HomeMy WebLinkAboutGeorgetown Mobility Coalition - Campaign Finance Report 07.15.2021SPECIFIC -PURPOSE COMMITTEE
FORM SPAC
CAMPAIGN
FINANCE REPORT
COVER SHEET PG 1
1 Filer ID (Ethics Commission Filers)
2 Total pages filed:
The SPAC Instruction Guide explains how to complete this form.
4/
3
COMMITTEE NAME
OFFICE USE ONLY
Date Received
4
COMMITTEE
ADDRESS / PO BOX; APT /SUITE #; CITY; STATE; ZIP CODE
ADDRESS
1, f t 7Dr ;vG
W J
JUL 5AP
Change of Address
GT. SAC
Date Hand -delivered or Date Postmarked
S
CAMPAIGN
MS / MRS / MR FIRST MI
Receipt #
Am
j(
TREASURER
NAME
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...... .................................. ............................. I.........
NICKNAME LAST SUFFIX
Date Processed
11n
Date Imaged
6
CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE;
ZIP CODE
TREASURER
STREETADDRESS
(Residence or Business)
G car,5e- -78 Cozy
CAMPAIGN
STREET ADDRESS OR PO BOX: APT / SUITE #; CITY: STATE:
ZIP CODE
TREASURER,/
11 4'
MAILING ADDRESS
I
❑ Change of Address
V G ov f� <�C.vi'/ 0
J
8
CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
r� /Z ) Bill'
\
9
REPORTTYPE
El January 15 F-1 301h day before election
Exceeded Modified Reporting Limit
i�F__1
July 15 8th day before election I>(I
Y❑�'
Dissolution Report (Attached PAC-FR)
Runoff
10th day after campaign treasurer termination
10 PERIOD
COVERED
Month Day Year
Month Day Year
z THROUGH
—7
7
11
ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
Primary ❑ Runoff ❑ Other
1�c�7711
General Special Description
GO TOPAGE 2
Forms provided by Texas Ethics Commission www.ethIcs.state.tx.us Revised 11 /13/2020
SPECIFIC -PURPOSE COMMITTEE REPORT:
FORM SPAC
PURPOSE AND TOTALS COVER SHEET PG 2
12 C6ITTEE NA ME
(l-Jc�-CX (��' I
13 Filer ID (Ethics Commission Filers)
G OW" Oct t i O
14 COMMIT
CANDIDATE/OFFICEHOLDER NAME
PURPOSE
El CANDIDATE
(Attach lists on plain paper to
complete this report if
necessary.)
OFFICE SOUGHT (candidate)/OFFICE HELD (officeholder)
OFFICEHOLDER
SUPPORT
BALLOT IDENTIFICATION/# ELECTION DATE
(Candidate or Measure)
Month Day Year
El SE
(Candidate(or Measure)
MEASURE
DESCRIPTIq�I
�
❑ ASSIST
(Officeholder)
(J\1}\
iT lXof a�Ct IYq+M � al �ilb"
15 CONTRIBUTION
1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
TOTALS
PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR
$
CONTRIBUTIONS MADE ELECTRONICALLY)
—
Check here if this report qualifies for the higher itemization threshold
2. TOTAL POLITICAL CONTRIBUTIONS
$
............................
(OTHER THAN PLEDGES, LOANS. OR GUARANTEES OF LOANS)
EXPENDITURE
3. TOTAL UNITEMIZED POLITICAL EXPENDITURES
$
TOTALS
U —�
4. TOTAL POLITICAL EXPENDITURES
$ U
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
........... ..... ....... I....
OF THE REPORTING PERIOD
OUTSTANDING
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$
LOAN TOTALS
LAST DAY OF THE REPORTING PERIOD
16 SIGNATURE I swear, or affirm, under penalty of perjury, that the accompan in report is true and correct and
nil tion required to a re Linde itle 5, lecti Code.
