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CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
I Filer ID (Ethics Commission Filers), 2 Total pages filed:
The C/01-1 Instruction Guide explains how to complete this form. I
3 CANDIDATE/ M$ / MRS i MR rkRST MI ME=
OFFICEHOLDER Ay
NAME L ......... ....... . Date Received
NICKNAME LAST SUFFIX
S� X to CANDIDATE/ ADDRESS I PO BOX, APT I SUITE CITY; STATES ZIP CODE J U L 1 5 2022
OFFICEHOLDER
MAILING
ADDRESS
Change of Address )FFICE OF CITY SECRET A RY
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION Date Hand4livered or Date Postmark
OFFIEHOLDER A
PHONCE
A-—9- S
6 CAMPAIGN MS I MRS I M� IRST MI W"p1
TREASURER I
NAME ...
Date Processed
...............
NICKNAME LAST SUFFIX
Date Imaged
7 CAMPAIGN STREETADDRESS (NO POBOX PLEA JE): APT S Erf; CITY; STATE; ZIP CODE
TREASURER
ADDRESS 4-0
(Residence or Business) -- < Uv.lm
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
PHONETREASURER
---------- ----- -
9 REPORT TYPE 30th day before election Runoff 15th day after campaign
El January 15 El E] treasurer appointment
(Officehorder Only)
ovicily 15 F—] 8th day before election Exceeded Modified Final Report (Attach C1014 - FRI
Reporting Limit
10 PERIOD Month Day Year Month Day Year
COVERED
THROUGH
Ill ELECTION ELECTION DATE ELECTION TYPE
Month Day Year Primary Runoff Other
Description
General Special
Otm,
12 OFFICE OFFICE HELq (it any 3 OFFICESOUGHT (ilknown)
14 NOTICE FROM THIS BOX IS FOR N044F OF POLITICAL CONTRIONIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL THE CANDIDATE I OFFICEHOLDER' THESE EXPENDITURES MAY HAVEREEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDER'$ KNOWLEDGE OR
CONSENT, CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEE(S) --- --- — ...,a_
COMMITTEE TYPE COMMITTEE NAME
GENERAL COMMITTEE ADDRESS
Additional Pages
----------
EISPECIFIC COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
.... ..... ------ -------
GO TO PAGE 2
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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 $ IVIA-
CONTRIBUTIONS MADE ELECTRONICALLY)
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) kp
EXPENDITURE
TOTALS 3, TOTAL UNITEMIZED POLITICAL EXPENDITURE, $
4. TOTAL POLITICAL EXPENDITURES I $
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST BAY
BALANCE 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 Coo
Signature of Candidate or Officeholder
Please complete either option below:
- - - - - - - - - - -
AMY SHELLEY
Notary Public, State of Texas
(1) Affidavit Comm. Expires 12-02-2023
".4, 0 Notary ID 12476110-5
NOTARY STAMP SEAL
Sworn to and subscribed before me by Uthis the day of
to certify which, witness m hand and seal of office.
si I , th . .,--A.. I I . 'h'
Signature v (ricer 6dnistering oath OF,
(2) Unsworn Declaration
My name is
My address
(street)
Executed in County, State of
Forms provided by Texas Ethics Commission
name of ottker administering oath
milm
and my date of birth is
(city) (state) (zip code) (country)
on the day of --(iikRt-h—), 20 (year)- — -
-
Signature of Candidate/Officeholder (Declarant)
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SUBTOTALS
- C/OH FORM C/OH
COVER SHEET PG 3
19
FILER NA
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
SUBTOTAL
NAME OF
SCHEDULE
AMOUNT
SCHEDULEAI:
MONETARY POLITICAL CONTRIBUTIONS
$
2.
SCHEDULE A2: NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS
$
3•
U
SCHEDULE B:
PLEDGED CONTRIBUTIONS
$
4.
SCHEDULE E:
LOANS
$ O
5.
SCHEDULE F1:
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
$ e—
ll.
SCHEDULE I: NON
-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$ �^
12.
SCHEDULE K:
INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED
$ r---
TO FILER
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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.
1 Total pages Schedule E:
2 FILER NA
3 Filer ID (Ethics Commission Filers) z
4 TOTAL OF UNITEMIZED LOANS
$
5 Date of loan
7 Nameoflender El out-of-statePAC (ID#: )
9 Loan Amount($)
... fA ...............................
8 Lender address; City; State; Zip Code
6 Is lender
10 Interest rate
a financial
Institution?
