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Carroll, Don-COH 2021-04-02CANDIDATE / OFFICEHOLDER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 1 1 Filer ID (Ethics Commission Filers) 2 Total pages filed:I The C/OH Instruction Guide explains how to complete this form. 3 CANDIDATE / MS / MRS / MR FIRST MI OFFICEHOLDER Mr Don R OFFICE USE ONLY NAME................................................................................. Date Received NICKNAME LAST SUFFIX Carroll Jr 2- 4 CANDIDATE / 4 ADDRESS / PO BOX, APT / SUITE #, CITY STATE, ZIP CODE OFFICEHOLDER Coppell, Texas 75019 MAILING ADDRESS �/ I� ; l� %Q"YY� �/ Change of Address 5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION Date Hand-delivered or Date Postmarked OFFICEHOLDER PHONE Receipt # Amount $ 6 CAMPAIGN MS /MRS ! MR FIRST MI TREASURER Mr Don R Date Processed NAME................................................................................. NICKNAME LAST SUFFIX Date Imaged Carroll Jr 7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE), APT / SUITE #: CITY STATE, ZIP CODE TREASURER Coppell, Texas 75019 ADDRESS (Residence or Business) 8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE 9 REPORT TYPE 7_ January 15 i 30th day before election Runoff 15th day after campaign treasurer appointment (Officeholder Only) July 15 8th day before election Exceeded Modified 1, Final Report (Attach C/OH - FR) --- Reporting Limit 10 PERIOD Month Day Year Month Day Year COVERED 08 21 03 31 21 02/ / THROUGH / / 11 ELECTION ELECTION DATE ELECTION TYPE Month Day Year Primary Runoff Other Description 05 / 01 / 21 General ■ Special 12 OFFICE OFFICE HELD (if any) 13 OFFICE SOUGHT (if known) none Coppell City Council Place 3 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 COMMITTEE(S) 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 Additional Pages SPECIFIC COMMITTEE CAMPAIGN TREASURER NAME COMMITTEE CAMPAIGN TREASURER ADDRESS GO TO PAGE 2 Forms provided by Texas Ethics c,,F Reset Formcs.S Reset Page Revised 8/17/2020 CANDIDATE / OFFICEHOLDER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 2 15 C/OH NAME 16 Filer ID (Ethics Commission Filers) Don Carroll 17 CONTRIBUTION 1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN 0 TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR $ CONTRIBUTIONS MADE ELECTRONICALLY) 2. TOTAL POLITICAL CONTRIBUTIONS$ 3000 ................... (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) EXPENDITURE TOTALS 3. TOTAL UNITEMIZED POLITICAL EXPENDITURE. $ 0 2619.20 ................... 4. TOTAL POLITICAL EXPENDITURES $ CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY 758.93 $ BALANCE .................. OF REPORTING PERIOD OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE 0 $ LOAN TOTALS 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. 2 Signature of Candidate or Officehold Please complete either option below: (1)Affi'PYPr/e'� ASHLEY M. OWENS ' Notary Public, State of Texas +� Comm. Expires 02-24-2023 Notary ID 130128128 NO () �,,nu^/�\/ Sworn to and subscribed before me byG'row this the day of 202 to cert hich, witness my hand and seal of office. Scr, Signature of officer a nistering oath Printed name of direr administering oath T' I of officer administ in 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) (year) Signature of Candidate/Officeholder (Declarant) Forms provided by Texas Ethics CommI Reset Form I -,.] Reset Page I Revised 8/17/2020 Forms provided by Texas Ethics Comm i stat Revised 8/17/2020 J z SUBTOTALS - C/OH FORM C/OH COVER SHEET PG 3 19 FILER NAME Don Carroll 20 Filer ID (Ethics Commission Filers) 21 SCHEDULE SUBTOTALS NAME OF SCHEDULE SUBTOTAL AMOUNT 1. ■ SCHEDULEAI: MONETARY POLITICAL CONTRIBUTIONS $ 3000 2_ SCHEDULEA2: NON -MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS $ 3, SCHEDULE B: PLEDGED CONTRIBUTIONS $ 4. SCHEDULE E: LOANS $ 5. ■ SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ 2241.07 6. SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $ 7 SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $ 8. ■ SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $ 378.13 9. ■ SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS $ 378.13 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 Comm i stat Revised 8/17/2020 J z MONETARY POLITICAL CONTRIBUTIONS Al SCHEDULE 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 Al: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) Don Carroll 4 Date 5 Full name of contributor out-of-state PAC (ID#. ) 7 Amount of contribution ($) Jason Cassity 2/21/21 ........................................................................ 