Fillable FORM C/OH: CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT (Texas Secretary of State)

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FORM C/OH: CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT (Texas Secretary of State)

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CANDIDATE / OFFICEHOLDER
CAMPAIGN FINANCE REPORT
FORM C/OH
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:
3 CANDIDATE /
OFFICEHOLDER
NAME
MS / MRS / MR FIRST MI
NICKNAME LAST SUFFIX
4
CANDIDATE /
OFFICEHOLDER
MAILING
ADDRESS
Change of Address
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
5 CANDIDATE/
OFFICEHOLDER
PHONE
AREA CODE PHONE NUMBER EXTENSION
( )
6
CAMPAIGN
TREASURER
NAME
MS / MRS / MR FIRST MI
NICKNAME LAST SUFFIX
7 CAMPAIGN
TREASURER
ADDRESS
(Residence or Business)
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
8
CAMPAIGN
TREASURER
PHONE
AREA CODE PHONE NUMBER EXTENSION
( )
9 REPORT TYPE
January 15
30th day before election
Runoff
15th day after campaign
treasurer appointment
(Officeholder Only)
July 15
8th day before election
Exceeded Modified
Final Report (Attach C/OH - FR)
Reporting Limit
10 PERIOD
COVERED
Month Day Year
THROUGH
Month Day Year
11
ELECTION
ELECTION DATE
Month Day Year
ELECTION TYPE
Primary
Runoff
Other
Description
General Special
12
OFFICE
OFFICE HELD (if any)
13
OFFICE SOUGHT (if known)
14
NOTICE FROM
POLITICAL
COMMITTEE(S)
Additional Pages
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
THE CANDIDATE / 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 TYPE
GENERAL
SPECIFIC
COMMITTEE NAME
COMMITTEE ADDRESS
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
GO TO PAGE 2
Date Imaged
OFFICE USE ONLY
Date Received
Date Hand-delivered or Date Postmarked
Date Processed
Receipt #
Amount $
Forms provided by Texas Ethics Commission
www.ethics.state.tx.us
Revised 8/17/2020
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CANDIDATE / OFFICEHOLDER
CAMPAIGN FINANCE REPORT
FORM C/OH
COVER SHEET PG 2
15 C/OH NAME
16
Filer ID (Ethics Commission Filers)
17
CONTRIBUTION
TOTALS
1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR
CONTRIBUTIONS MADE ELECTRONICALLY)
$
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
$
EXPENDITURE
TOTALS
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
$
4. TOTAL POLITICAL EXPENDITURES
$
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
OF REPORTING PERIOD
$
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LAST DAY OF THE REPORTING PERIOD
$
18 SIGNATURE
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.
Signature of Candidate or Officeholder
Forms provided by Texas Ethics Commission
www.ethics.state.tx.us
. . . . . . . . . . . . . . . . . . .
CONTRIBUTION
BALANCE
. . . . . . . . . . . . . . . . . .
OUTSTANDING
LOAN TOTALS
Revised 8/17/2020
Please complete either option below:
(1) Affidavit
NOTARY STAMP / SEAL
Sworn to and subscribed before me by
_______________________________________________
this the
_
_______
day of
__________________
,
20
___________
,
to certify which, witness my hand and seal of office.
Signature of officer administering oath
Printed name of officer administering oath
Title of officer administering oath
(2) Unsworn Declaration
My name is _____________________________________________________, and my date of birth is _______________________________.
My address is ________________________________________________, ___________________, _______, __________, ______________.
(street) (city) (state) (zip code) (country)
Executed in ___________________ County, State of ______________ , on the _______ day of _______________, 20______.
(month)
Signature of Candidate/Officeholder (Declarant)
(year)
. . . . . . . . . . . . . . . . . . .
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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.
SCHEDULE A1: MONETARY POLITICAL CONTRIBUTIONS
$
2.
SCHEDULE A2: NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS
$
3.
SCHEDULE B: PLEDGED CONTRIBUTIONS
$
4.
SCHEDULE E: LOANS
$
5.
SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
6.
SCHEDULE F2: UNPAID INCURRED OBLIGATIONS
$
7.
SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$
8.
SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD
$
9.
SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
$
10.
SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/O
$
11.
SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
12.
SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED
TO FILER
H
$
Revised 8/17/2020
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Forms provided by Texas Ethics Commission
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SCHEDULE
A1
The Instruction Guide explains how to complete this form.
