Williamson Semi July 2021CANDIDATE / OFFICEHOLDER
FORM CIOH
CAMPAIGN FINANCE REPORT
COVER SHEET PG I
Filer ICf (Ethics Commission Filers)
The C10H Instruction Guide explains how to complete this form. T
2 Total pages filed:
3 CANDIDATE/
OFFICEHOLDER
MS / MRS(t,
ek (k z
NAME
..................... ........................... ..........................
NICK jrE LASTtj SUFFIX
------
Data Re-7,13EUENEU
4 CANDIDATE
ADDRESS / PO BjbX; APT / SUITE CITY; STATE; ZIP CODE
J U L 1 2 2021
OFFICEHOLDER
MAILING
/
OFFICE OF CITY SECRETAR
r
5 CANDIDATE/
OFFICEHOLDER
AREA CODE PHONE NUMBER EXTENSION
cla� INV Date Postmarked —
PHONE
Ad t
6 CAMPAIGN
TREASURER
MS / MRS / MR F MI
9—
Receipt # Amount $
NAME...........................
./;IT
7 4
..... .............................. .........
Date Processed
NICKNAME LAS T SUFFIX
Lo
Date Imaged
7 CAMPAIGN
TREASURER
STREETADDRESS (NO PO BOX PLEASE); fiffISUITE #; CITY,
STATE; ZIP CODE
ADDRESS
(Residence or Business)
/6
CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
Yl?)
REPORT TYPE
January 15 ❑ 30th day before election ❑ Runoff
15th day after campaign
treasurer appointment
(Officeholder Only)
Eg"July 15 El 8th day before election Exceeded Modified
El Final Report (Attach C/OH - FR)
Reporting Limit
10 PERIOD
Month Day Year Month
Day Year
COVERED
/ / 6 / THROUGH 7
11 ELECTION
ELECTION DATE ELECTION TYPE
Month Day Year 1:1 Primary El Runoff 00ther
Description
General Special
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT ffknown)
14 NOTICE FROM
I I—TICAL NeL
THIS BOX is FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
THE CANDIDATE I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE MTHOUT THE CANDIDATES OR OFFICEHOLDERS KNOWLEDOE OR
COMMI
qMj��
CONSENT. CANDIDATES AND OFFICEHOLDER$ ARE REQUIRED 70 REPORT THIS INFORMATION ONLY IF THEY RECEIVE UCH EXPENDITURES.
-CMMITTEE TYPE COMMITTEE NAME
DGENERAL COMMI RESS
::7MPAIGN
:COMMITTEE
Ej Additional Pages
CAMPAIGN TREASURER NAME
TREASURER SPEC
COMMITTEE CAMPAIGN TREASURER ADDRESS
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
CANDIDATE / OFFICEHOLDER
FORM CIOH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
16 Cf01-1 NAMEA
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)
EXXPPEENTOTALSDITURE
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
4. TOTAL POLITICAL EXPENDITURES
CONTRIBUTION
BALANCE
5, TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
6 { ! "'�
s 41
OF REPORTING PERIOD
/
OUTSTANDING
6. TOTAL PRINCIPALAMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$
LOAN TOTALS
LAST DAY OF THE REPORTING PERIOD
( /
18 SIGNATURE I swear, or affirm, under penalty of perjury, that the accompanying re rt 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:
AMY SHELLEY
(1)Affidavit
_ ;Notary P i ate of Texas
- Public, St
�Pi
P: Comm. Expires 12-02-2023'
Notary ID 12476110.5
NOTARY STAMP/SEAL
Sworn to and subscribed before me by&Qt1W'j(V1&3V1
ca�' this the t
day of
1 to certifywhich, witness my hand an al of office.
Sign e of offi er- dministering oath Printed n . e of officer admi stering oath
Title f officer administeri oath
() Unsorn 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 wvwv.ethics. state.tx.us Revised 8/17/2020
SUBTOTALS - C/OH FORM C/OH
COVER SHEET PG 3
18
FILER NAME
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAME OF SCHEDULE
SUBTOTAL
AMOUNT
1.
11 SCHEDULE Al: MONETARY POLITICAL CONTRIBUTIONS
$
2.
11 SCHEDULEA2: NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS
$
3.
El SCHEDULE B: PLEDGED CONTRIBUTIONS
$
4.
El SCHEDULE E: LOANS
$
5•
21, SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
J
$
S.
SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
$
7.
SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$
8•
SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD
$
9.
El SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
$
10.
El SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH
$
11.
El SCHEDULE I: NON -POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
12./SCHEDULE
K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED
u TO FILER
$
Forms provided by Texas Ethics Commission wwwethics. state.bc.us Revised 8/17/2020
POLITICAL EXPENDITURES MADE
SCHEDULE F1
FROM POLITICAL CONTRIBUTIONS
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense
Event Expense Loan Repayment(Reimbursement SolicitatioWlundralsing Expense
Accounting/Banking
Consulting Expense
Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
FoodfBeverage Expense Polling Expense Travel In District
Contributions/Donations Made By
GIVAumrds/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SalariesAtVager(Contract Labor Other (enters category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule Fl:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
/1),,&
4 Date
--- i 2—?-1
5 Payee name
6 D
-i - 0 OIL,
6 Amount F$)-
Payee address; I City; State; Zip Code
L
i
z9
/, kv-14
(a) Category (See Categories listed at the top of this schedule) (b) Description
PUROFPOSE
EXPENDITURE
(c) El Check if travel outside of Texas. Complete Schedule T ❑ Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct
Candidate / Officeholder name Office sought Office held
expenditure to benefit CIOH
Date
Payee name
Amount
Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check Whavel outside ofTexas. Complete Schedule T El Check if Austin, TX, officeholder living expense
Complete ONLY if direct
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/01-1
Date
Payee name
Amount
Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
ElCheck iftravel outside ofTexas. Complete Schedule T El Check if Austin, TX, officeholder living expense
Complete ONLY if direct
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/01-1
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER SCHEDULE K
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. I Total pages Schedule K:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date $ Name of person from whom amount is received # Amount
........................ ........................
6— Address of person from m** w—h'o'*m' *amount is received; city; State; Zip Code
Wry
'L4 t L-4 k
7 Purpose for which amount is received ❑ Check if political contribution returned to filer
Date Name of person from whom amount is received Amount
............ I ........................................................... ........................
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received Check if political contribution returned to filer
Date Name of person from whom amount is received Amount
........................................................................ ........................
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received ❑ Check if political contribution returned to filer
Date Name of person from whom amount is received Amount
........................................................................ ........................
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received Check if political contribution returned to filer
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020