HomeMy WebLinkAboutCampaign Finance Report - Jonathan Dade 04.28.2023CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 Filer ID (Ethics Commission Filers)
2 Total pages filed
The C/OH Instruction Guide explains how to complete this form.
3 CANDIDATE /
MS / MRS / MR
FIRST MI
OFFICEHOLDER
Mr.
Jonathan L
OFFICE USE ONLY
NAME....
...........................................................................
Date Received
NICKNAME
LAST SUFFIX
Dade
EI V F)
4 CANDIDATE /
ADDRESS / PO BOX;
APT / SUITE #; CITY; STATE; ZIP CODE
OFFICEHOLDER
PO BOX 877, Georgetown TX 78627-0877
MAILING
ADDRESS
� Secret
y
Change of Address
5 CANDIDATE/
AREA CODE
PHONE NUMBER EXTENSION
Date Hand -delivered or Dale Postmarked
OFFICEHOLDER
512
525.0736
D'i (Z ) Z.o 3
PHONE
S Z
Receipt #
Amount $
6 CAMPAIGN
MS /MRS / MR
FIRST MI
TREASURER
Mr-
Kenneth Dale
NAME...................
---••--- - ---- -..--.......-...........I..............
Date Processed
7 CAMPAIGN
TREASURER
ADDRESS
(Residence or Business)
8 CAMPAIGN
TREASURER
PHONE
NICKNAME LAST SUFFIX
Jacobson Date I a ad
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
500 W 2nd Street Suite 1900, Austin TX 78701
AREA CODE PHONE NUMBER
(512 710-0890
EXTENSION
9 REPORT TYPE
January 15 30th day before election
Runoff
15th day after campaign
treasurer appointment
(Officeholder Only)
July 15 n 8th day before election
Exceeded Modified
Final Report (Attach C/OH - FR)
Reporting Limit
10 PERIOD
Month Day Year
Month
Day Year
COVERED
Q4 f 19 j 23
THROUGH 04 /
28 / 23
/
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
Primary
Runoff Other
Description
05 / 06/ 23
General
Special
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (if known)
Mayor
14 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE
BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL
THE CANDIDATE I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO
REPORT THIS INFORMATION ONLY IF THEY
RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEE(S)
COMMITTEE TYPE I COMMITTEE NAME
Additional Pages
GENERAL I COMMITTEE ADDRESS
SPECIFIC I COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
GO TO PAGE 2
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CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
15 C/OH NAME 16 Filer ID (Ethics Commission Filers)
17 CONTRIBUTION 1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR $ $0
CONTRIBUTIONS MADE ELECTRONICALLY)
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) $ $0
EXPETOTALS
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE. $
$0
4. TOTAL POLITICAL EXPENDITURES $ $440.72
CONTRIBUTION 5, TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE OF REPORTING PERIOD $ $0
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ $0
18 SIGNATURE I swear, or affirm, under penalty of perjury, that the accompanying report is and correct and includes all information
required to be reported by me under Title 15, Election Code.
Signature of Candidate or Officeholder
Please complete either option below:
t**'� "��, ROBYN LOUISE DENSMORE
(1)Affidavit ' Notary ID 4125657056
�,� }� My Commission Expires
0has April 15, 2026
NOTARY STAMP/SEAL
Sworn to and subscribed before me by this ft day of
20 Z to certify which, witness my hand and seal of office.
Signature of o icer administering oath Printed name f officer administering oath TJtle of officer admintste ng oath
(2) Unsworn Declaration
My name is
My address is
Executed in
Forms provided by Texas Ethics
, and my date of birth is
(street) (city) (state) (zip code) (country)
County, State of on the day of , 20
(month) (year)
Signature of Candidate/Officeholder (Declarant)
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SUBTOTALS - C/OH
19 FILER NAME
FORM C/OH
COVER SHEET PG 3
20 Filer ID (Ethics Commission Filers)
21 SCHEDULE SUBTOTALS
NAME OF SCHEDULE
1 SCHEDULEAI: MONETARY POLITICAL CONTRIBUTIONS $
2
3.
4
5
6.
7
8
9.
10.
11
12.
