HomeMy WebLinkAboutContributions and Expenditure Statements-Campaign Finance Reports & Filings-01/14/2020CANDIDATE / 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:
a
3 CANDIDATE/
OFFICEHOLDER
NAME
MSIMRS/MR FIRST MI
�A/A�n ++ nn u
.IY, .�I�.n� 1. 1.
NICKNAME LAST SUFFIX
OFFICEUSEONLY
Date �OT
Err E � t� n E
^
JAM , 4 �l 2C
q CANDIDATE /
OFFICEHOLDER
ADDRESS / PO BOX; APT / SUITE p; CITY; STATE; ZIP CODE
MAILING
ADDRESS
133 Al oN C6Ll Yvrac TX 7p3y
CITY SECRETARY'S OFFIC
❑ Change of Address
3� `+1-r,-
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
PHONE HOLDER
��� 1
/ 9o�-3.234
Date Hand -delivered or Date Postmarked
6 CAMPAIGN
MS / MRS / MR FIRST MI
Receipt N
Amount $
TREASURER
NAME
/�� i. 146D
.t : t. . . . . . . . . .
Date Processed
NICKNAME LAST SUFFIX
4 ANSUE
Date Imaged
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT I SUITE k; CITY;
STATE; ZIP CODE
TREASURER
ADDRESS
(Residence or Business)
133 ACaFF LN
X 76 t),1
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
PHONE TREASURER
(R17
9 REPORTTYPE
® January 15 ❑ 30th day before election Runoff
15th day after campaign
treasurer appointment
(Officeholder Only)
❑ July 15 ❑ Bit day before election ❑ Exceeded $500limit
❑ Final Report (Attach CIOH- FR)
10 PERIOD
COVERED
Month Day Year Month Day Year
19
07 /r,[ / THROUGH I f-. / 3I / 19
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
/ /
❑ Primary ❑ Runoff ❑ Other
Description
❑ General ❑ Special
12 OFFICE
OFFICE HELD (if any)
13 OFFICESOUGHT (ifknown)
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.N.us Revised 9/2612019
CANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C/OH NAME
15 Filer ID (Ethics Commission Filers)
CHAD 14 AP496c LF
16 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICAL
SUPPORT THE CANDIDATE / OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDER'S
COMMITTEE(S)
KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENDITURES.
COMMITTEE TYPE
COMMITTEE NAME
GENERAL
SPECIFIC
COMMITTEE ADDRESS
COMMITTEE CAMPAIGN TREASURER NAME
❑ Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
TOTALS
PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR
$ Q —
CONTRIBUTIONS MADE ELECTRONICALLY), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS
$
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
M
V —
EXPENDITURE
3.
TOTALS
TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
$ --
UNLESS ITEMIZED
4. TOTAL POLITICAL EXPENDITURES
$
Q
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
OF REPORTING PERIOD
7.29.9ti
OUTSTANDING
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS
LAST DAY OF THE REPORTING PERIOD
$
18 AFFIDAVIT
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.
J°�ftV>I��y GULZAR MOHAMMED
I'S Notary Public, State of Texas
Comm. Expires 06-04-2021
c� r
Notary ID 129445821
—� Signature of Candidate or Officeholder
AFFIX NOTARY STAMP / SEALABOVE
A n
Sworn to and subscribed before me, by the said ��� �t �I' V---C `� �— , this the 11t�
day of - M , 209-0 , to certify which, witness my hand and seal of office.
M. 4 N
t
i
ITre of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.elhics.state.tx.us Revised 9/26/2019