McCaskill Semi Jan 2022CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PIG 1
ID (Ethics Commission Filers)
1 2 Total pages filed:
The C/OH Instruction Guide explains how to complete this form.
rler
3 CANDIDATE
Ms I MRS Mft FIRST MI
OFFICE USE ONLY
OFFICEHOLDER
5"1-1
NAME
......... ....... ................... ...
Date eceived r1rIVED
NICKNAME LAST SUFFIX
A IN 1 3 2022
4 CANDIDATE
ADDRESS I PO BOX; APT I SUITE #: CITY; STATE, ZIP CODE
OFFICEHOLDER
J
MAILING
ADDRESS
Change of Address
OFFICE OF CITY SECRETA
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
pate —Hand-detivered or Date Postmarked
OFFICEHOLDER
PHONE
Receipt #
Amount $
6 CAMPAIGN
MS 1 6)/ MR FIRST MI
TREASURER
0
NAME.......
.......... ......... __ ....
Date Processed
NICKNAME LAST SUFFIX
Date Imaged
I-
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE: ZIP CODE
TREASURER
ADDRESS
&Q)k (�)7_6tiAA-C- A-a-Q-6-
(Residence or Business)
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
C)
9 REPORT TYPE
54 / January 15 30th day before election El Runoff F-1 15th day after campaign
treasure, appointment
(Officeholder Only)
F-1 July 15 F] 8th day before election Exceeded Modified Final Report (Attach C/OH - FIR)
Reporting Limit
10 PERIOD
Month Day Year Month Day Year
COVERED
/ a / ") 0) THROUGH r/ IS / aioac-�
11 ELECTION
ELECTION DATE
ELECTION TYPE
q
a
F� Primary Runoff F-1 Other
Month Day( Year
Description
General Special
12 OFFICE
OFFICE HELD (if any) o u_ n_t t ik L
13 OFFICE SOUGHT (if known)
cc) -3
14 NOTICE FROM
THIS BOX 13 FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL
THE CANDIDATE t OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE 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
COMMITTEE ADDRESS
ll
1-1 GENERAL
Additional Pages
DSPECIFIC
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
_a JTJ I gAJ M III, I a I J1, rAJ Z L em
FORM C/OH
COVER SHEET PG 2
15 C/OH NAME 16 File ID (Ethics Commission Filers)
. t--IA 0 '- Lk k �-k-
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
CONTRIBUTION
BALANCE
..................
OUTSTANDING
LOAN TOTALS
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
4. TOTAL POLITICAL EXPENDITURES
$
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
OF REPORTING PERIOD
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE $
LAST DAY OF THE REPORTING PERIOD A LJ t
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
THERESA K HOWARD
Notary Public, State of Texas
(1) Affidavit Notary ID#: 121663-2
6 My Commission Expires 07-31-2025
N:W
NOTARY STAMP/ SEAL
Sworn to and subscribed before me by k V. this the day of
20 D)t)- to certify which, witness my hand and seal of office.
Signature of officer administering oath
(2) Unsworn Declaration
1 rt'r-vv-s 0, n':kjO
Printed name of officer administering oath
Title-o7 officer administering oath
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 8/1712020
SUBTOTALS - C/OH FORM C/OH
COVER SHEET PG 3
19
FILER NAME
154-A t k t (,A iLk k U,_
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAME OF SCHEDULE
SUBTOTAL
AMOUNT
1
SCHEDULEAl: MONETARY POLITICAL CONTRIBUTIONS
$ Saw. as-
2.
SCHEDULEA2: NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS
$
3.
SCHEDULE B: PLEDGED CONTRIBUTIONS
$
4.
SCHEDULEE:LOANS
$
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
$
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
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
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 I Schedule At
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
A I'q -A
4 Date
5 Full name of contributor F-1 out-of-state PAC (04: 1
7 Amount of contribution
Gu 0 I'j (r'i o'�
..............
6 Contributor address; city-, State; Zip Code
8 Principal occupation / Job title (See Instructions)
g Employer (See Instructions)
Date
Full name of contributor El out-of-state PAC (ID#:
Amount of contribution
_jb fw-- 0
.................... ....... *''**'* ...... * ..................
