Patton Semi Jan 2022CANDIDATE / OFFICEHOLDER
FORM C/OH
REPORTCAMPAIGN FINANCE
COVER SHEET PG 1
1 Filer ID (Ethics Commission Filers)
2 Total pages filed:
The CJOH Instruction Guide explains how to complete this form.
3 CANDIDATE /
OFFICEHOLDER
MS 1 MRS MR FIRST MI
OFFICE USE ONLY
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NAME.
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-.:.......: .......::......... . . _ .......:.
Date Receiv I V ED
NICKNAME AST SUFFIX
JAN 1 0 2022
4 CANDIDATE /
ADDRESS t PO BOX; APT / S,UIITE #; CITY; STATE; ZIP CODE
OFFICEHOLDER
- YF ` iM i
MAILING
ADDRESS
C3 LG4C,
Change of Address
OFFICE OF CITY SECRETAR,
KtHand-delivered or Date Postmarked
'
5 CANDIDATE/
OFFICEHOLDER
PHONE
AREA CODE PHONE NUMBER EXTENSION
rr
t Cat �T ( q I
Receipt #
Amount $
6 CAMPAIGN
MS / MRS M FIRST MI
TREASURER
.t
Date Processed
NAME"
... . `I
NICKNAME LASTSUFFIX
Date Imaged
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7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY;
STATE; ZIP CODE
TREASURER
(o Y,, k i
ADDRESS
$
(Residence or Business)
Vc.-V-c tteo f 1,
8 CAMPAIGN
AREA CODE PHONE .NUMBER .EXTENSION
TREASURER
PHONE
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$ REPORT TYPE
January 15 30th day before election Runoff
15th day after campaign
treasurer appointment
(Officeholder Only)
❑ July 15 8th day before election Exceeded Modified
El Final Report (Attach CtOH - FIR)
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
t
General El Special
12 OFFICE
OFFICE HELD (if any)
13. OFFICE SOUGHT (if known) _
14 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL
THE CANDIDATE ! OFFICEHOLDER. THESE EXPENDITURES MAY HAVE SEEN MADE WITHOUTTHE 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(S)
COMMITTEE TYPE
COMMITTEE NAME
GENERAL
COMMITTEE ADDRESS
Additional Pages
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
GO TPAGE
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
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)
EXPALNEDITURE
TOTS
3, TOTAL UNITEMIZED POLITICAL EXPENDITURE.
$
4. TOTAL POLITICAL EXPENDITURES
$
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
OF REPORTING PERIOD
OUTSTANDING
6, TOTAL PRINCIPAL AMOUNT 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 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:
AMY SHELLEY
(1) AffidaVit State of Texas
-' 'vO'� Notary Public,
12-02-2023
zow-Comm, Expires
Notary ID 1247611"
NOTARY S
Sworn to and subscribed before me by 4 this the lcil� day of
19-eertify which, witness my hand d seal of office.
-1
x (rell 4qq
Sig n atw—foffice -a- V inistering oath Print k4 me of officer adnim
oath
-i .
tle of officer administ 11ng oathistering
(2) Unsworn Declaration
My name is and my date of birth is
My address is 11
(street) (city) (state) (zip code) (country)
Executed in Countv. 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