Robbins Semi July 2023 CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
The ClOH Instruction Guide explains how to complete this form. 1 Filer ID (Ethics Commission Filers) 2 Total pages filed:
3 CANDIDATE/ MS/MRS/MR zn,
MI
OFFICEHOLDER y{�2 /
NAME !'.r'.`...................... .�........................tom........ I:_:_
OFFICE USE ONLY
NICKNAME AST SUFFIX RECEIVED
/n
4 CANDIDATE/ ADDRESS I PO BOX; APT I SUITE#; CITY; STATE; ZIP CODE
OFFICEHMAIL NG OLDER
- GJ
❑ Change of Address
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION
(� Y
PHONE OFFICEHOLDER / }
Receipt# Amount$
6 CAMPAIGN MS/ RS/MR FIRST MI
TREASURER
NAME ........ ...................I.��...................................... Date Processed
NICKNAME LAST SUFFIX
Data Imaged
7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT I SUITE#; CITY; STATE; ZIP CODE
TREASURER
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
9 REPORT TYPE ❑ January 15 ❑ 30th day before election D Runoff 15th day after campaign
treasurer appointment
(Officeholder Only)
July 15 Sth day before election ❑ Exceeded Modified ❑ Final Report(Attach C/OH-FR)
Reporting Limit
10 PERIOD Month Day Year Month Day Year
COVERED
/ 6/ T/ a..3 THROUGH
11 ELECTION ELECTION DATE ELECTION TYPE
Month Day Year ❑ Primary ❑ Runoff ❑ Other
Description
�•) /� f / ' General ❑ Special
12 OFFICE �'o
ICE HELD (if any) 13 OFFICESOUGHT (ifknown)
�„�l. 1 .1, Ct' �v�� I plfc _
14 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL - THE CANDIDATE/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 RECENE NOTICE OF SUCH EXPENDITURES.
COMMITTEE(S)
COMMITTEE TYPE COMMITTEE NAME
GENERAL COMMITTEE ADDRESS
Additional Pages
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 11/15/2022
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 $
CONTRIBUTIONS MADE ELECTRONICALLY)
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) $. . . . . . . . . . . . . . . . . . .
TOTALS EXPENDITURE 3. TOTAL UNITEMIZED POLITICAL EXPENDITURE. $
A. TOTAL POLITICAL EXPENDITURES $
. . . . . . . . . . . . . . . . . . . Q
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY 2
BALANCE OF REPORTING PERIOD $
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ 't" L9oD.
IS SIGNATURE I swear, or affirm, under penalty of perjury, that the accompanying repo i true and correct and includes all information
required to be reported by me under Title 15,Election Code.
Signet re of Candidate or Officeholder
Please complete either option below:
VERONICA LOMAS
�' c Notary Public,State of Texas
(1)Affidavit **, Comm.Expires 06-27.2024
°,;,�� Notary ID 129013128
NOTARY STAMP/SEAL
Sworn to and subscribed before me by this the &)ZA day of v
20 Z 3 ,to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath itle of officer administering oath
(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 11/15/2022
SUBTOTALS - C/OH FORM -C/OH
COVER SHEET PG 3
19 FILER NAME 20 Filer ID(Ethics Commission Filers)
21 SCHEDULE SUBTOTALS SUBTOTAL
NAME OF SCHEDULE AMOUNT
1. El SCHEDULEAI: MONETARY POLITICAL CONTRIBUTIONS $
2• SCHEDULE A2: NON-MONETARY(IN-KIND)POLITICAL CONTRIBUTIONS $ r--
3. SCHEDULE B: PLEDGED CONTRIBUTIONS $ ^
4. SCHEDULE E: LOANS $ �—
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• El SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS $
10. El 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 11/15/2022
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 Event Expense Loan Repayment/Reimbursement Solicitation/FundralsingExpense
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/ContractLabor Other(enter a category not listed above)
Credit Card Payment
The I truction Guide explain how to complete this form.
1 Total pages Schedule F1: 2 FILER NAME 1 3 Filer ID (Ethics Commission Filers)
Ito W/�
4 Date 5 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
8 (a) Category (See Categories listed at the top of this schedule) (b) Descriptio
PURPOSE
OF
EXPENDITURE
(C) Check iftravel outside ofTexas. om ate Schedu Check if Austin,TX,officeholder living expense
9 Complete ONLY if direct C ndidate/Officeholder na a UOffice sought Office held
expenditure to benefit C/OH
Date Paye e
Amount ($) Payee address; ity; State; Zip Code
Category(See Categories listed at t t p of this schedule) Description
PURPOSE
OF
EXPENDITURE
Check If travel outside of Texas.Complete Schedule El 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
ElCheck tftravel outside ofTexas.Complete ScheduleT. 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 Revised 11/15/2022
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