Smith Semi Jan 2023Firefox
about: blank
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG I
Filer ID (Ethics Commission Fite'rin 2 Total pages filed:
The 0/0H Instruction Guide explains how to complete this form.
F
3 CANDIDATE/ MS I MRS, is FIR T MI OFFICE USE ONLY
OFFICEHOLDER
NAME N . ICKN . A . ME LA . S . T.... ...... SU F . FIX Date ReceiveRECEIVED
4 CANDIDATE/ ADDRESS I PO BOX; APT I SUITE C CITY; STATE: ZIP CODE
OFFICEHOLDER JAN 1 7 2023
MAILING po C4
ADDRESS
F
Change of Address 0 Q
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION ID Mand-delivered of Date Postinarke'd
OFFICEHOLDER
PHONE
- Receipt # Amon $
6 CAMPAIGN MS0 FIRST MI
TREASURER MR. "-"' " "W -
ic. Date Processed
NAME .. ...
NICKNAME LAST SUFFIX
Date Imaged
7 CAMPAIGN STREET ADDRESS (NO POB10f LEASE); APT /SUITE#, CITY; STATE: ZIP CODE
TREASURER
ADDRESS
(Residence or Business)
a CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
9 REPORT TYPE Kmuary 15 0 30th day before election Runoff 15th day after campaign
treasurer appointment
(Officeholder Only)
El July 15 8th day before election El Exceeded Modified Final Report (Attach CIOH - FRI
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
General Special
E
12 OFFICE OFFICE E HEL (if any) uct.--
OFFICE SOUGHT (il known)
13
--- C"f
14 NOTICE FROM THIS BOX IS FOR OT E OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL THE CANDIDATE I EHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT ONE 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
EJ GENERAL COMMITTEE ADDRESS
E] Additional Pages
E]SPECIFIC COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
--------------
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state,tx.us Revised 1111512022
of 18
1/ 17/23, 12:06 PM
Firefox
about: blank
CANDIDATE 1 OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT
COVER SHEET PG 2
15 C/OH NAME
16 Filar ID (Ethics Commission Filers)
17 CONTRIBUTION
TOTALS
1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR
If
CONTRIBUTIONS MADE ELECTRONICALLY)
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
TOTALSEXPENDITURE
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
POLITICALC TOTAL
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE OF REPORTING PERIOD $ /I
OUTSTANDING 6, TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD
18 SIGNATURE1 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
P Notary Public, State of Texas
(1) Affidavit Comm. Expires 12-02-2023
.,vrF 0F,�,�-4,4
'+auttNotary ID 12476110-5
NOTARY STAMP/SEAL
Swom to and subscribed before me by —Rf �kxiitp? this the day of h
1^�
O� to certify which, witness my hand and �hai of officq.
administering oath
(2) Unsworn Declaration
My name is _
My address is
Executed in
Printed namWf officer admi
(street)
County, State of
Forms provided by Texas Ethics Commission
and my date of birth is.
(city) (state) (zip code) (country)
on the day of m_, 20
(month) (year)
Signature of Candidate/Officeholder (Declarant)
www.ethies.state.tx.us Revised 11/15/2022
2 of 18 1 / 1'7/23 , 12:06 PM
Firefox
about: blank
SUBTOTALS
- C/OH FORM C/OH
COVER SHEET PG 3
19
FILER NAME
a 20 Filer ID (Ethics Commission Filers)
1
21
SCHEDULE SUBTOTALS
NAME OF SCHEDULE
N
SUBTOTAL
AMOUNT
1
y
SCHEDULE Al:
MONETARY POLITICAL CONTRIBUTIONS
$
2•
SCHEDULEA2:
NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS
$
3•
SCHEDULE B: PLEDGED CONTRIBUTIONS
$--
4.
❑
SCHEDULE E:
LOANS
$ Ll/S
/1
5.
El
SCHEDULE F1:
POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$ K
8.
El
SCHEDULE F2:
UNPAID INCURRED OBLIGATIONS
7.
U
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 I: NON -POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
12.
SCHEDULE K:
INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETU��
TO FILER
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/15/2022
of 18
1 / 17/23 , 12:06 PM