Mathew, Biju-COH 2021-04-23CANDIDATE / 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/
OFFICEHOLDER
MS / MRS / MR FIRST MI
pp t �J
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OFFICE USEONLY
NAME..........................
�ju
Date Received
.l. ......................1 . .............
NICKNAME LAST SUFFIX
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4 CANDIDATE /
ADDRESS / PO BOX, / SUITE #; CITY, STATE, ZIP CODE
OFFICEHOLDER'
�
412-3),Z
123 h�
ADDRESS
yy^,•
Cts S�
❑ 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
Date Processed
NAME
...................... ..................................
NICKNAME LAST SUFFIX
Date Imaged
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE), APT / SUITE #, CITY,
STATE; ZiP CODE
TREASURER
ADDRESS
Gn 2 P H E i Sig 1V T W
TX 75
(Residence or Business)
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
I
p 1 �l y
( l i ` 5i6
9 REPORT TYPE
F-1JaJanuary 15 ❑ 30th day before election Runoff
15th day after campaign
treasurer appointment
(Officeholder Only)
July 15 Isa 8th day before election Exceeded Modified
❑ Final Report (Attach C/OH - FR)
Reporting Limit
10 PERIOD
Month Day Year Month
Day Year
COVERED
o /Q Z / Zoa r THROUGH d /a3 /D 2
I
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
❑ Primary ❑ Runoff ❑ Other
b 5—j 0 ( /?,a 2'
Description
General F-]Special
12 OFFICE
OFFICE HELD (if any)
L�2 CaInCil XLfie 6
13 OFFICE SOUGHT (if known)
("'aslj C""'Qj/ 2 )Oep
14 NOTICE FROM
(a,0141,
THIS BOX IS FOR NOTICE OF POLITI AL CONTRIBUTIONS ACCEPTED OR POLI CAL EXPENDITURES MADE BY POLITI AL COMMITTEES TO SUPPORT
'
POLITICAL
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.
COMMITTEES)
COMMITTEE TYPE
COMMITTEE NAME
GENERAL
COMMITTEE ADDRESS
Additional Pages
COMMITTEE CAMPAIGN TREASURER NAME
SPECIFIC
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 CIO" NAME 16 Filer ID (Ethics Commission Filers)
) '--� U, N P, —f t4F Lnl—
17 CONTRIBUTION 1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR $ f
CONTRIBUTIONS MADE ELECTRONICALLY) /
2. TOTAL POLITICAL CONTRIBUTIONS $
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
...................
EXPENDITURE
TOTALS
...................
CONTRIBUTION
BALANCE
..................
OUTSTANDING
LOAN TOTALS
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
$
4. TOTAL POLITICAL EXPENDITURES $ a j v
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY $
OF REPORTING PERIOD
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE $ D o
LAST DAY OF THE REPORTING PERIOD
18 SIGNATURE I swear, or affirm, under penalty of perjury, that the accomp ing report is true and correct and includes all information
required to be reported by me under Title 15, Election Code
R
at orlUfficeholder
Please complete either option below:
0011"' ASHLEY M. OWENS
:Zo. _Notary Public, State of Texas
=v a Comm. Expires 02-24-2023
(1) Affidavit
Notary ID 130128126
NOTARY STAMP/ SEAL � I�)
Sworn to and subscribed before me by P";"t-o � ry (�wak w this the day of
20 to certify w I witness my hand and se f Wiice.n Q A
A 1 ► i . . . AI ii�-'i�=,1/11jo l A U JI A
Signature of officer adminifteting oath
1 (2) Unsworn Declaration
My name is _
My address is
I Executed in
Printed name of officer ahministering oath
, and my date of birth is
officer administering
(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
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
SUBTOTALS
- C/OH FORM C/OH
COVER SHEET PG 3
19
FILER NAME 13 �' qA /A` j
►`�" � � v1 I V ` � 7� NN
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAME OF SCHEDULE
SUBTOTAL
AMOUNT
1 .
®
SCHEDULEA1:
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
$ zo
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•
El
SCHEDULE G:
POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
$
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 Commission www.ethics.state.tx.us 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 Al:
2 FILER NAME n ? /
3 Filer ID (Ethics Commission Filers)
4 Date
5 Full name of contributor(❑ out-of-state PAC (ID#: )
7 Amount of contribution ($)
.Pam... ...-je.rf.... .Vaane /.............................
6 Contributor address; City; State; Zip Code
(O
6 o 1 E SaAa e
8 Principal occupation / Job title (See Instructions)
g Employer (See Instructions)
/ EM
Date
Full name of contributor ❑ out-of-state PAC (ID#: )
Amount of contribution ($)
7.Y.... '�P.�0.....��L ..... O.t�.tam�. ..
Contributor addre s; City; State;" Zip Code
04 if' g3 / /V r: --S-5 L A/
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
sic"4A
Date
Full name of contributor ❑ out-of-state PAC (ID#: )
Amount of contribution ($)
M. 1 - rok..�-...ASS0.C_- �0n..��.eeo/kxs...
Contributor address; City; State; Zip Code
f\J s TF NV',1 �
ja
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
� I
Date
Full name of contributor ❑ out-of-state PAC (ID#: )
Amount of contribution ($)
..................................................................................
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 Commission www.ethics.state.tx.us Revised 8/17/2020
POLITICAL EXPENDITURES MADE
SCHEDULE F1
FROM POLITICAL CONTRIBUTIONS
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 F1:
2 FILER NAME
-LA
3 Filer ID (Ethics Commission Filers)
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4 Date `
5 Payee name
PP
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6 Amount ($)
7 Payee address; City; State; Zip Code
14:-�ci r\)cn T 6 P4
a)5-- 46
8
(a) Category (See Categories listed at the top of this schedule)
(b) Description
PURPOSE
OF
^�
EXPENDITURE
(C) Check if travel outsid 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
L(/ 2 l 21
\// s rjA te) 7`
Amount ($)
Payee address; City; State; Zip Code
a ,3, 3
vAE�yvU T6 ; ✓� A
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
'�j�
EXPENDITURE
`
❑ Check if travel outside of Texas. Complete Schedule Check if Austin, TX, officeholder living expense
Complete ONLY if direct Candidate / Officeholder name Office sought Office held
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
EXPENDITURE
Check iftraveloutside 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 SCHEDULEAS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020