1
Total pages Schedule A1:
2
FILER NAME
3
Filer ID (Ethics Commission Filers)
4
Date
5
Full name of contributor
out-of-state PAC (ID#:_______________________)
6
Contributor address; City; State; Zip Code
7
Amount of contribution ($)
8
Principal occupation / Job title (See Instructions)
9
Employer (See Instructions)
Date
Full name of contributor
out-of-state PAC (ID#:_______________________)
Contributor address; City; State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Date
Full name of contributor
out-of-state PAC (ID#:_______________________)
Contributor address; City; State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor
out-of-state PAC (ID#:_______________________)
Contributor address; City; State; Zip Code
Amount of contribution ($)
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.
Revised 8/17/2020
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MONETARY POLITICAL CONTRIBUTIONS
If the requested information is not applicable, DO NOT include this page in the report.
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Forms provided by Texas Ethics Commission
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SCHEDULE
A2
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#:______________________)
7
Contributor address; City; State; Zip Code
8
Amount of
Contribution $
9
In-kind contribution
description
Check if travel outside of Texas. Complete Schedule T.
10
Principal occupation / Job title (FO
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#:______________________)
Contributor address; City; State; Zip Code
Amount of
Contribution $
In-kind contribution
description
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)
R NON-JUDICIAL)
(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.
Revised 8/17/2020
9
In-kind contribution
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NON-MONETARY (IN-KIND) POLITICAL
CONTRIBUTIONS
If the requested information is not applicable, DO NOT include this page in the report.
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Forms provided by Texas Ethics Commission
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SCHEDULE
B
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#:_______________________)
7
Pledgor address; City; State; Zip Code
8
Amount
of Pledge $
9
In-kind contribution
description
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#:_______________________)
Pledgor address; City; State; Zip Code
Amount
of Pledge $
In-kind contribution
description
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#:_______________________)
Pledgor address; City; State; Zip Code
Amount of
Pledge $
In-kind contribution
description
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#:_______________________)
Pledgor address; City; State; Zip Code
Amount of
Pledge $
In-kind contribution
description
Check if travel outside of Texas. Complete Schedule T.
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.
Revised 8/17/2020
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PLEDGED CONTRIBUTIONS
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SCHEDULE
E
2 FILER NAME
4
TOTAL OF UNITEMIZED LOANS
$
1
Total pages Schedule E:
3
Filer ID (Ethics Commission Filers)
The Instruction Guide explains how to complete this form.
5
Date of loan
7
Name of lender
out-of-state PAC
(ID#:__________________________ )
6
Is lender
a financial
Institution?
Y N
8
Lender address; City; State; Zip Code
9
Loan Amount ($)
10
Interest rate
11
Maturity date
12
Principal occupation / Job title (See Instructions)
13
Employer (See Instructions)
14
Description of Collateral
none
15
Check if personal funds were deposited into political
account (See Instructions)
16
GUARANTOR
INFORMATION
not applicable
17
Name of guarantor
18
Guarantor address; City; State; Zip Code
19 Amount Guaranteed ($)
20
Principal Occupation (See Instructions)
21
Employer
(See Instructions)
Date of loan
Name of lender
out-of-state PAC
(ID#:__________________________ )
Is lender
a financial
Institution?
Y
N
Lender address;
City;
State; Zip Code
Loan Amount ($)
Interest rate
Maturity date
Principal occupation / Job title
(See Instructions)
Employer (See Instructions)
Description of Collateral
none
Check if personal funds were deposited into political
account
(See Instructions)
GUARANTOR
INFORMATION
not applicable
Name of guarantor
Guarantor address; City; State; Zip Code
Amount Guaranteed ($)
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.
Revised 8/17/2020
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LOANS
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SCHEDULE
F1
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense
Accounting/Banking
Consulting Expense
Contributions/Donations Made By
Candidate/Officeholder/Political Committee
Credit Card Payment
Event Expense
Fees
Food/Beverage Expense
Gift/Awards/Memorials Expense
Legal Services
Loan Repayment/Reimbursement
Office Overhead/Rental Expense
Polling Expense
Printing Expense
Salaries/Wages/Contract Labor
Solicitation/Fundraising Expense
Transportation Equipment & Related Expense
Travel In District
Travel Out Of District
Other (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1
Total pages Schedule F1:
2 FILER NAME
3 Filer ID (
Ethics Commission Filers)
4
Date
5
Payee name
6
Amount ($)
7
Payee address;
City; State; Zip Code
8
PURPOSE
O F
EXPENDITURE
(a)
Category
(See Categories listed at the top of this schedule)
(b) Description
(c)
Check if travel outside of Texas. Complete Schedule T.
Check if Austin, TX, officeholder living expense
9
Complete ONLY if direct
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address;
City; State; Zip Code
PURPOSE
O F
EXPENDITURE
Category
(See Categories listed at the top of this schedule)
Description
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
Date
Payee name
Amount ($)
Payee address;
City; State; Zip Code
PURPOSE
O F
EXPENDITURE
Category
(See Categories listed at the top of this schedule)
Description
Check if Austin, TX, officeholder living expense
Check if travel outside of Texas. Complete Schedule T.