SCHEDULEA2:
SCHEDULEB:
SCHEDULE E:
NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS
PLEDGED CONTRIBUTIONS
LOANS
$
$
$
SCHEDULE F1:
POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
SCHEDULE F2:
SCHEDULE F3:
SCHEDULE F4:
SCHEDULE G:
SCHEDULE H:
UNPAID INCURRED OBLIGATIONS
PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
EXPENDITURES MADE BY CREDIT CARD
POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH
$
$
$
$
$
SCHEDULE I: NON -POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED
TO FILER
$
$
SUBTOTAL
AMOUNT
$0
$0
$0
$0
$440.72
$0
$0
$0
$0
$0
$0
$0
Forms provided by Texas Ethics Commi. Reset Form state Reset Page Revised 8/17/2020
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule At,
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date
5 Full name of contributor out-of-state PAC (ID#: )
7 Amount of contribution ($)
6 Contributor address; City; State; Zip Code
8 Principal occupation / Job title (See Instructions)
g Employer (See Instructions)
Date
Full name of contributor out-of-state PAC (ID#: )
Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor out-of-state PAC (ID#: ) Amount of contribution ($)
Contributor address; City; State, Zip Code
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date
Full name of contributor out-of-state PAC (ID#: )
Amount of contribution ($)
Contributor address; city; State; Zip Code
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Com Reset Form s. st Reset Page Revised 8/17/2020
NON -MONETARY (IN -KIND) POLITICAL
CONTRIBUTIONS SCHEDULE A2
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule A2:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED IN -KIND POLITICAL CONTRIBUTIONS
$
5 Date
6 Full name of contributor ❑ out-of-state PAC (ID#: )
8 Amount of I g In -kind contribution
Contribution $ I description
I
7 Contributor address; City; State; Zip Code
I
Check if travel outside of Texas. Complete Schedule T.
10 Principal occupation / Job title (FOR NON-JUDICIAL)(See Instructions)
11 Employer (FOR NON-JUDICIAL)(See Instructions)
12 Contributor's principal occupation (FOR JUDICIAL)
13 Contributor's job title (FOR JUDICIAL) (See Instructions)
14 Contributor's employer/law firm (FOR JUDICIAL)
15 Law firm of contributor's spouse (if any) (FOR JUDICIAL)
16 If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL)
Date
Full name of contributor ❑ out-of-state PAC (ID#: )
Amount of I In -kind contribution
Contribution $ I description
I
.............................................. .....
Contributor address; City; State; Zip Code
I
Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (FOR NON -JUDICIAL) (See Instructions)
Employer (FOR NON-JUDICIAL)(See Instructions)
Contributor's principal occupation (FOR JUDICIAL)
Contributor's job title (FOR JUDICIAL) (See Instructions)
Contributor's employer/law firm (FOR JUDICIAL)
Law firm of contributor's spouse (if any) (FOR JUDICIAL)
If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Comm Reset Form JslaFReset Page Revised 8/17/2020
PLEDGED CONTRIBUTIONS SCHEDULE B
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule B:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED PLEDGES
$
5 Date
6 Full name of pledgor ❑ out-of-state PAC (ID#: )
8 Amount I 9 In -kind contribution
of Pledge $ I description
7 Pledgor address; City; State; Zip Code
I
i
i.
Check if travel outside of Texas. Complete Schedule T.
10 Principal occupation
/ Job title (See Instructions)
11 Employer (See Instructions)
Date
Full name of pledgor ❑ out-of-state PAC (ID#: )
Amount I In -kind contribution
of Pledge $ I description
i
.............. ........ ......................... ....................
Pledgor address; City; State; Zip Code
I
I,
Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of pledgor ❑ out-of-state PAC (ID#: )
Amount of In -kind contribution
Pledge $ I description
I
_
Pledgor address; City; State; Zip Code
I
i.
Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of pledgor ❑ out-of-state PAC (ID#: )
Amount of I In -kind contribution
Pledge $ I description
............................................... _ ..................
Pledgor address; City; State; Zip Code
I
I
Check if travel outside of Texas. Complete Schedule T-
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS NEEDED
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements,
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LOANS
SCHEDULE E
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule E:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED LOANS
$
5 Date of loan 7 Name of lender
❑ out-of-state PAC (ID#: I 9 Loan Amount ($)
6 Is lender 8 Lender address;
City; State; Zip Code 10 Interest rate
a financial
Institution?
