMMITTEE CAMPAIGN TREASURER NAME
SPECIFIC
COMMITTEE CAMPAIGN TREASURER ADDRESS
GO TOPAGE 2
Forms provided by Texas Ethics Commission www.ethics.state,ix.us Revised 8/1712020
CANDIDATE I OFFICEHOLDER
CAMPAIGN FINANCE REPORT
15 C:Ot-i mal" -
17 GO\ i-IFU ± i t ION
TOTALS
E XPENDFIFURE
TOTALS
BALANCE
------------------
OLFI-STANsJ' ING
LOAN TOTALS
1. TOTAL UNITEUILZED POLITICAL CONTRIBUTIONS (OTHER THAN
PLEDGES. LOANS OR GUARANTEES OF LOANS. OR
CONTIRIBUTIVINS MADE ELECTRONICALLY.•
3. TOTAL POLITICAL CONTRIBUTIONS
(OTHER Tmik% PLEDGES, LC NS_ OR GUARANTEES OF LOANS)
TOTAL UNiTEMIZED POLITICAL \-E%_!+URE
4. TOTAL POLITICAL EXPENDITURES
FORM C/OH
COVER SHEET PG 2
16 F& 113 (EIN" Commsion FOws)
C FIA
5- TATA'_ POLITICAL CON'TRItBuTiC1S MkINTAINED AS OF THE LAST DAY � S
OF REPORTPNG PER'^D
o. TOTAL PRIXCiPAL AItOt kT C= ALL OUTSTANDING )C NS AS OF'o iE
LIST DAY OF THE REPORTING PERIOD
0.06
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IS S=GNATURE i ssre:u. (if ar-t, undef e(a '-Z ixsy. dug the acmmpanyifV report is mm and coffed and incudes ag infumtaccn l
recru=--ed to be rep-- r by are undz? - ;Je t 5. E;acl--oi Cods.
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Signature a` Candidate or Officeholder
Please complete either option below.
(2) Unsworn Declaration
p 'i name is
My address is
and my cafe of birth is
(Street) (City) (state) (zip code) (country)
County, State of an the day of 20
(month) (year)
Signature of CandidatelOff(cef+otder (Decierartt)
t;y Teras Ethics Corr mssizon •, w& elm Vs.s>.ate.fx.us Revised 9117,2020
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�VERONICA LAMAS
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Comm. Expires 06-27-2024
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'1117 Notary ID 129013128
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NOTARY STAMP
2 (( MA4
�hy
fhs the day u Y u-
S.'icn) m ar'd SLb�scr �d r.1E'.tY:e )rte by
_` of
20 to c€rt fy satecfr, tress my hand and seai of oflit:e.
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S -s .a:ufe cerf zef sr r aysrervtg oath Parted name of oN`cer ad.^ur:stenng oath
Titie of officer administering oath
(2) Unsworn Declaration
p 'i name is
My address is
and my cafe of birth is
(Street) (City) (state) (zip code) (country)
County, State of an the day of 20
(month) (year)
Signature of CandidatelOff(cef+otder (Decierartt)
t;y Teras Ethics Corr mssizon •, w& elm Vs.s>.ate.fx.us Revised 9117,2020
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