Williamson Semi Jan 2022CANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT
COVER SHEET PG 1
The C10H Instruction Guide explains how to complete this form.
1 Filer ID (Ethics Commission Filers)
2 Total pages filed:
3 CANDIDATE/
OFFICEHOLDER
MS MRS(CP FIRST MI > 4
A4 -,Lr�L
OFFICE USE ONLY
NAME
..........
ICR
NAME LAST SUFFIX
M�N,
Date Received
RECEIVED
/ 4Y/L
1 2022
4 CANDIDATE/
OFFICEHOLDER
-
ADDRESS / PO BOX; APT / SUITE,#; CITY; STATE; ZIP CODE
, , A �--
of Address
OFFICE OF CITY SECRETARY
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER
PHONE
(N )
�
6 CAMPAIGN
MS I MRS / MR RST MI
Receipt W
Amount $
TREASURER
Date Processed
NAME
...... .........
NICKNAME LAST SUFFIX
Date Imaged
7 CAMPAIGN
TREASURER
STREET ADDRESS (NO PO BOX PLEASE), APT/ ITE#;,,,, CITY;
STATE; ZIP CODE
ADDRESS
(Residence or Business)
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
e17
REPORT TYPE
nuary 15 30th day before election Runoff
lelljJa F
15th day after campaign
1:1
treasurer appointment
(Officeholder Only)
I--] July 15 F-1 8th day before election Exceeded Modified
Final Report (Attach C/OH - FIR)
Reporting Limit
10 PERIOD
Month Day Year Month
Day Year
COVERED
—7 /3 t
/ THROUGH /
/ /
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
F-1 Primary F-1 Runoff F� Other
Description
General ❑Special
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (if known)
NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
AL
THE CANDIDATE/ OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICER DSR-��EOR
OR
COMMIT IT
CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY I OF SUCH EXPENDITURES.
MITTEE TYPE
COMMITTEE NAME
GENERAL
—ZOMWTTEE AD❑ DJR�
Additional Pages
FIs c
COMMITTEE CAMPAIGN THE 'NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
L
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx,us Revised 8117/2020
CANDIDATE l OFFICEHOLDER FORM CIOH
CAMPAIGNCOVER SHEET PIG
15 G/C7H 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)
TOTALS ITURE 3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
4. TOTAL POLITICAL EXPENDITURES
CONTRIBUTION 5 TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY j/ .,
BALANCE OF REPORTING PERIOD ✓ <J " ° F
OUTSTANDING 5, TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE yyyy -
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ /�G✓
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:
—00
(1) Affidavit rpur��
AMY SHELLEY
.Notary Public, State of Texas
Comm. Expires 12-02-2023
NOTARY STA f�° Notary ID 12476110-5
t t t
Sworn to and subscribed before me by t / this the 4day of �1
to certify which, witness my hand an s 1 of office. ii
l
Sign of offi r ministering oath Printe me of officer admin tering oath Title of officer administering ath
(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
COVER SHEET PG 3
19
FILERNAME
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAME OF SCHEDULE
SUBTOTAL
AMOUNT
2,
SCHEDULEA2:
NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS
$
5.
SCHEDULE Fl:
POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
6.
SCHEDULE F2:
UNPAID INCURRED OBLIGATIONS
$
7.
SCHEDULE F3:
PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
S
8.
SCHEDULE F4:
EXPENDITURES MADE BY CREDIT CARD
$
9,
SCHEDULE G:
POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
$
10.
SCHEDULE H:
PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH
$
11,
SCHEDULE 1: NON -POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
12.
SCHEDULE K:
INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED
TO FILER
$ Iq
Forms provided byTexas Ethics Commission wwvw. ethimo.state. txua Revsed8/17/2U2o
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER SCHEDULE
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form.
1 Total pages Schedule K:
2 FILER NAME141�6L_��6
3 Filer ID (Ethics Commission Filers)
4 Date
5 Name of person from whom amount is received
8 Amount
............ ...........
Address of from whom amount is received; City; State; Zip Code
1-4/1
person
7 Purpose for which amount is received El 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 E:] 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