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised 8/17/2020
POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS
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Forms provided by Texas Ethics Commission
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SCHEDULE
F2
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense
Accounting/Banking
Consulting Expense
Contributions/Donations Made By
Candidate/Officeholder/Political Committee
Event Expense
Fees
Food/Beverage Expense
Gift/Awards/Memorials Expense
Legal Services
Loan Repayment/Reimbursement
Office Overhead/Rental Expense
Polling Expense
Printing Expense
Salaries/Wages/Contract Labor
Solicitation/Fundraising Expense
Transportation Equipment & Related Expense
Travel In District
Travel Out Of District
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
7
Amount ($)
8
Payee address;
City; State; Zip Code
9
TYPE
OF
EXPENDITURE
Political
Non-Political
10
PURPOSE
OF
EXPENDITURE
(a)
Category
(See Categories listed at the top of this schedule)
(b) Description
(c)
Check if travel outside of Texas. Complete Schedule T.
Check if Austin, TX, officeholder living expense
11
Complete ONLY if direct
Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount
($)
Payee address;
City; State; Zip Code
TYPE
OF
EXPENDITURE
Political
Non-Political
PURPOSE
OF
EXPENDITURE
Category
(See Categories listed at the top of this schedule)
Description
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 SCHEDULE AS NEEDED
Revised 8/17/2020
UNPAID INCURRED OBLIGATIONS
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PURCHASE OF INVESTMENTS MADE
FROM POLITICAL CONTRIBUTIONS
SCHEDULE
F3
The Instruction Guide explains how to complete this form.
1
Total pages Schedule F3:
2
FILER NAME
3
Filer ID (Ethics Commission Filers)
4
Date
5
Name of person from whom investment is purchased
6
Address of person from whom investment is purchased; City; State; Zip Code
7
Description of investment
8
Amount of investment ($)
Date
Name of person from whom investment is purchased
Address of person from whom investment is purchased; City; State; Zip Code
Description of investment
Amount of investment ($)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised 8/17/2020
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If the requested information is not applicable, DO NOT include this page in the report.
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Forms provided by Texas Ethics Commission
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SCHEDULE
F4
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense
Accounting/Banking
Consulting Expense
Contributions/Donations Made By
Candidate/Officeholder/Political Committee
Event Expense
Fees
Food/Beverage Expense
Gift/Awards/Memorials Expense
Legal Services
Loan Repayment/Reimbursement
Office Overhead/Rental Expense
Polling Expense
Printing Expense
Salaries/Wages/Contract Labor
Solicitation/Fundraising Expense
Transportation Equipment & Related Expense
Travel In District
Travel Out Of District
Other (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1
Total pages Schedule F4:
2
FILER NAME
3 Filer ID (
Ethics Commission Filers)
4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TO A CREDIT CARD
$
5
Date
6
Payee name
7
Amount ($)
8
Payee address;
City; State; Zip Code
9
TYPE
OF
EXPENDITURE
Political
Non-Political
10
PURPOSE
OF
EXPENDITURE
(a)
Category
(See Categories listed at the top of this schedule)
(b) Description
(c)
Check if travel outside of Texas. Complete Schedule T.
Check if Austin, TX, officeholder living expense
11
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address;
City; State; Zip Code
TYPE
OF
EXPENDITURE
Political
Non-Political
PURPOSE
OF
EXPENDITURE
Category
(See Categories listed at the top of this schedule)
Description
Check if travel outside of Texas. Complete Schedule T.
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
Revised 8/17/2020
EXPENDITURES MADE BY CREDIT CARD
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SCHEDULE
G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense
Accounting/Banking
Consulting Expense
Contributions/Donations Made By
Candidate/Officeholder/Political Committee
Credit Card Payment
Event Expense
Fees
Food/Beverage Expense
Gift/Awards/Memorials Expense
Legal Services
Loan Repayment/Reimbursement
Office Overhead/Rental Expense
Polling Expense
Printing Expense
Salaries/Wages/Contract Labor
Solicitation/Fundraising Expense
Transportation Equipment & Related Expense
Travel In District
Travel Out Of District
Other (enter a category not listed above)
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 ($)
Reimbursement from
political contributions
intended
7
Payee address;
City; State; Zip Code
8
PURPOSE
O F
EXPENDITURE
(a)
Category
(See Categories listed at the top of this schedule)
(b) Description
(c)
Check if travel outside of Texas. Complete Schedule T.
Check if Austin, TX, officeholder living expense
9
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date Payee name
Amount ($)
Reimbursement from
political contributions
intended
Payee address;
City; State; Zip Code
PURPOSE
O F
EXPENDITURE
Category
(See Categories listed at the top of this schedule)
Description
Check if travel outside of Texas. Complete Schedule T.
