McCaskill Semi Jan 2024CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE EP T COVER SHEET PG 1
1 Filer ID (Ethics Commission Filers)
2 Total pages filed:
The C/OH Instruction Guide explains how to complete this form.
3 CANDIDATE/
MS I MRS MR FIRST MI
OFFICE USE ONLY
OFFICEHOLDER
6 t lltii
NAME,
.:....................::....:................:....
NICKNAME .LAST SUFFIX
"
4 CANDIDATE/
ADDRESS I PO BOX; APT 1 SUITE #; CITY; STATE, ZIP CODE
OFFICEHOLDER
MAILING
{ C f?O " —zi., ;.A r -( V1U.— C-r
JAi3
ADDRESS
Change of Address
�` ¢
i
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
a ad- e br ei?tys
OFFICEHOLDER
PHONE
Receipt #
Amount S
6 CAMPAIGN
MO/MR FIRST MI
TREASURER
Ld-, Lk
NAME
......
D,at�.r secs _
NICKNAME LAST SUFFIX
1�•�
Date Imaged
�}
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE), APT 7 SUITE #; CITY, STATE; ZIP CODE
'TREASURER
ADDRESS
s 'C� i.>` i � fit.. 4�=-
(Are--
(Residence or Business)
8 CAMPAIGN
AREA CODE PHONE NUMBER - .EXTENSION
TREASURER
PHONE
$ — 3
8 REPORT TYPE—y
January 15 30th day before election Runoff -15th day after campaign
I�fJJ
treasurer appointment
(Officeholder Only)
❑ July 15 8th day before election ❑ Exceeded Modified Final Report (Attach C/OH - FIR)
Reporting Limit
10 PERIOD
Month Day Year Month Day Year
COVERED
_ y THROUGH } r
J c
11 ELECTION
.ELECTION DATE
ELECTION TYPE
❑ Primary Runoff ❑ Other
Month Day Year
Description
}}
IvGeneral ❑ Special
12 OFFICE
OFFICE HELD (if any) T't,_I;.',,.t/.1..1;(1.
13 OFFICESOUGHT (ifknown)
C It `E CC�kIJC.1l: is —C
14 NOTICE FROM
THIS SOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL
CANDIDATE t OFFICEHOLDER. THESE EXPENDITURES MAY HAVE: SEEN 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.
CONSENT.
COMMITTEE(S)
COMMITTEE TYPE
COMMITTEE NAME -
1\J FF A
1
GENERAL
COMMITTEE ADDRESS
❑ Additional Pages
COMMITTEE CAMPAIGN TREASURER NAME
❑SPECIFIC
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)
/�
i {-1 A W. N `` C✓> s V`k mil_
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)
TOTALSEXPENDITURE
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
$
...................
4. TOTAL POLITICAL EXPENDITURES
$
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
..................
OF REPORTING PERIOD
OUTSTANDING
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$
LOAN TOTALS
LAST DAY OF THE REPORTING PERIOD
(,� a �O .. U
l
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
Please complete either option below:
(1) A
AMY SHELLEY
_x°:•�allotary Public, State of Texas
=°a•• P� Comm. Expires 12-02-2027
NiP/Sq�
OTary ID 124761105
_ �t Swom to and subscribed before me by — �' 'v C C 5 o. ` this the 19 t4 —t—
day of J ���,"�`1,
to certify which, witness my hand a d seal of office.
Sign tur of o cer administering oath Printed &me f officer administering oat i e of officer administerin o th
•
(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 120
(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
w'I C�st���L
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAME OF SCHEDULE
SUBTOTAL
AMOUNT
1
SCHEDULEAI:
MONETARY POLITICAL CONTRIBUTIONS
$
2
SCHEDULE A2:
NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS
$
3.
SCHEDULE B:
PLEDGED CONTRIBUTIONS
$
4.
SCHEDULE E:
LOANS
$
5.
SCHEDULE F1:
POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
6.
El 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 I: 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
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.
1 Total pages Schedule Al
2 FILER NAME
5 t--( t4 IN IJ 0 � C V),-:5 V, l L l
3 Filer ID (Ethics Commission Filers)
4 Date
5 Full name of contributor out-of-state PAC (ID#:
...............................................................1...................
6 Contributor address, City; State; Zip Code
7 Amount of contribution ($)
8 Principal occupation / Job title (See Instructions)
g Employer (See Instructions)
Date
Full name of contributor out-of-state PAC (ID#. )
..................................................................................
Contributor address; City; State, Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor out-of-state PAC (ID#. )
..................................................................................
Contributor address; City, State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Ernployer (See Instructions)
Date
Full name of contributor E] out-of-state PAC (ID#: }
.........................................................................