_
11 Maturity date
Y N
12 Principal occupation / Job title (See Instructions)
13 Employer (See Instructions)
14 Description of Collateral
15
Check if personal funds were deposited into political
account (See Instructions)
none
16 GUARANTOR 17 Name ofguarantor
19 Amount Guaranteed ($)
INFORMATION
18 Guarantor address;
City; State; Zip Code
not applicable
20 Principal Occupation (See Instructions)
21 Employer (See Instructions)
Date of loan Name of lender
❑ out-of-state PAC (ID#: ) Loan Amount ($)
.........................................
Is lender Lender address;
...................................... .......
City; State; Zip Code Interest rate
a financial
Institution?
Maturity date
Y N
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Description of Collateral
Check if personal funds were deposited into political
account (See Instructions)
none
GUARANTOR
Name of guarantor
Amount Guaranteed ($)
INFORMATION
Guarantor address,
City; State; Zip Code
not applicable
Principal Occupation (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If lender is out-of-state PAC, please see Instruction guide for additional reporting requirements.
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POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F1
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Re ment/Reimbursement
paY Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (entera category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
5 Payee name
4 Date
6 Amount ($)
7 Payee address; City; State, Zip Code
8
(a) Category (See Categories listed at the lop of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas. Complete Schedule Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See Categories listed at the lop of this schedule) Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas. Complete Schedule Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State, Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas. Complete Schedule Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
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UNPAID INCURRED OBLIGATIONS SCHEDULE F2
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense
Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking
Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense
Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Pdnting Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/VVages/Contract Labor Other (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F2:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS
$
5 Date
6 Payee name
8 Payee address; City; State; Zip Code
7 Amount ($)
9 TYPE OF
EXPENDITURE
Political Non -Political
10
(a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas. Complete Schedule Check if Austin, TX, officeholder living expense
11 Complete ONLY if direct
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Payee address; City; State; Zip Code
Amount ($)
TYPE OF
EXPENDITURE
Political Non -Political
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas. Complete ScheduleT Check if Austin, TX, officeholder living expense
Complete ONLY if direct
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
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EXPENDITURES MADE BY CREDIT CARD SCHEDULE F4
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense
Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking
Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense
Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F4:
1. 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED
EXPENDITURES CHARGED TOACREDIT CARD $
5 Date
6 Payee name
7 Amount ($)
8 Payee address; City; State; Zip Code
9 TYPE OF
EXPENDITURE
Political Non -Political
10
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas. Complete Schedule Check if Austin, TX, officeholder living expense
11
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE
Political Non -Political
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas. Complete Schedule Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
—11
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Cornmtss Reset Form ate Reset Page Revised 8/17/2020
POLITICAL EXPENDITURES MADE FROM
SCHEDULE G
PERSONAL FUNDS
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment& Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salades/VVages/Contract Labor Other(entera category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas Complete Schedule Check if Austin, TX, officeholder living expense
9 Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas Complete Schedule Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas Complete Schedule Check if Austin, TX, officeholder living expense
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
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PAYMENT MADE FROM POLITICAL CONTRIBUTIONS
TO A BUSINESS OF C/OH SCHEDULE H
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date
5 Business name
6 Amount ($)
7 Business address; City; State; Zip Code
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas Complete Schedule T Check if Austin, TX, officeholder living expense
9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/01-1
Date
Business name
Amount ($)
Business address; City; State, Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check iftravel outside ofTexas. Complete ScheduleT Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Business name
Amount ($)
Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas Complete Schedule T Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS NEEDED
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NON -POLITICAL EXPENDITURES
MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE I
If the requested information
is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form.
1 Total pages Schedule I:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Payee name
6 Amount ($)
7 Payee address;
City State Zip Code
8
(a)Category (See instructions for examples of acceptable
(b)Description (See instructions regarding type of information
PURPOSE
categories)
required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address;
City State Zip Code
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
PURPOSE
categories.)
required.)
OF
EXPENDITURE
Date
Payee name
Amount ($)
Payee address;
City State Zip Code
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
PURPOSE
categories)
required.)
OF
EXPENDITURE
Date
Payee name
Payee address;
City State Zip Code
Amount ($)
Category (See instructions for examples of acceptable
Description (See instructions regarding type of information
PURPOSE
categories)
required )
OF
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Coin Reset Form I
ISS
Reset Page Revised 8/17/2020
INTEREST, CREDITS, GAINS, REFUNDS,
AND
CONTRIBUTIONS RETURNED TO FILER
SCHEDULE K
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form.