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 ($)
Reimbursement from
political contributions
intended
Payee address;
City; State; Zip Code
PURPOSE
O F
EXPENDITURE
Category
(See Categories listed at the top of this schedule)
Description
Check if Austin, TX, officeholder living expense
Check if travel outside of Texas. Complete Schedule T.
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised 8/17/2020
POLITICAL EXPENDITURES MADE FROM
PERSONAL FUNDS
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SCHEDULE
H
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense
Accounting/Banking
Consulting Expense
Contributions/Donations Made By
Candidate/Officeholder/Political Committee
Credit Card Payment
Event Expense
Fees
Food/Beverage Expense
Gift/Awards/Memorials Expense
Legal Services
Loan Repayment/Reimbursement
Office Overhead/Rental Expense
Polling Expense
Printing Expense
Salaries/Wages/Contract Labor
Solicitation/Fundraising Expense
Transportation Equipment & Related Expense
Travel In District
Travel Out Of District
Other (enter a category not listed above)
The Instruction Guide explains how to complete this form.
1
Total pages Schedule H:
2
FILER NAME
3
Filer ID (
Ethics Commission Filers)
4
Date
5
Business name
6
Amount ($)
7
Business address;
City; State; Zip Code
8
PURPOSE
O F
EXPENDITURE
(a)
Category
(See Categories listed at the top of this schedule)
(b) Description
(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/OH
Date Business name
Amount ($)
Business address;
City; State; Zip Code
PURPOSE
O F
EXPENDITURE
Category
(See Categories listed at the top of this schedule)
Description
Check if travel outside of Texas. Complete Schedule T.
Check if Austin, TX, officeholder living expense
Complete ONLY if direct
Candidate / Officeholder name Office sought
Office held
expenditure to benefit C/OH
Date Business name
Amount ($)
Business address;
City; State; Zip Code
PURPOSE
O F
EXPENDITURE
Category
(See Categories listed at the top of this schedule)
Description
Check if Austin, TX, officeholder living expense
Check if travel outside of Texas. Complete Schedule T.
Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised 8/17/2020
PAYMENT MADE FROM POLITICAL CONTRIBUTIONS
TO A BUSINESS OF C/OH
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SCHEDULE
I
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 ($)
7
Payee address;
City State Zip Code
8
PURPOSE
OF
EXPENDITURE
(a)Category
(See instructions for examples of acceptable
categories.)
(b)
Description
(See instructions regarding type of information
required.)
Date
Payee name
Amount ($)
Payee address;
City State Zip Code
PURPOSE
OF
EXPENDITURE
Category
(See instructions for examples of acceptable
categories.)
Description
(See instructions regarding type of information
required.)
Date
Payee name
Amount ($)
Payee address;
City Zip CodeState
PURPOSE
OF
EXPENDITURE
Category
(See instructions for examples of acceptable
categories.)
Description
(See instructions regarding type of information
required.)
Date
Payee name
Amount ($)
Payee address;
City Zip CodeState
PURPOSE
OF
EXPENDITURE
Category
(See instructions for examples of acceptable
categories.)
Description
(See instructions regarding type of information
required.)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised 8/17/2020
NON-POLITICAL EXPENDITURES
MADE FROM POLITICAL CONTRIBUTIONS
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SCHEDULE
K
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
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
8
Amount ($)
Date
Name of person from whom amount is received
Address of
person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
Check if political contribution returned to filer
Amount ($)
Date
Name of person from whom amount is received
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
Amount ($)
Date
Name of person from whom amount is received
Address of
person from whom amount is received; City; State; Zip Code
Purpose for which amount is received
Check if political contribution returned to filer
Amount ($)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised 8/17/2020
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . .
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER
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SCHEDULE
T
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 COH-UC
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
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(J)
Schedule C2
Schedule B
Schedule G
Schedule F2
Schedule F4
Schedule H
Schedule D
Schedule COH-UC
Schedule F1
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 Purpose of travel (including name of conference, seminar, or other event)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Revised 8/17/2020
IN-KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES
FOR TRAVEL OUTSIDE OF TEXAS
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CANDIDATE / OFFICEHOLDER REPORT:
DESIGNATION OF FINAL REPORT
FORM
C/OH - FR
The Instruction Guide explains how to complete this form.
•• Complete only if "Report Type" on page 1 is marked "Final Report" ••
1 C/OH NAME
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
Revised 8/17/2020
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FORM COH: CANDIDATE OFFICEHOLDER CAMPAIGN FINANCE REPORT (Texas Secretary of State)

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Completed 10 January 2022

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