Contributor address; City; State; Zip Code
i
Amount of contribution ($)
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 www.ethics.state.tx.us Revised 11 /1512022
NON -MONETARY (IN -KIND) POLITICAL
CONTRIBUTIONS SCHEDULE A2
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)
S 1—i a t.r..1 rJ 0` C f*s V_ t L
4 TOTAL OF UNITEMIZED IN -KIND POLITICAL CONTRIBUTIONS
$
5 Date
6 Full name of contributor ❑ out-of-state PAC (ID#:
$ 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 Contributor's 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 ❑ out-of-state PAC (ID#:
Amount of I In -kind contribution
Contribution $ I description
I
....................................................................
Contributor address; City; State; Zip Code
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 fine 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 Revised 11/1512022
PLEDGED CONTRIBUTIONS SCHEDULE B
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 B:'
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
Sh1✓�W,�S r� `C/aS��L1
4 TOTAL OF UNITEMIZED PLEDGES
$
5 Date
6 Full name of pledgor ❑ out-of-state PAC (ID# )
g Amount 9 In -kind contribution
of Pledge $ description
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 In -kind contribution
of Pledge $ description
............... I ...... ,.......... ........... ...............................
Pledgor address: City, State; Zip Code
❑ 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 $ ( 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 F1 out -of -stale PAC (ID#:
Amount of In -kind contribution
Pledge $ ( 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 www.ethics.state.tx.us Revised 11115/2022
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 pagei s Schedule E:
2
FILER NAME
3 Filer ID (Ethics Commission Filers)
n
�1--w, V`f rJ N ' , CV*S LA 1 L. �-
4
TOTAL OF UNITEMIZED LOANS
$
5
Date of loan
7 Name of lender
...................................................................................
8 Lender address;
❑ out-of-state PAC (ID#: )
City; State; Zip Code
9 Loan Amount ($)
6 Is lender
10 Interest rate
a financial
Institution?
11 Maturity date
Y N
12
Principal occupation / Job title (See Instructions)
13 Employer (See Instructions)
14 Description of Collateral
15
❑ Check if personal funds were deposited into political
❑ none
account (See Instructions)
16
GUARANTOR
17 Name ofguarantor
19 Amount Guaranteed ($)
INFORMATION
..................................................................................
18 Guarantor address;
City; State; Zip Code
❑ not applicable
20
Principal Occupation (See Instructions)
21 Employer (See Instructions)
Date of loan
Name of lender
..................................................................................
Lender address;
❑ out-of-state PAC (ID#:
City; State; Zip Code
Loan Amount ($)
Is lender
Interest rate
a financial
Institution?
Maturity date
Y N
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Description of Collateral
❑ Check if personal funds were deposited into political
❑ none
account (See Instructions)
GUARANTOR
Name of guarantor
Amount Guaranteed ($)
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 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/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 SalarieslWages/Contract Labor Other (entera category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
S1-t�Wri `C✓aSLCt�
4 Date
5 Payee name
6 Amount (3)
7 Payee 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
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
I Payee narne
Amount (S)
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
Date
Payee name
Arnount (S)
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 Scheduler El 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
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 RepaymenVReimbursement 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 GifVAwards/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)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F2:n2F11LER
NAME
3 Filer ID (Ethics Commission Filers)
i-1 A V.! tJ TA I- C da-S IBC_ t l_.1...-
4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS
$
5 Date
6 Payee name
7 Amount ($)
8 Payee address; City; State; Zip Code
9 TYPE OF
EXPENDITURE
----------------- -------
� Political Non -Political
10
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) u Check if travel outside of Texas. Complete Schedule T. ❑ Check if Austin. TX.. officeholder living expense
11 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE
Political Non -Political
Category (See Categories listed at the 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 OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.LIS Revised 11115/2022
PURCHASE OF INVESTMENTS MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F3
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:
i
2 FILER NAME
S1-tAll4 Pn Acj V-1.�—t
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 ($)
Date
Name of person from whom investment is purchased
.......... ................... ............. .................................. ........................................... I........