U �jU( 'r
C uX
11 Maturity date
Y N
\ J1 �j� I 6 UQ
12 Principal occu at on / Job title (See Instructions)
13 Employer (See Instructions)
14 Description Collateral
n Check if personal funds were deposited into political
none
account (See Instructions)
16 GUARANTOR
INFORMATION
17 Nameofguaranto
j
19 Amount Guaranteed($)
I ..
.. r\SA..,....................................
LA
18 ad��ddrr��ess; City; State; Zip Code
Soo
❑ not applicable
t/(` t V)owG�uarantor
1 � o s-�
vv
I
20 Principal Occup do (See Instructions)
21 Employer (See Instructions)
Date of loan
Name of lender out -of -slate PAC (ID#: ` )
............................................................................
Lender address; City; State; Zip Code
Loan Amount ($)
Is lender
— -----
Interest rate
a financial
Institution?
Maturity date
Y N
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Description of Collateral
Check if personal funds were deposited into political
0- none
account (See Instructions)
^S GUARANTOR
Name of guarantor —` vv-
Amount Guaranteed($) —
INFORMATION
..................................................................................
Guarantor address; City; State; Zip Code
( not applicable
v
Principal Occupation (See Instructions)v
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.
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POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS
SCHEDULE F1
If the requested information is not applicable, DO NOT include this
page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense
Accounting/Banking
Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Fees Office Overhead/Rentat Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
ContributionslOonations Made By Gif /Awards/Memonals Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries=ages/Contracl Labor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete
this form.
1 Total pages Schedule Fl:
2 FILER NAME
D
y
3 Filer ID (Ethics Commission Filers) a
4 Date
5 Paye me
6 Amount ($)
7 Payee address;
tax- ��Sc-o
City; State; Zip Code
16 �' 1-71
ok
8
PURPOSE
(a) Category(SeeCategories listed at the lop of this schedule)
(b) Description
4", �I
OF
(V
'
EXPENDITURE
` o
(C) Check if travel outside of Texas. Complete Schedule T
Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct
Candidate / Officeholder name
Office sought Office held
expenditure to benefit C/OH
Date
Payee name
,bci
Amount ($)
Payee address;
City; State; Zip Code
ls�
T�_-
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
'n^
C`�1 V�� a Q� e \ O�
��ci"vo• v VCR
EXPENDITURE
Check if travel outside of Texas. Complete Schedule T
El Check if Austin. TX, officeholder living expense
Complete ONLY if direct
Candidate / Officehoifier name
Office sought Office held
expenditure to benefit C/OH
Date
Payee name
o a - -a
C(� (k
Amount ($)
Payee addre ;
City; State; Zip Code
1 b0u
M
' LU- -TI 16,6401
Category (See Categories listed at the lop of this schedule)
DesscrrippttiioonJ`,
PURPOSE
OF
EXPENDITURE
�/� /� /�/��
Cam" r lP W "'V t •�
Y
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 OF THIS SCHEDULE AS NEEDED
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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 R 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 SalariesNVages/Contract Labor Other (enter a category not listed above)
The Instruction Guide explains how to complete this form.
Total pages Schedule F4:
2 FIL AMA iME J��3
Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TO A CREDIT CARD
w
$
5 Date
6 Payee name
_a oaNW
7 Amount ($)
8 Payee address; City; State; Zip Code
��
%yk ' • ' ��
TYPE OF
EXPENDITUREPolitical
El Non -Political
10
PURPOSE
(a) Category (See Categories listed at the top of this schedule)
(b) Description I I -
��/f 1 / ` �, (� b a��ll` J,(/I/J/t
OF
wLA
1 `CJ�/N V vti /� i �� ttYY �I �J
EXPENDITURE
�1
(C) Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense
11 Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
e,oiA-
TYPE OF
EXPENDITURE
Political Cl Non -Political
Category (See Categories listed at the lop of this schedule) Description ( C
Fay ii:JT
PURPOSE
OF
V
CG A 1 (/�/� - ,
W 1�0 ►,
EXPENDITURE
CA_
ElCheck if travel outside of Texas. Complete Schedule T. 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
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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
� V—
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 treasur appointment on file.
gnature 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:
L:] I do not have unexpended contributions or unexpended interest or income earned from political contributions.
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
Chec my one:
I do not retain assets purchased with political contributions or interest or other income from political contributions.
0 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 ••
n I am aware that I remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer on
file. I 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
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