ASHLEE NWLE MMSR
A: g MYtptylDD#1130ignature rant)
Op,�Please
complete either option below:
(1) Affidavit
AFFIX NOTARY STAMP / SEALABOVE
1 Q
Sworn to and subscribed before me, by the said / C JYG� l (;�;��I LCI this the 1,�) 111
dav of 20 -� 1 to certify which, witness my hand and seal of office.
C /k� v
Signature of officer administering oath Printed name of officer administering oath Title of officer alLiministering oath
,
(2) Unsworn Declaration
My name is and my date of birth is
My address is
'
(street) (city) (state) (zip codeXcountry)
Executed in County, State of on the day of 20
(month) (year)
Signature of Campaign Treasurer (Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11 /13/2020
FORM SPAC
SUBTOTALS - SPAC
COVER SHEET PG 3
17 COMMITTEE
AME
18 Filer ID (Ethics Commission Filers)
19
SCHEDULE SUBTOTALS
SUBTOTAL
NAME OF SCHEDULE
AMOUNT
1•
❑
SCHEDULEAI: MONETARY POLITICAL CONTRIBUTIONS
$ .. 4 —
2.
❑
SCHEDULE A2 : NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS
$ C> —.
3.
❑
SCHEDULE B: PLEDGED CONTRIBUTIONS
$ O -^
4.
SCHEDULE Cl: MONETARY CONTRIBUTIONS FROM CORPORATION OR LABOR ORGANIZATION
$ v --.
5
❑
SCHEDULE C2 : NON -MONETARY (IN -KIND) CONTRIBUTIONS FROM CORPORATION OR LABOR
$
ORGANIZATION
O
6.
❑
SCHEDULE D: PLEDGED CONTRIBUTIONS FROM CORPORATON OR LABOR ORGANIZATION
$ U
7.1-1
SCHEDULE E: LOANS
$
8.
El
SCHEDULE F1 : POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
9•
SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
$
10•
SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$ _
11.
SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD
$
12•
❑
SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH
$
13.
SCHEDULE I: NON -POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$ �. V
14
SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED
$
TO FILER
V �'
Forms provided by Texas Ethics Commission www.ethics.state.Ix.us Revised 11/13/2020
POLITICAL COMMITTEE
STATEMENT OF DISSOLUTION FORM PAC - DR
The Instruction Guide explains how to complete this form.
•• Complete only if "Report Type" on page 1 is marked "Dissolution" --
1 COMMITTEE NAME
2 Filer ID (Ethics Commission Filers)
3 Statement of Dissolution
I, the undersigned campaign treasurer, do not expect the occurrence of any further reportable activity by
this political committee for this or any other campaign or election for which reporting under the Election
Code is required. I declare that all of the information required to be reported by me has been reported. I
understand that designating a report as a dissolution report terminates the appointment of campaign
treasurer. I further understand that a political committee may not make or authorize political expenditures
or accept political contributions without having an appointment of campaign treasurer on file.
Q Q\ - 11�� - . - —
Signature of Campaign Treasurer
DO NOT SIGN UNLESS POLITICAL
COMMITTEE IS TO BE DISSOLVED
Please complete either option below:
�: ASKEE NICOLE t�OUSER
(1) Affidavit I.WsNOWy ID # 13MJ024
AFFIX NOTARY STAMP/SEAL ABOVE Expires December 2 , 2022
J'
Sworn to and subscribed before me, by the said t, �Irt/lS/, l ."U'y I t L this the 6AA
d6 of 20 .-� to certify which, witness my hand and seal of office.
i
Signature of officer administering oath Printed name of officer administering oath Title of officer Aministering oath
(2) Unsworn Declaration •
My name is and my date of birth is
My address is
(street) (city) (state) (zip codeXcountry)
Executed in County, State of on the day of 20
(month) (year)
Signature of Campaign Treasurer (Declarant)
Revised 11 /13/2020