Robbins Semi Jan 2022CANDIDATE / OFFICEHOLDER
FORM CIO ,
CAMPAIGN FINANCE REPORT
COVER SHEET PG I
The C10H Instruction guide explains hove to complete this form. � Filer ID (E nice Commission Filers))
2 Total pages riled:
3 CANDIDATE /
OFFICEHOLDERa
MS V MRS 1 MR F T - -::.. _ MI
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NAME
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Date Receovat9
NICKNAME ST.SUFFW .
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4 CANDIDATE/
ADDRESS t ED SOX; APT f SUITE Y, 0TY, .STATE; ZIP CODE
P t1 N � 2022
OFFICEHOLDER
�
MAILING
ADDRESS
Change ®t Address
OFFICE OF CITYSECRET
5 CANDIDATE/
OFFICEHOLDER
AREA CODE PHONE NUMBER EXTENSION
arked
� d �MY'
PHONE
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CAMPAIGN
h"aS e' R I MR FIRST MI
Receipt.# Rmounl S
TREASURED
NAME
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gate Processed
NICKNAME LAST SUFFIX
Elate Imaged
7 CAMPAIGN
� STREET ADDRESS. (NO PO BOX PLEASEY APT ; SLI:i u E 4: CI T `ti
ZIP CODE
TREASLIRER
gSTATE:
ADDRESS
J
(Residence or Business)..
8 CAMPAIGN
AREA COOS PHONE NUN, DER Ek(TENSION
TREASURER
PHONE
� � �y' r
9 REPORTTYPE
I j January 15 �; 301h lay before: tt?ecbon � RUntri€
� i5tciday after campaign:
treasurer
appointment
(Mcehalder Only)
July:15 air day before eiectlon. Exceeded Modified
� Final Report (Aturch CK)9H-. FRI
Reporting Limit
10 PERIOD
Mgatn Day Year Month
Day Year
COVERED
-),- L J THROUGH
f
F
k
➢
11 ELECTION
� ELECTION DATE ELECTION TYPE
i
(. Primary Runoff Cotner..
Month Day. Year
Description
G®neral El Special
12 OFFICE
_
OFFICE HERD (ifany) 1>3 OFFICE SOUGHT (it known)
l
14 NOTICE FROM
THIS BOX I5 FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY HOLITICAL COMMITTEES TO SUPPORT
PC LITICAL
THE CANDIDATE 8 OFFICEHOLDER. THESE EXPENDITURES MAY HAVE SEEN MADE WrFHOUT THE CANDIVAT" OR OFFICEHOLDERS KNOWLEDGE OR
CONSENT: CANDIDATES AND OFFICEHOLDER$ ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES. '..
C ➢4iMri-T( )
COMMITTEE TYPE. COMMITTEE NAME
7 GENERAL. COM4MiTTEE ADDRESS
_.. .
�- Additional Pages
E—jSPEGIF'IC COMMITTEE CAMPAIGN TREASURER NAME
GOMMtTTEE CAMPAIGN TREASURERADDRESS
•
Forms provided by Texas Ethics Commission ww ethl .s➢ate.tx.us Devised 8117f2020
CANDIDATE I OFFICEHOLDER FORM CIOH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
15 CIOH NAME 16 Filer ID (Ethics Commission Filers)
17 CONTRIBLITION 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 37 TOTAL UNITEMIZED POLITICAL EXPENDITURE
TOTALS $
4- TOTAL POLITICAL EXPE14DITURES $
CONTRIBUTION 5TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE OF REPORTING PERIOD $ q—
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS 3 LAST DAY OF THE REPORTING PERIOD $
Woo, 00
19 SIGNATURE I swear, or affirm, under penalty of perjury, `hat the accompanying report 6s a and correct and inctudes all information
required to be reported by me under Title I ED, S action Code.
