HomeMy WebLinkAboutContributions and Expenditure Statements-Campaign Finance Reports & Filings-01/15/2021 (2)CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 File� ID (Ethics Commissian Filers) 2 ToTai pages filed:
The C/OH Instruction Guide explains how to complete this form, a
3 CANDIDATE / MS / MRS / MR FIRST M� OFFICE USE ONLY
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NICKNAME LAST
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q CANDIDATE / ADDRESS ! PO BOX; APT / SUITE #; qTY; STATE; ZIP CO)�E ! I ,, I .,.� ----
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5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION pate Hand-delivered or Da�e Postmatked
OFFICEHOLDER � (i' 7 � ���, 3�� (�
PHONE � C
Receipt # I Amount $
6 CAMPAIGN MS/MRS/MR FlRST MI
TREASURER AA ' /�
NAME '�'1� Lf��T� „ OatePmcessed
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NIGKNAME LAST SUPFIX
Dale Imaged
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7 CAMPAIGN STREET A��RESS (NO PO BOX PLEASE); APT I SUITE #; CITV; STATE; ZIP CODE
TREASURER ��� /��uF6L� (:06LEyVILL� �%�(� ����J,3�
ADDRESS
(Residence or Business)
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE . � �i� � E.��� ��3�
9 REPORT TYPE � �anuary 15 � 30th tlay before election � Runoff � 15Ih day after campaign
treasurer appoin�ment
(otflceholder Only)
� July 15 � Bth day bafore election � Exceeded Modifed � Flnal Report (AHach C/OH-FR)
Reporting Limit
10 PERIOD Monih oay Vear Mon�h �ay Vear
COVERED y
U`� /� 1 /��,��y THROUGH l'.l /.3f /�rJ,;Z(1
'I'I ELECTION ELECTION OATE ELECTION TYPE
Month Da Vear ❑ Primary � Runaff ❑ Other
Y �escriplion
/ / � Generel � Special
12 OFFICE oFFlce HE�o (if eny) 13 oFFICE SoucHr (It known)
14 NOTICE FROM THIS BOX IS POR NOTICE OF POLITICAL CONTRIBlIT10N3 ACCEPTEO OR POLITICAL EXPEN�ITURES MA�E BV POLITICAL COMMITTEES TO SUPPORT
POLITICAL THE CAN�I�ATE 1 OFFICEHOL�ER. TNESE EXPENOITURES MAY HAVE 9EEN MADE WITHOUTTHE CANDIDATE'S OAOFFICEHOLOER'S KNOWLEDGE OR
CONSENT. CANOIDATESANUOFFICEHOLDERSAREREQUIREDTOREPORTTHISINFORMATIONONLYIFTHEYRECEIVENOTICEOFSUCNEXPENDITIlRES.
COMMITiEE(S)
COMMITTEE TYPE COMMITTEE NAME
.. .. .. . . .. . .. . . ... _
�GENERAL COMMITTEEADDRESS
� Additional Pages
�SPEGFIC COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER AD�RE55
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Forms provided byTexas Ethics Commission www.ethics.state.tx.us Kevisea ari nzuzo
CANDIDATE / OFFICEHOLDER
CAMPAIGN FINANCE REPORT
15 C/OH NAME
� ��� �t"��LLI
17 CONTRIBUTION 1.
TOTALS
2.
..................
EXPENDITURE
TOTALS
..................
CONTRIBUTION
BALANCE
..................
OUTSTANDING
LOAN TOTALS
18 SIGNATURE
TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
PLEDGES,LOANS,OR GUARANTEES OFLOANS,OR
CONTRIBUTIONS MADE ELECTRONICALLY)
TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
3.
4.
5.
6.
TOTAL UNITEMIZED POLITICAL EXPEN�ITURE.
TOTAL POLITICAL EXPENDITURES
I swear, or affirm, under penalty of perjury, that the accompanying report is true and correct and includes all information
required to 6e reported by me under Title 15, Election Code.
,�.� �r%�
Signature of Canditlate or Officeholtler
Please complete either option below:
(1) Affidavit
NOTARY STAMP/SEAL
and my date of birth is
Sworn to and subscribed before me by ��%� L//YK��`�� this the �_ day of1,����
20 i��k�'—/�to certi h' , witness my hand and seal ofoffice.
� � ,'�N,U/e /�EG-�/S �0✓r.�,�l�
� Title of officer administerin oath
Signature of officeradministering oath Printed name of officer administering oath 9
(2) Unsworn Declaration
My name is _
My address is
Executed in
TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY --'7
OF REPORTING PERIOD � /�9.
TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE I �
LAST DAV OF THE REPORTING PERIOD
����pYP��/ OONNA DEGUTIS
:z4�'..... e�= Notary Public, State of Texas
i9''�'+e� Comm. Expires OB-05-2023
/°'�i°;;��`d Notary ID 132114718
(street)
County, State of
an the
FORM C/OH
COVER SHEET PG 2
16 Filer ID (Ethics Commisslon Filers)
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$ � �
$ (� _
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(city) (siate) (zip code) (country)
_ day of , 20
(month) (year)
Signature of Candidate/O�ceholder (Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised