6. COH-UC Candidate-Officeholder Report of Unexpended ContributionsCANDIDATE / OFFICEHOLDER
REPORT OF UNEXPENDED CONTRIBUTIONS
FORM C/OH-UC
COVER SHEET PG 1
The C/OH-UC Instruction Guide explains how to complete this form.
1 Filer ID (Ethics Commission Filers)
OFFICE USE ONLY
Date Received
Date Hand-delivered or Date Postmarked
Date Processed
Date Imaged
Receipt #Amount $
2 CANDIDATE /
OFFICEHOLDER
NAME
MS/MRS/MR FIRST MI
NICKNAME LAST SUFFIX
3 CANDIDATE /
OFFICEHOLDER
ADDRESS
change of address
ADDRESS / PO BOX;APT / SUITE #;CITY;STATE;ZIP CODE
4 REPORT
TYPE Annual Final Disposition
5 PERIOD
COVERED
Month Day Year
THROUGH
Month Day Year
6 TOTALS 1.TOTAL AMOUNT OF UNEXPENDED POLITICAL CONTRIBUTIONS AS OF
DECEMBER 31 OF THE PREVIOUS YEAR.$
2.TOTAL AMOUNT OF INTEREST AND OTHER INCOME EARNED ON
UNEXPENDED POLITICAL CONTRIBUTIONS DURING THE PREVIOUS YEAR.$
7 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/Officeholder
Please complete either option below:
(1) Affidavit
NOTARY STAMP / SEAL
Sworn to and subscribed before me by _______________________________________________ this the ________ day of __________________,
20 ___________, to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title 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 1/1/2024
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2024
C/OH REPORT OF UNEXPENDED CONTRIBUTIONS:
EXPENDITURES
FORM C/OH-UC
PG 2
8 C/OH NAME 9 Filer ID (Ethics Commission Filers)
10 Date 11 Payee name
12 Payee address;City;State;Zip Code
13 Amount
($)
14 Purpose of expenditure (See instructions regarding type of information required.)
Check if travel outside of Texas. Complete Schedule T.
15
Is expenditure a contribution Yes
to a candidate, officeholder, or
Nopolitical committee?
Date Payee name
Payee address;City;State;Zip Code
Amount
($)
Purpose of expenditure (See instructions regarding type of information required.)
Check if travel outside of Texas. Complete Schedule T.
Is expenditure a contribution Yes
to a candidate, officeholder, or
Nopolitical committee?
Date Payee name
Payee address;City;State;Zip Code
Amount
($)
Purpose of expenditure (See instructions regarding type of information required.)
Check if travel outside of Texas. Complete Schedule T.
No
YesIs expenditure a contribution
to a candidate, officeholder, or
political committee?
Date Payee name
Payee address;City;State;Zip Code
Amount
($)
Purpose of expenditure (See instructions regarding type of information required.)
Check if travel outside of Texas. Complete Schedule T.
No
YesIs expenditure a contribution
to a candidate, officeholder, or
political committee?
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED
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AFFIDAVIT FOR
CANDIDATE OR OFFICEHOLDER:
ELECTRONIC FILING EXEMPTION
An exemption affidavit must be submitted with each paper report.
Beginning on January 1, 2024, a candidate or officeholder who has accepted more than
$32,810 in political contributions or made more than $32,810 in political expenditures
in any calendar year must file all subsequent reports electronically.
Filer name Filer ID #
Receipt #
Date Hand-delivered or Date Postmarked
OFFICE USE ONLY
Date Processed
Date Received
Date Imaged
Amount $
1.I swear or affirm that I have not accepted more than $32,810 in political contributions or mademore than $32,810 in political expenditures in a calendar year.
2.I 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.I further swear or affirm that no person acting as my agent or consultant, and no person with whom I 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 $32,810 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.
5.I am filing this affidavit with the __________________ report due on _______________________.I understand that this affidavit is required to be filed with each campaign finance report for which I am claiming an exemption from electronic filing.
Please complete either option below:
(1)Affidavit
Signature of Filer
NOTARY STAMP / SEAL
Sworn to and subscribed before me by _______________________________________________________ __________________,
___________,
_____________________________________________________,_______________________________.
________________________________________________, ___________________, _______, __________, ______________.
this the day of
20 to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title 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
(month)
20
(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 1/1/2024