's
Contributor address; City; State; Zip Code
19q T- 1-t t 7, 0A r?- E_ 7-
--t-k L cl, a),
Principal occupation Job title (See Instructions)
Employer (See Instructions)
}/
6 (,P- 5 0 Q"N E4�-
G U rX,-C-(A_ C) Q. 41,_ 0 \J ", -1 _k
Date
Full name of contributor El out-of-state PAC (ID#:
Amount of contribution
.............
Contributor address; City; State; Zip Code
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor E] out-of-state PAC (ID4:
Amount of contribution
..... ... I ............. 1. I .... I I ...... .... ..............
Contributor address; City; State; Zip Code
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULERS NEEDED
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
NON -MONETARY (IN -KIND) POLITICAL
CONTRIBUTIONS SCHEDULE AZ
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 A2:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED IN -KIND POLITICAL CONTRIBUTIONS
$
5 Date
6 Full name of contributor ❑ out-of-state PAC (ID#: )
8 Amount of I g In -kind contribution
Contribution $ I description
I
7 Contributor address; City; State; Zip Code
❑ Check if travel outside of Texas. Complete Schedule T.
10 Principal occupation / Job title (FOR NON-JUDICIAL)(See Instructions)
11 Employer (FOR NON-JUDICIAL)(See Instructions)
12 Contributor's principal occupation (FOR JUDICIAL)
13 Contributors job title (FOR JUDICIAL)(See Instructions)
14 Contributor's employer/law firm (FOR JUDICIAL)
15 Law firm of contributor's spouse (if any) (FOR JUDICIAL)
16 If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL)
Date
Full name of contributor Elout-of-statePAC (ID#: 1
I
Amount of In -kind contribution
Contribution $ I description
I
............................................................................
Contributor address; City; State; Zip Code
I
I
❑ Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (FOR NON -JUDICIAL) (See Instructions)
Employer (FOR NON-JUDICIAL)(See Instructions)
Contributor's principal occupation (FOR JUDICIAL)
Contributor's job title (FOR JUDICIAL) (See Instructions)
Contributor's employer/law firm (FOR JUDICIAL)
Law firm of contributor's spouse (if any) (FOR JUDICIAL)
If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Nevlsea ovi nzuzu
PLEDGED CONTRIBUTIONS SCHEDULE B
If the requested information is not applicable, DO NOT include this page in the report.
1 Total pages Schedule B:
The Instruction Guide explains how to complete this form.
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
y-1t-A UJ--,! vt
4 TOTAL OF UNITEMIZED PLEDGES
$
5 Date
6 Full name of pledgor ❑ out-of-state PAC (ID#: )
a Amount I $ In -kind contribution
of Pledge $ I description
I
...........................................................................
7 Pledgor address; City; State; Zip Code
I
❑ Check if travel outside of Texas. Complete Schedule T.
10 Principal occupation / Job title (See Instructions)
11 Employer (See Instructions)
Date
Full name of pledgor ❑ out-of-state PAC (ID#: )
Amount I In -kind contribution
of Pledge $ I description
I
...........................................................................
Pledgor address; City; State; Zip Code
I
❑ Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of pledgor El out-of-state PAC (ID#: 1
Amount of I In -kind contribution
Pledge $ description
I
Pledgor address; City; State; Zip Code
I
❑ Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of pledgor ❑ out-of-state PAC (ID#: )
Amount of In -kind contribution
Pledge $ I description
...........................................................................
Pledgor address; City; State; Zip Code
I
❑ Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission Iwww.ethics.state.tx.us Revlseo 611 nzuzu
LOANS SCHEDULE E
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 E:
t
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
)"-I�, ,j t,� 5 Ck
4 TOTAL OF UNITEMIZED LOANS
$ Ll (ac)
t
5 Date of loan
7 Name of lender out-of-state PAC (ID#:
9 LoanAmount($)
'n'A k o %" 5
1 1 e)- 0 S V'- ( l- '-
I (' (Q
............ -- .......... — ............. ........... ......
8 Lender address; City; State; Zip Code
6 Is lender
10 Interest rat
a financial
Institution?
11 Maturity date
1-4
Yis
12 Principal occupation / Job title (See Instructions)
13 Employer (See Instructions)
& r'4 L -1
6 C� 'r) W C'-4 R), G N11 "'" P C-
14 Description of Collateral
15 Check if personal funds were deposited into political
Enone
19/ account (See Instructions)
16 GUARANTOR
17 Name of guarantor
19 Amount Guaranteed ($)
INFORMATION
........... .......... ................. .................