500 6 Contributor address, City. State, Zip Code 840 Crane Dr, Coppell, Texas 75019 8 Principal occupation / Job title (See Instructions) g Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#. ) Amount of contribution ($) Amy Davis 2/21/21 .................................................................................. 100 Contributor address, City, State, Zip Code 122 Tennyson PI, Coppell, Texas 75019 Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID# ) Amount of contribution ($) Robert Stokes 100 2/26/21 .................................................................................. Contributor address, City, State; Zip Code 735 Oriole Ln, Coppell, Texas 75019 Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#: ) Amount of contribution ($) Don Carroll 2/26/21 ............................................................................ 500 Contributor address, City; State; Zip Code 924 Hidden Hollow Ct, Coppell, Texas 75019 Principal occupation / Job title (See Instructions) Employer (See Instructions) banker Bank of America ATTACH ADDITIONAL COPIES OF THIS SCHEDULEAS NEEDED If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements. Forms provided by Texas Ethics Com s.st Revised 8/17/2020 MONETARY POLITICAL CONTRIBUTIONS Al SCHEDULE 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 Al: 3 2 FILER NAME 3 Filer ID (Ethics Commission Filers) Don Carroll 4 Date 5 Full name of contributor out-of-state PAC (ID#: ) 7 Amount of contribution ($) Don Carroll 3/8/21 ........................................................................... 1500 6 Contributor address, City; State; Zip Code 924 Hidden Hollow Ct, Coppell, Texas 75019 8 Principal occupation / Job title (See Instructions) g Employer (See Instructions) banker Bank of America Date Full name of contributor out-of-state PAC (ID#: ) Amount of contribution ($) Quay Bratton 3/10/21 .................................................................................. 100 Contributor address, City, State, Zip Code 139 Moore Dr, Coppell, Texas 75019 Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#. ) Amount of contribution ($) Timothy Tidwell 50 3/22/21 .................................................................................. Contributor address; City, State; Zip Code 313 Parkview PI, Coppell, Texas 75019 Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#: ) Amount of contribution ($) Isaac Richardson 3/23/21 .......................................................................... 100 Contributor address, City, State; Zip Code 6009 Gateridge Dr, Flower Mound, Texas 75028 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. Forms rovided b Texas Ethics Com ���, // s.st Revised 8/17/2020 P Y MONETARY POLITICAL CONTRIBUTIONS Al SCHEDULE 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 Al: 2 FILER NAME 3 Filer IO (Ethics Commission Filers) Don Carroll 4 Date 5 Full name of contributor out-of-state PAC (ID#: 7 Amount of contribution ($) Lydia Goulas 3/25/21 ......................................................................... 50 6 Contributor address, City; State; Zip Code 905 Crestview Dr, Coppell, Texas 75019 8 Principal occupation / Job title (See Instructions) g Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID# Amount of contribution ($) .................................................................................. 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 s. Revised Revised 8/17/2020 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 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 F1: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) Z Don Carroll 4 Date 5 Payee name 3/25/21 Paypal 6 Amount ($) 7 Payee address, City, State, Zip Code 31.10 2211 North First St, San Jose, CA 95131 8 (a) Category (See Categories listed at the top of this schedule) (b) Description PURPOSE fees online contribution processing fees OF EXPENDITURE (c) Check if travel outside of Texas. Complete Schedule Check if Austin, TX, officeholder living expense 9 Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name 2/25/21 PrintPlace Amount ($) Payee address; City, State; Zip Code 34.56 1130 Ave H East, Arlington, Texas 76011 Category (See Categories listed at the top of this schedule) Description printing expense hand cards 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 3/7/21 Marni G Designs Amount ($) Payee address; City; State, Zip