Signature of Candidate or Officeholder
AMY SHELLEY
(1) Affidavit 11
=Notary Public, State of Texas
Comm. Expires 12-02-2023
A L EY Texas 3
M Y SHELL
4
b State
of
ary Public,
St' mm Expires
1 2 2 202
Notary ID 12476110-5
NOTARY STAN I
Sworn to and subscribed before me by aA
2 to certify which, witness my hand and seal of otliie
(2) Unsworn Declaration
My name is
My address is
ad n= WRIN
oath print
(street)
County, State of _, on the
this the OPL day of J&AXk"
A
Mm.
and my date of birth is
(City) (state) (zlp code) (country)
— day of (month} —' 20 T);5-0 '
Signature of Candidate/Officeholder (Declarant)
Forms provided by Texas Ethics Commission www,ethics, state tx,us Revised 8117/2020
SUBTOTALS - C/OH FORM CIOH
COVER T PG 3
L
ER
ME 20 Filer ID (Ethlc�s Comrnisslort Filers)
1
SCHEDULESUBTOTALS
SUBTOTAL
NAMEOF
SCHEDULE
AMOUNT
1,
SCHEDULEA1: MONETARY POLITICAL CONTRIBUTIONS
2,
SCHEDULEA2: NON -MONETARY (IN-KIND)POUTIGALCONTR16UTIONS
3^
F1
SCHEDULE B: PLEDGED CONTR613UT➢ONS
$
4-
SCHEDULE E' LOANS
$
5..
SCHEDULE F1- POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
S..
0
SCHEDULE F2- UNPAID INCURRL-.D OBLIGATIONS �
$
7-
SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
8.
SCHEDULE F4: EXPENDITURES MADE BY. CRS-s..,c E. e-;ARL.7
SCHEDULE G- POLITICAL EXPENDITURES , . ... ' ,Ow,+3 PERSONAL FUNDS �.
$
10.
SCHEDULE H; PAYMENT MEha T MADE FROMF fit_+. ? "E t 3LNTkC3N5 TOA BUSINESS OF CJfli
f
$
SCHEDULEI: NON-POLITICALEXPEND6'iURE--NLADE',FF"w'.OVY7:POLIT➢r-ALCONTR&BUTIONS.
$ >
12.
Lj
SCHEDULE K' INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED
$ ..
TO FILER
Forms provided by Texas Ethics COMmisslon .elhCcs s4ate.bt:tls
Revised 811'7/2020
POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE
If the requested information is not applicable, DO NO rleNelde this � s`rI iFl� re st.
EXPENDITURE CATEGORIES FOR BOX of a)
Advertising :Expense. EventExpense Loan Repaym rriV to reciarseanrent So[tcaEataorrtFvncirarsEnzd Expense
AccourtmgfEianking Fees Of im Overhead/Rental'Expense Transportation Eceviertnent $ Related Expense
Consulting Expense FoodfBeverageFxpamse Palling Expeose Travel he District
Gmrr". +arsadan5 made kly Gifh`A%xand lMamaaeials Expense Printing Expensa Travel Out Of District
CandidatelOgtoolookidi Ificai Committee Legal Services SalariesMJages✓Ctmtmcf Labor Other (eater a category not listed above)
CreditCardPayymsnt
The Instruction Guide explains hntt tcscomplete this form,.
i Total pages Schedule Ft. 2 FILER IdAA s Filar ID tEthi Commission rllaraj
Payee nam
6 Amount �$� i 7 Payee ad ress; City: State: Zip Code
I
(a) .Category (See Calegones listed at lop or this schedule) (la) Description
PURPOSE k
OF
EXPENDITURE
i) l Gnecsc if trove auis�deo`Texas.Comclatz:Scheduler Check sf Austin. TX, officeholder living expense
9 Cernpiete. C7: N_LY if direct.. Candidate / Qfficeho9der narne. Office sought Office held
expenditure to benefit CIOH
Date- Payee name
i
E
krr cs ant t s) I Payee address: Clty, State; Zip Code
Category (see Cattagorres te5TAd1 si cne toga of mils schedule} C)eScri pttdn
PURPOSE
OF C
EXPENDITURE'
Check if travel cuixrder ®t lexxS. Ccmp4ralr.5clemou.e T. � Check ifAustin, TX, es5cehaldtiyr. wong expense
Complete . N Y rf direct Candidate / Officeholder name Office sought Office held
expenditure to benefit GfOH
Data Payee name
Amryunt d? Payee address; City; State; Zip Cade
Category (SeeCategories listed at the top of f a schedule) � Description.
PURPOSE �
OF
EXPENDITURE
Check ifL-"el:arns:de of Texas. Cornikree Schedule T. Check if .Austen. TX, officeholder. Wnef expense
Complete QNLY if direct Candidate ! Officeholder name � Office sought Office held
expenditure to benefit CfOfl
ATTACH ADDITIONALCOPIES OF THIS UL EAS NEEDED
Farms provided by Texas Ethics Commission othics.stete.ix:us Revised 6117/2020
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