18 Guarantor address; City; State; Zip Code
M/not applicable
20 Principal Occupation (See Instructions)
21 Employer (See Instructions)
Date of loan
Name of lender E] out-of-state PAC (ID#:
Loan Amount ($)
........... ............I ..........................
Lender address; City; State; Zip Code
Is lender
Interest rate
a financial
G(jk
Maturity date
Institution?
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
(,A- —(T70A -� � —1
6uo4j , � ins0 /" P �-
Description of Collateral
Check if personal funds were deposited into political
d account (See Instructions)
E/none
GUARANTOR
Name of guarantor
Amount Guaranteed ($)
INFORMATION
........... ...... ....... .............
Guarantor address; City; State; Zip Code
[not applicable
Principal Occupation (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If lender is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.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/Reimbursernent Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense FoodlBeverage Expense Polling Expense Travel In District
Contributionsi'Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SalariesAA/ages/Contract Labor Other (enter a category not listed above)
Credit Card Payment The Instruction Guide explains how to complete this form.
I Total pages Schedule Fi:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount
7 Payee address; City; State; Zip Code
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
(c) Check if travel outside of Texas, Complete Schedule T. El Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
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 if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
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 if travel Outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OFTHIS SCHEDULEAS NEEDED
Forms provided b*Texas Ethics Commission neviscdanr/2ouo
UNPAID INCURRED OBLIGATIONS SCHEDULE F2
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SaladesMages/Contract Labor Other (entera category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F2:
2 NAME
3 Filer ID (Ethics Commission Filers)
/FILER
`? 1-1 � �- L'V - i`. A ( ice- r a \ L-' --
4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS
$
5 Date
6 Payee name
7 Amount ($)
8 Payee address; City; State; Zip Code
9 TYPE OF
EXPENDITURE
Political El Non -Political
10
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas. Complete Schedule Check if Austin, TX, officeholder living expense
11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE
Political Non -Political
Category (See Categories listed at the lop of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas. CompleteSchedulel Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Kevlsea b/i r/zuzu
PURCHASE OF INVESTMENTS MADE SCHEDULE F3
FROM POLITICAL CONTRIBUTIONS
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 F3:
t
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Name of person from whom investment is purchased
................................................................................................................................
6 Address of person from whom investment is purchased; City; State; Zip Code
7 Description of investment
8 Amount of investment ($)
Date
Name of person from whom investment is purchased
................................................................................................................................
Address of person from whom investment is purchased; City; State; Zip Code
Description of investment
Amount of investment ($)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Newseu of 1 ,,cu/u
EXPENDITURES MADE BY CREDIT CARD SCHEDULE F4
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F4:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
1
Sc-t v-1 rJ to ' C S (C , L �,_
4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TOACREDIT CARD
$
5 Date
6 Payee name
7 Amount ($)
8 Payee address; City; State; Zip Code
9 TYPE OF
EXPENDITURE
El Political Non -Political
10
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(C) Check if travel outside of Texas. Complete ScheduleT. El Check if Austin, TX, officeholder living expense
11 Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE
❑ Political ❑ Non -Political
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
❑ Check if travel outside of Texas. Complete ScheduleT. ❑ Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
POLITICAL EXPENDITURES MADE FROM
SCHEDULE G
PERSONAL FUNDS
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 Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By GifUAwards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
❑Reimbursementfrom
political contributions
intended
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas. Complete ScheduleT. Check if Austin. TX, officeholder living expense
g Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Reimbursement from
Elpolitical contributions
intended
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
❑ Check if travel outside of Texas. Complete Schedule Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
OReimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
❑ Check if travel outside of Texas. Complete ScheduleT. Ej Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/1U2U
PAYMENT MADE FROM POLITICAL CONTRIBUTIONS
SCHEDULE H
TO A BUSINESS OF C/OH
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SalariesM/ages/Contract Labor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
SF-If'�u":.l �A(C✓AS���LL_
4 Date
5 Business name
6 Amount ($)
7 Business address; City; State: Zip Code
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas. Complete Schedule T. Check if Austin. TX, officeholder living expense
g Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Business name
Amount ($)
Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas.CoripleleScheduleT. Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Business name
Amount ($)
Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas. Complete Scheduler. Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission vAw,/.ethics.state.tx.us Revised 8/17/2020
NON -POLITICAL EXPENDITURES
MADE FROM POLITICAL CONTRIBUTIONS 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 I:
2 FILERNAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City State Zip Code
8
(a) Category (See instructions for examples of acceptable
(b) Description (See instructions regarding type of information
PURPOSE
categories.)
required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City State Zip Code
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
PURPOSE
categories.)
required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City State Zip Code
PURPOSE
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
OF
categories.)
required.)