1 Total pages Schedule K:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date 5 Name of person from whom amount is received
8 Amount ($)
6 Address of person from whom amount is received; City;
State; Zip Code
7 Purpose for which amount is received
Check if political contribution returned to filer
Date Name of person from whom amount is received
Amount ($)
Address of person from whom amount is received; City;
State; Zip Code
Purpose for which amount is received
Check if political contribution returned to filer
Date Name of person from whom amount is received
Amount ($)
Address of person from whom amount is received; City;
. ....4 ........................
State; Zip Code
Purpose for which amount is received
Check if political contribution returned to filer
Date Name of person from whom amount is received
Amount ($)
Address of person from whom amount is received; City;
State; Zip Code
Purpose for which amount is received
Check if political contribution returned to filer
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Corn Reset Form ISIS
Reset Page Revised 8/17/2020
IN -KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES SCHEDULE T
FOR TRAVEL OUTSIDE OF TEXAS
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule T:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
5 Contribution / Expenditure reported on:
Schedule A2 Schedule B Schedule B(J) Schedule C2 Schedule D Schedule F1
Schedule F2 Schedule F4 Schedule G Schedule H Schedule COH-UC Schedule B-SS
6 Dates of travel 7 Name of person(s) traveling
8 Departure city or name of departure location
9 Destination city or name of destination location
10 Means of transportation 11 Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
Contribution / Expenditure reported on:
Schedule A2 Schedule B Schedule B(J) Schedule C2 Schedule D Schedule F1
Schedule F2 Schedule F4 Schedule G Schedule H Schedule COWLIC Schedule B-SS
Dates of travel Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation I Purpose of travel (including name of conference, seminar, or other event)
Name of Contributor / Corporation or Labor Organization / Pledgor / Payee
Contribution / Expenditure reported on. -
Schedule A2 Schedule B Schedule B(J) Schedule C2 Schedule D
Schedule F2 Schedule F4 Schedule G Schedule H Schedule COWLIC
Dates of travel Name of person(s) traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation I Purpose of travel (including name of conference, seminar, or other event)
Schedule F1
Schedule B-SS
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Corn I Reset Form 71171F Reset Page
Revised 8/17/2020
CANDIDATE / OFFICEHOLDER REPORT:
DESIGNATION OF FINAL REPORT
FORM C/OH - FR
The Instruction Guide explains howto complete this form.
•• Complete only if "Report Type" on page 1 is marked "Final Report" •-
1 C/OH NAME 1 2 Filer ID (Ethics Commission Filers)
3 SIGNATURE
I do not expect any further political contributions or political expenditures in connection with my candidacy, I understand that
designating a report as a final report terminates my campaign treasurer appointment. I also understand that I may not accept any
campaign contributions or make any campaign expenditures without a campaign treasurer appointment on file.
Signature of Candidate / Officeholder
4 FILER WHO IS NOT AN OFFICEHOLDER
•• Complete A & B below only if you are not an officeholder •-
A. CAMPAIGN FUNDS
Check only one:
I do not have unexpended contributions or unexpended interest or income earned from political contributions.
I have unexpended contributions or unexpended interest or income earned from political contributions. I understand that I
may not convert unexpended political contributions or unexpended interest or income earned on political contributions to
personal use I also understand that I must file an annual report of unexpended contributions and that I may not retain
unexpended contributions or unexpended interest or income earned on political contributions longer than six years after
filing this final report. Further, I understand that I must dispose of unexpended political contributions and unexpended
interest or income earned on political contributions in accordance with the requirements of Election Code, § 254.204,
B. ASSETS
Check only one:
I do not retain assets purchased with political contributions or interest or other income from political contributions.
I do retain assets purchased with political contributions or interest or other income from political contributions. I understand
that I may not convert assets purchased with political contributions or interest or other income from political contributions to
personal use. I also understand that I must dispose of assets purchased with political contributions in accordance with the
requirements of Election Code, § 254 204.
Signature of Candidate
5 OFFICEHOLDER
•• Complete this section only if you are an officeholder ••
I am aware that I remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer on
file. I am also aware that I will be required to file reports of unexpended contributions if, after filing the last required report as
an officeholder, I retain political contributions, interest or other income from political contributions, or assets purchased with
political contributions or interest or other income from political contributions.
Signature of Officeholder
Forms provided by Texas Ethics Coml Reset Form Ics s{ Reset Page I Revised 8/17/2020