Code 2162.84 602 Hood, Coppell, Texas 75019 Category (See Categories listed at the top of this schedule) Description PURPOSE printing expense signs OF EXPENDITURE Check if travel outside of Texas. Complete Schedule Check if Austin. TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Com %/��cs s 01"'� Revised 8/17/2020 POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F1 If the requested information is not applicable, DO NOT include this page in the report. EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense Consulting Expense Food/Beverage Expense Polling Expense Travel In District Contnbutions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District Candidate/Officeholder/Political Committee Legal Services Salades/VVages/Contract Labor Other (enter a category not listed above) Credit Card Payment The Instruction Guide explains how to complete this form. 1 Total pages Schedule F1: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 121- Don Carroll 4 Date 5 Payee name 3/11/21 Bank of America 6 Amount ($) 7 Payee address, City; State; Zip Code 12.57 100 North Tryon St, Charlotte, NC 28255 8 (a) Category (See Categories listed at the top of this schedule) (b) Description PURPOSE fees checks OF EXPENDITURE (c) Check if travel outside ofTexas. 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 ($) Payee address; City; State; Zip Code Category (See Categories listed at the top of this schedule) Description PURPOSE OF EXPENDITURE Check iftravel outside ofTexas. Complete ScheduleT Check if Austin. TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name Office sought Office held expenditure to benefit C/OH Date Payee name Amount ($) Payee address; City, State; Zip Code Category (See Categories listed at the top of this schedule) Description PURPOSE OF EXPENDITURE Check iftravel outside ofTexas. 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 Forms provided by Texas Ethics Com �� ��/i% ," ii��i% CS's �' ��%�// "' Revised 8/17/2020 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: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 3 Don Carroll 4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TOA CREDIT CARD $ 5 Date 6 Payee name 2/22/21 SquareSpace 7 Amount ($) 8 Payee address, City, State; Zip Code 28.15 225 Varick St, 12th floor, New York, NY 10014 9 TYPE OF Political Non -Political EXPENDITURE 10 (a) Category (See Categories listed at the top of this schedule) (b) Description advertising expense website PURPOSE OF EXPENDITURE (c) Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX. officeholder living expense 11 Candidate / Officeholder name Office sought Office held Complete ONLY if direct expenditure to benefit C/OH Date Payee name 2/22/21 SquareSpace Amount ($) Payee address; City, State, Zip Code 20 225 Varick St, 12th floor, New York, NY 10014 TYPE OF EXPENDITURE � r I Political Non -Political Category (See Categories listed at the top of this schedule) Description advertising expense domain 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 Forms provided by Texas Ethics Commiss Reset Form ate Reset Page Revised 8/17/2020 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: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 3 Don Carroll 4 TOTAL OF UN ITEMIZED EXPENDITURES CHARGED TOACREDIT CARD $ 5 Date 6 Payee name 3/3/21 Dallas County Elections 7 Amount ($) 8 Payee address, City, State; Zip Code 18.95 1520 Round Table Dr, Dallas, Texas 75247 9 TYPE OF �" N Political Non EXPENDITURE I -Political 10 (a) Category (See Categories listed at the top of this schedule) (b) Description fees voter roll data PURPOSE OF EXPENDITURE (c) Check if travel outside of Texas. Complete Schedule T. Check if Austin.. TX. officeholder living expense 11 Candidate / Officeholder name Office sought Office held Complete ONLY if direct expenditure to benefit C/OH Date Payee name 3/6/21 Coppell Gazette Amount ($) Payee address, City, State; Zip Code 200 3501 E Plano Parkway #200, Plano, Texas 75074 TYPE OF— EXPENDITURE r L0 ` Political I Non -Political Category (See Categories listed at the top of this schedule) Description advertising expense newspaper ads 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 Forms provided by Texas Ethics Commiss Reset Form" Reset Page Revised 8/17/2020 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: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 3 Don Carroll 4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TOA CREDIT CARD $ 5 Date 6 Payee name 3/22/21 SquareSpace 7 Amount ($) 8 Payee address, City, State; Zip Code 28.15 225 Varick St, 12th floor, New York, NY 10014 9 TYPE OF I - Political Non EXPENDITURE ) -Political 10 (a) Category (See Categories listed at the top of this schedule) (b) Description advertising expense website PURPOSE OF EXPENDITURE (c) Check if travel outside of Texas. CompleteScheduleT Check if Austin. TX, officeholder living expense 11 Candidate / Officeholder name Office sought Office held Complete ONLY if direct expenditure to benefit C/OH Date Payee name 3/22/21 Lowe's Amount ($) Payee address, City, State; Zip Code 82.88 11920 Inwood Rd, Dallas, Texas 75244 TYPE OF EXPENDITURE r� I Political Non -Political Category (See Categories listed at the top of this schedule) Description advertising expense poles for signs PURPOSE OF EXPENDITURE Check iftravel outside ofTexas. Complete ScheduleT 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 Forms provided by Texas Ethics Commiss 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 Salanes/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 G: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) Don Carroll 4 Date 5 Payee name 3/31/21 Bank of America 6 Amount ($) 7 Payee address, City; State, Zip Code 378.13 100 North Tryon St, Charlotte, NC 28255 Reimbursement from political contributions intended 8 (a) Category (See Categories listed at the top of this schedule) (b) Description PURPOSE credit card payment p y OF EXPENDITURE (c) Check iftraveloutside ofTexas.Complete Schedule Check if Austin, TX, off'ceholder living expense 9 Candidate / Officeholder name Office sought Office held Complete ONLY if direct expenditure to benefit C/OH Date Payee name Amount ($) 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 ofTexas. 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 iftravel outside ofTexas .Complete ScheduleT 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 Forms provided by Texas Ethics Com Reset Form cs s Reset Page Revised 8/17/2020 TE piAFFIDAVIT FOR y CANDIDATE OR OFFICEHOLDER: ELECTRONIC FILING EXEMPTION An exemption affidavit must be submitted with each paper report OFFICE USE ONLY DateReceived 2 4 �I �_� *W Ir3'-15-W Date Hand -delivered or Date Postmarked Beginning on January 1, 2021, a candidate or officeholder who has accepted more than $28.420 in political contributions or made more than $28,420 in political expenditures Receipt# in an calendar year must file all subsequent reports electronically. Filer name Filer ID # D©n C -o ►1 Date Processed Date Imaged Amount $ 1. I swear or affirm that I have not accepted more than $28,420 in political contributions or made more than $28,420 in political expenditures in a calendar year. 2. 1 further swear or affirm that I do not use computer equipment to keep current records of political contributions, political expenditures, or persons making political contributions to me. 3. 1 further swear or affirm that no person acting as my agent or consultant, and no person with whom I contract, uses computer equipment to keep current records of political contributions, political expenditures, or persons making political contributions to me. 4. 1 further swear or affirm that I understand that I am required to file my campaign finance reports electronically if I, my agent or consultant, or a person with whom I contract exceeds $28,420 in political contributions or political expenditures in a calendar year, or uses computer equipment to keep current records of political contributions, political expenditures, or persons making political contributions to me. 5. 1 am filing this affidavit with the C A•MpR1 &#a P%,iuAo-iFreport due on A Piz 1 ` i , 2-c,2- I . I understand that this affidavit is required to be filed with each campaign finance report for which I am claiming an exemption from electronic filing. Please complete either option below: (1)Afridav �ASHLEY M. ow ENS �=Notary Public, State of Texas '•+r Comm. Expires 02-24-2023 �0;,��Notary ID 130128128 Sworn to and subscribed before me by Z 20 �12A , to certify is witness my hand and seal of office. r Signature Filer this the day of Signature of officer admini7Aing oath Printed name of officer administering oath Title of oAcer administering (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) (year) Signature of Filer (Declarant) FILERS WHO ARE EXEMPT FROM THE ELECTRONIC FILING REQUIREMENT ARE STILL REQUIRED TO FILE CAMPAIGN FINANCE REPORTS ON PAPER Forms provided by Texas Ethics Commission www. ethics. state. tx.us Revised 1/1/2021