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City State Zip Code
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
PURPOSE
categories.)
required.)
OF
EXPENDITURE
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.
1 Total pages Schedule K:
1
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
o t C '4 L
4 Date
5 Name of person from whom amount is received
8 Amount ($)
................................................................................................
6 Address of person from whom amount is received; City; State; Zip Code
7 Purpose for which amount is received Check if political contribution returned to filer
Date
Name of person from whom amount is received
Amount ($)
................................................................................................
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 ($)
................................................................................................
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received Check if political contribution returned to filer
Date
Name of person from whom amount is received
Amount ($)
................................................................................................
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 8/1712020
IN -KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES SCHEDULE T
FOR TRAVEL OUTSIDE OF TEXAS
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 T:
2 FILER NAME
`J 1_1 A w:-"� NA I C v__� G I; k �_-`-
3 Filer ID (Ethics Commission Filers)
4 Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
5 Contribution / Expenditure reported on:
❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1
❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COH-UC Schedule B-SS
6 Dates of travel
7 Name of person(s) traveling
8 Departure city or name of departure location
9 Destination city or name of destination location
10 Means of transportation
11 Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
Contribution / Expenditure reported on:
❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1
❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COH-UC ❑ Schedule B-SS
Dates of travel
Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation
Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
Contribution / Expenditure reported on:
❑ Schedule A2 ❑ Schedule B ❑ Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1
❑ Schedule F2 ❑ Schedule F4 ❑ Schedule G ❑ Schedule H ❑ Schedule COH-UC ❑ Schedule B-SS
Dates of travel
Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation
Purpose of travel (including name of conference, seminar, or other event)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
CANDIDATE / OFFICEHOLDER REPORT:
DESIGNATION OF FINAL REPORT FORM C/OH - FR
The Instruction Guide explains how to complete this form.
•• Complete only if "Report Type" on page 1 is marked "Final Report' --
I C/OH NAME
2 Filer ID (Ethics Commission Filers)
3 SIGNATURE
I do not expect any further political contributions or political expenditures in connection with my candidacy. I understand that
designating a report as a final report terminates my campaign treasurer appointment. I also understand that I may not accept any
campaign contributions or make any campaign expenditures without a campaign treasurer appointment on file.
Signature of Candidate / Officeholder
4 FILER WHO IS NOT AN OFFICEHOLDER
•• Complete A & B below only if you are not an officeholder. ••
A. CAMPAIGN FUNDS
Check only one:
I do not have unexpended contributions or unexpended interest or income earned from political contributions.
I have unexpended contributions or unexpended interest or income earned from political contributions. I understand that I
may not convert unexpended political contributions or unexpended interest or income earned on political contributions to
personal use. I also understand that I must file an annual report of unexpended contributions and that I may not retain
unexpended contributions or unexpended interest or income earned on political contributions longer than six years after
filing this final report. Further, I understand that I must dispose of unexpended political contributions and unexpended
interest or income earned on political contributions in accordance with the requirements of Election Code, § 254.204.
B. ASSETS
Check only one:
0 I do not retain assets purchased with political contributions or interest or other income from political contributions.
I do retain assets purchased with political contributions or interest or other income from political contributions. I understand
that I may not convert assets purchased with political contributions or interest or other income from political contributions to
personal use. I also understand that I must dispose of assets purchased with political contributions in accordance with the
requirements of Election Code, § 254.204.
Signature of Candidate
5 OFFICEHOLDER
•• Complete this section only if you are an officeholder •-
F --- I I am aware that I remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer on
file. 1 am also aware that I will be required to file reports of unexpended contributions if, after filing the last required report as
an officeholder, I retain political contributions, interest or other income from political contributions, or assets purchased with
political contributions or interest or other income from political contributions.
Signature of Officeholder
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 811 1/202u