Address of person from whom investment is purchased; City; State; Zip Code
Description of investment
Amount of investment ($)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11115/2022
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 Salanes/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)
S 1-1 ra 0 1 CV)- 5 LA_ L.l--
4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TO A CREDIT CARD
$
5 Date ----------- _ ----6
Payee name ---------------- -
7 Amount ($)
8 Payee address; City; State: Zip Code
8 TYPE OF --
EXPENDITURE
-------------- --
Political Non-PDlitical
10
(a) Category (See Categories listed at the lop of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas. Complete Schedule T. ❑ Check if Austin, TX, officeholder living expense
11 Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE
Political ❑ Non -Political
Category (See Categories listed at the top of this schedule)
I Description
PURPOSE
OF
EXPENDITURE
Check 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
Forms provided by Texas Ethics Commission vAvw.ethics.state.tx.us Revised 11/1512022
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 Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SaladesANages/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 ($)
7 Payee address, City, State, Zip Code
Reimbursement from ❑
political contributions
intended
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas. Complete Schedule Check if Austin, TX, officeholder living expense
9 Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
❑Reimbursement from
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. 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 ($)
Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas. Complete Schedule El Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/15/2022
PAYMENT MADE FROM POLITICAL CONTRIBUTIONS
TO A BUSINESS OF C/OH SCHEDULE H
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office OverheadiRental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (entera category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
`
4 Date
5 Business name
6 Amount ($)
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. 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
Business name
Amount ($)
Business address: City; State, Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
ElCheck if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Business narne
Amount (S)
Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Chechif travel outside of Texas. Complete Schedule T. F-1 Check if Austin. TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder narne Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/15/2022
NON -POLITICAL EXPENDITURES
MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE 1
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form.
1 Total pages Schedule I:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
5 1-1 ✓+ w t-� CV_As b� l L l-
4 Date
5 Payee name
6 Amount (S)
7 Payee address; City State Zip Code
8
(a)Category (See instructions for examples of acceptable
(b)Description (See instructions regarding type of information
PURPOSE
categories.)
required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address; City State Zip Code
PURPOSE
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
OF
categories.)
required.)
EXPENDITURE
Date
Payee name
Amount (S)
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 ($)
Payee address; City State Zip Code
PURPOSE
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
OF
categories.)
required)
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11115/2022
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER SCHEDULE K
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form.
1 Total pages schedule K.
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
.S ►-1 /� U.1 c LDS LZ l LL
4 Date
5 Name of person from whom amount is received
8 Amount ($)
................................................................................................
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 wham 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 11/15/2022
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
5)�i--),wrI N�� CA.SI.CI�
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 11 /15/2022
CANDIDATE / OFFICEHOLDER REPORT:
DESIGNATION OF FINAL REPORT FORM C/OH - FR
The Instruction Guide explains how to complete this form.
-- Complete only if "ReportType" on page 1 is marked "Final Report" ••
1 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.
0 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.
F---J 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 ••
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
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11115/2022
OFFICE USE ONLY
Date Re CFID 8
.� AFFIDAVIT FOR
CANDIDATE OR OFFICEHOLDER:
ELECTRONIC FILING EXEMPTION
An exemption affidavit must be submitted with each paper repo r . )
Date Hand- qli e r Sag
Beginning on January 1, 2022, a candidate or officeholder who has accepted more tha{a--
$28,800 in political contributions or made more than $28,800 in political expenditures Receipt# Amount$
in any calendar year must file all subsequent reports electronically:
ores d
S•.` 1.�
Filer name ! Filer ID:# Date imaged
1, I swear or affirm that l have not accepted more than $28,800 in political contributions or made
more than $28,800 in political expenditures in a calendar year.
2. 1 further swear or affirm that I do not use computer equipment to keep current records of political
contributions; political expenditures,- or persons making political contributions to me.
3. 1 further swear or affirm that no person acting as my agent or consultant, and no person with whom
contract, uses computer equipment to keep current records of political contributions, political
expenditures, or persons making political contributions to me.
4. I further swear or affirm that I understand that I am required to file my campaign finance reports
electronically if I, my agent or consultant, or a person with whom I contract exceeds $28,800 in political
contributions or political expenditures in a calendar year, or uses computer equipment to keep current
records of political contributions, political expenditures, or persons making political contributions to me.
Ct} rA?A-'o r
5. I am filing this affidavit with the ssc report due on
I understand that this affidavit is required to be filed with each campaign finance report for which 1 am
claiming an exemption from electronic filing.
Please complete either option below:
(1) Affidavit
_�w�aq
,o�vP�'',j AMY SHELLEY
. Notary Public, State of Texas Signature of Filer
o;.c
WA..Epires 12-02-2027
Notary ID 124761105
-{✓ vt. ni INA co'-5CK i this the day of
to certify which, witness my hand an seal of office.
Sign officer administering oath Pr' inte' me of officer adminis ring oath Title S&fficer administering f
a•
(2) Unsworn Declaration
My name is and my date of birth is
My address is
(street) (city) (state) ' (zip co e ' (country)
Executed in County, State of on the day of 20
(month) (year)
Signature of Filer (Declarant)
FILERS WHO ARE EXEMPT FROM THE ELECTRONIC FILING REQUIREMENT
ARE STILL REQUIRED TO FILE CAMPAIGN FINANCE REPORTS ON PAPER
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/15/2022