HomeMy WebLinkAboutWirth, Jason_CFR 01.15.2020CANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 Flier ID (Ethics Commleslon Filers)
2 Total pages filed:
The C/OH Instruction Guide
explains how to complete this form.
3 CANDIDATE /
MS / MRS / MR FIRST M1
OFFICE USE ONLY
OFFICEHOLDER
,/��/�
��j� '
NAME
f r ile ��1
Date Received
NICKNAME LAST SUFFIX
REC E ��E
O`r��
4 CANDIDATE /
ADDRESS / PO BOX; APT / SURE 0; CITY; STATE; ZIP CODE
JAN 16 2020
OFFICEHOLDER
MAILING
r� "_ �{
c7 �� I'i�l(ZI�WA sr oi9-0tykc,.0 I1C
ADDRESS
p
'� � $(� Z r7
City Secretai.
❑ Change of Address
S CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER
_ T p
( 5 1 1 r�
Date Hand -delivered or Date Postmarked
PHONE
r2 c7
8 CAMPAIGN
MS /MRS / MR FIRST MI
Receipt N Amount $
TREASURER
rT A5a,- aNAME
. . . . . . . J . . . . . .
Date Processed
NICKNAME LAST SUFFIX
` `ir-41L
Date Imaged
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE;
ZIP CODE
TREASURER
ADDRESS
`��� �A2kt.ra� Si '1R.�Qc��Jrtil4��9C
`�6 GV
(Residence or Business)
O
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASUPHONE RER
C tL �� Tfy �i7
9 REPORT TYPE
January 15 ❑ 30th day before election ❑ Runoff
/
151h day after campaign
treasurer appointment
(Officeholder Only)
❑ July 15 ❑ Bth day before efectlon ❑ Exceeded $500llmlt
❑ Final Report (Attach C/OH - FR)
10 PERIOD
Month Day Year Month
Day Year
COVERED
'7 /' THROUGH , ££. is
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
❑ Prima ❑ Runoff ❑ Other
Description
/ Z / 2 Oz
Ganoral ❑ Special
12 OFFICE
OFFICE HELD (If any)
13 OFFICE SOUGHT (if known)
GO TOPAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C/OH NAME ^^ 15 Filer ID (Ethics Commission Filers)
16 NOTICE FROM I THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICAL SUPPORT THE CANDIDATE I OFFICEHOLDER. THESE EXPENDRURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE S OR OFFICEHOLDERS
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
COMMITTEE ADDRESS
❑ SPECIFIC
❑ Additional Pages
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
1.
TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
$
100
TOTALS
PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED
0
2.
TOTAL POLITICAL CONTRIBUTIONS
00
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
3.
TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
$
TOTALSEXPENDITURE
UNLESS ITEMIZED
��'
4.
TOTAL POLITICAL EXPENDITURES
$
0,00
CONTRIBUTION
5.
TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
BALANCE
OF REPORTING PERIOD
OUTSTANDING
6.
TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$
�fl�
LOAN TOTALS
LAST DAY OF THE REPORTING PERIOD
1 18 AFFIDAVIT
r *�" ROBYN LOUISE DENSMORE
R' My Notary ID # 125657056
E ores Apri115, 2022
AFFIX NOTARY STAMP/SEALABOVE
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 TK ec n Code.
Candidate or Officeholder
Sworn to and subscribed before me, by the said
day of -)(Xanll�1 20 1 > , to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath
Pnrmm nrnviriarl by Tav— Pthira (7nmmlasinn www_ethics.State.tX.Us
this the��
Title of ofHEer administering oat
Revised 9181 015
SUBTOTALS - C/OH FORM C/OH
COVER SHEET PG 3
19
FILER NAME
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•
El
SCHEDULE B: PLEDGED CONTRIBUTIONS
$
4.
C
SCHEDULE E: LOANS
$
5.
Ci
SCHEDULE Fi: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
8•
SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
$
7.
SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$
8•
9•
❑
SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD
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 9/8/2015