Bernstein, Davin-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:
The C/OH Instruction Guide
explains how to complete this form.
3 CANDIDATE /
MS / MRS MR FIRST MI
OFFICEHOLDER
b A v. t Ai
OFFICE USE ONLY
NAME
................................... ........................................
Date Received
NICKNAME LAST SUFFIX
4 CANDIDATE /
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
OFFICEHOLDER
MAILING
/,/�
Po 310x / 9T
ADDRESS
�'"y
-0, ��
❑ Change of Address
/
5 CANDIDATE/
AREA CODE PHONE NUMBER EXTENSION
Date Hand-delivered or Dale Postmarked
OFFICEHOLDER
PHONE
\ Z �7 7
-
Receipt #
Amount $
---
6 CAMPAIGN
is MRS / MR FIRST MI
TREASURER
j" E--)%
NAME...........................................................................
Processed
NICKNAME LAST SUFFIX
[Date
te Imaged
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE): APT / SUITE #; CITY:
STATE; ZIP CODE
TREASURER
6 CJ G Z. e: 2 I i3S
ADDRESS
-Dg
(Residence or Business)
G 10,0040 C— 1-'7�lj/
'
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
�f[ `'
28 —7
9 REPORT TYPE
January 15 54 30th day before electionF-1Runoff
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
Month Day Year Month
Day Year
COVERED
/ 1 / z f THROUGH 3
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
❑ Primary ❑ Runoff ❑ Other
Description
5
❑ General 19 Special
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (if known)
14 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL
THE CANDIDATE / 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
F]GENERAL
COMMITTEE ADDRESS
Additional Pages
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
GO TO PAGE 2
Forms provided by Texas Ethics Commission www. ethics. state.tx.us 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)
17 CONTRIBUTION
1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
TOTALS
PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR
$
CONTRIBUTIONS MADE ELECTRONICALLY)
.
2. TOTAL POLITICAL CONTRIBUTIONS
$
...................
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
O
EXPENDITURE
TOTALS
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
$ O
4. TOTAL POLITICAL EXPENDITURES
$ 0
...................
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY U
$
BALANCE OF REPORTING PERIOD 1 Or
..................
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ v
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
Please complete either option below:
(1) Affidavit
TIFFANY LIGHT
.TS Not�:ry Public, State of Texas
9'•., �v� Comm. Expires 09.12-2022
NOTARY STAMP/SEAL Notary ID 13171693-6
(gyp sr�11f�
Sworn to and subscribed before me by AJ1u� +�`rh this the NA day of Y�
20 to certify which, witness my hand and seal of office.
S,pature f VC, aa-,:iwsterng oath Printed name of of icer administering oath Title of officer administering oath
(2) Unsworn Declaration • .
Aly name is _
My address is
Executed in
, 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)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020