01-09-2023CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
The C/OH Instruction Guide explains how to complete this form. 1 Filer ID (Ethics Commission Filers) 2 Total pages filed:
3 CANDIDATE / MS / MRS / MR FkRST I
OFFICEHOLDER J� r- W�pa ^ OFFICE USE ONLY
NAME/......................:�.`..Cr....... ......................... .
Date Received
NICKNAME LAST SUFFIX
4 CANDIDATE / /X; SUITE #; CITY; STATE; ZIP CODE 0_ I
OFFICEHOLDER �lii� �
MAILING
ADDRESS f 4pP❑ Change of Address
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION Date Hand -delivered or Date Postmarked
OFFICEHOLDER �'�" "ice � �t�� ---
PHONE !��
Receipt # Amount $
6 CAMPAIGN MS /,MRSFIRST MI
TREASURER JL"� i 71� QUF-,�,Q/ Date Processed
NAME............................................................ .....................
NICKNAME LAST SUFFIX
��� Date Imaged
7 CAMPAIGN APjA&1�fi&i �C ODE
TREASURER
ADDRESS
(Residence or Business)
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER A911k_
PHONE
9 REPORT TYPE January 15 ❑ 30th day before election Runoff 15th day after campaign
treasurer appointment
y�. (Officeholder Only)
ElJuly15 ❑ 8th day before election ❑Exceeded Modified I Final Report (Attach C/OH -FR)
Reporting
10 PERIOD Month Day Year Month Daly Year
COVERED / / 1a P/
THROUGH
11 ELECTION ELECTION DATE ELECTION TYPE
Month Day Year ❑ Primary Runoff ❑ Other
Description
r) J /-D-3 ❑ General ❑ Special
12 OFFICE OFFICE HELD (if any) 13 OFFICE GHT (if known)
-
14 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPEt UREA MADE BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL THE CANDIDATE / OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDERS 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
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
CAMPAIGN FINANCE REPORT
15 C/OH NAME,
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)
..................
EXPENDITURE
TOTALS
CONTRIBUTION
BALANCE
..................
OUTSTANDING
LOAN TOTALS
18 SIGNATURE
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
4.
5.
11
TOTAL POLITICAL EXPENDITURES
FORM C/OH
COVER SHEET PG 2
16 Filer ID (Ethics Commission Filers)
TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY + $
OF REPORTING PERIOD
TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LAST DAY OF THE REPORTING PERIOD $
WPM
0
C
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.
limp
Signature of Candida ,iceholder
SY UBLI EDTATEOFT Please complete either option below:
DSON
NOTARY PUBLIC • STATE OF TE><AS p p -
ID f 12495213.1
My Commission Exp,res V17fl1125
(1) Affidavit
NOTARY STAMP/SEAL (' y9"a,
( j �/+Swom to and subscribed before me by �.o J .V �t•lr this the day o 'Wall
20 to ce ' ich, itness my hand an Qt s al of ffice..�r
j r
Sign re of office a mini tering oa h Printed name of officer administering oath Title of Off ij r administerin 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 120
(month) (year)
Signature of Candidate/Officeholder (Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/15/2022
19
21
SUBTOTALS - C/OH FORM C/OH
COVER SHEET PG 3
FILER NA {E 20 Filer ID (Ethics Commission Filers)
SCHEDULE SUBTOTALS SUBTOTAL
NAME OF SCHEDULE AMOUNT
1-
2.
3.
4.
El
SCHEDULEAI: MONETARY POLITICAL CONTRIBUTIONS
SCHEDULE A2: NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS
SCHEDULE B: PLEDGED CONTRIBUTIONS
SCHEDULE E: LOANS
$
$
e9
$
$
5.
El
SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
V
6.
7-
El
SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$
')
$
$•
9.
❑
SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD
SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
$
$
$
10.
11.
❑
SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH
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
CANDIDATE / OFFICEHOLDER REPORT:
DESIGNATION OF FINAL REPORT
1 C/OH NAME
3 SIGNATURE
The Instruction Guide explains how to complete this form.
FORM C/OH - FR
•• Complete only if "Report Type" on page 1 is marked "Final Report" •-
2 Filer ID (Ethics Commission Filers)
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 1 may not accept any
campaign contributions or make any campaign expenditures without a campaign tre appointment on file.
r,
—$lgnatureof&- ndidat iceholder
4 FILER WHO IS NOT AN OFFICEHOLDER
•• Complete A & B below only if you are not an officeholder. ••
A. CAMPAIGN FUNDS
Check my one:
not have unexpended contributions or unexpended interest or income earned from political contributions.
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
Chec my one:
I do not retain assets purchased with political contributions or interest or other income from political contributions.
I do retain assets purchased with political contributions or interest or other income from political contributions. I understanc
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 p ica contcordance 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 11/15/2022