Bernstein, Davin-COH CorrectionCORRECTION/AMENDMENT AFFIDAVIT
FOR CANDIDATE/OFFICEHOLDER
FORM COR -CION
1 Filer ID (Ethics Commission Filers)
2 Tblal pages sled
OFFICE USE ONLY
3 CANDIDATE I
us "KIIS MR
"Rs- M
Davin
Daer
OFFICEHOLDER
NAME
"`K""W
"AS' Bernstein �"�°`•��
4 ORIGINAL REPORT
❑ JX%Wy Is
❑ "I" ❑ Fitt report
Dele "arch ewereo or Dare Peamartea
TYPE
❑ Aly 1 S
❑ Exceeded nlDdrk O n por-rq
tirl
Receipt a
ATOUM 6
® JQ1 � (7eR1re eie�On Olher 1�tt'/)
❑ 9th Wy belore elecion
1 Sfl day af0et trEti361fer
❑ Z tar�ce+amv mb'
Date Procnsea
5 ORIGINAL PERIOD
Marm Day Year time Dir Year
COVERED
1/ 1 / THROUGH /22/21 21 3
Date imaoeo
6 EXPLANATION OF CORRECTION
When filling out the 30 day report, I had not received an invoice. When the invoice was
sent, it reflected a date that should have been reported on the 30 day report.
7 SIGNATURE 1 swear, or affirm, under penalty of perjury, that this corrected report is true and correct.
Check ONLY if applicable-
E]
pplicable:
❑Semiannual reports I swear. or affirm, that the original report was made in good faith and without an intent to
mislead or to misrepre-sent the information contained in the report.
Other reports. I swear, or affirm, that I am filing this corrected report not later than the 14th business day after the
date 1 leamed that the report as originally filed is inaccurate or incomplete. I swear, or , that any error or
omission m the report as originally filed was made in good fait -
Y p//� ASHLEY M.OWENS T.,grature of C 3,1Icate cmoehaoer
?i �= Notary Public, State of Texas
P; Comm. Expires 02-24-2023 Please complete either option below:
of `� Notary ID 130128128
1
NO'ARY STAMP i SEAL ►(�� /y �y� �7_iAY^1
Sw--rr to a ►d subscribed before me by � Ih �.>IG/� � l�5Wk C'� tn:s tie ` day of
0 L to r which. witness mynand and of officeF)i --MA
' - i
signature oroTcer aV!�,stering oaT
(2) Unsworn Declaration
My Warne is
My address is
Executed in
Prnted came o' orlc
(street)
County, State of
nice-ing oath
and my date of girth is
lie ofgMcer adrnlntsterlrg
icrtyl (state) (rip code) (country)
on the day of , 2D
merit (year)
Signature of CandidaWOf iceholder (Declarant)
Remember To Attach Any Part Of The Campaign Finance Report Form Needed To Report And Explain Corrections
Forms provided by Texas Ethics Commrssion www ethics state tx us Revsed4f16=1
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)
1
Davin Bernstein
4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TOACREDIT CARD
$
5 Date
6 Payee name
03/19/2021
Star Local Media
7 Amount ($)
8 Payee address; City; State; Zip Code
318.50
PO Box 860248, Plano, TX 75086
9 TYPE OF
f
Political Non
EXPENDITURE
I_ -Political
10
(a) Category (See Categories listed at the lop of this schedule)
(b) Description
Advertising Expense
Digitial Advertising
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense
11 Candidate / Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date
Payee name
Amount ($)
Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE
f�
I 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 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
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
Davin Bernstein
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAME OF SCHEDULE
SUBTOTAL
AMOUNT
1.
SCHEDULEAI:
MONETARY POLITICAL CONTRIBUTIONS
$
2.
SCHEDULEA2:
NON -MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS
$
3.
SCHEDULE B:
PLEDGED CONTRIBUTIONS
$ b '
4.
SCHEDULE E:
LOANS
$ O —
5.
SCHEDULE F1:
POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$ — Q —
6.
SCHEDULE F2:
UNPAID INCURRED OBLIGATIONS
$ ` Q
7.
SCHEDULE F3:
PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS
$ — O —
8.
SCHEDULE F4:
EXPENDITURES MADE BY CREDIT CARD
$ 318.50
9•
SCHEDULE G:
POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS
$ — V ._-
10.
SCHEDULE H:
PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH
—D--
s-0--
11.
11.
SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$ ^
12.
SCHEDULE K:
INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED
TO FILER
$
( f
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
CANDIDATE / OFFICEHOLDER
CAMPAIGN FINANCE REPORT
FORM C/OH
COVER SHEET PG 1
1 Filer ID (Ethics Commssion Fifers) 2 Total pages filed:
Tile C10H Instruction Guide explains how to complete this form.
3 CANDIDATE,' Ads «MRS MR FIRST MI
Of= FICEHOL.DER Vt N OFFICE USE ONLY
P Af1E L ....................... .
14 CANDIDATE
OFFICEHOLDER
I MAILING
ADDRESS
5 CANDIDATE/
I OFFICEHOLDER
PHONE
6 CAMPAIGN
TREASURER
NAME
7 CAMPAIGN
TREASURER
ADDRESS
18 CAMPAIGN
TREASURER
PHONE_
i 9 REPORT TYPE
10 PERIOD
COVEREDI
i
11 E;_EcrION
I
i
j12 OFFICE:
14 NOTICE FROM
y POLITICAL
COMMITTEES)
i
i
i
i
-- ---
f
N-CKNAME
- _
LAST SUFFIX
'8e7eN s �_ I&
C,v, R- e,
�
ADDRESS : PO BOX:
APT! SUITE a. CI SrATE. ZIP CODE
Month
THROUGH
r D -31,9x- 9 9
`
ELECTION TYPE
Tx 75-4.)j q
4
AREA (,OttD``E
PHONE NUMBER_.__ Ex IFNSI:.)N
Date Hand -delivered or Date Postmarked
1
Z T i
'717 - 15'3- 7
MRS t MR
FIRST MI
Receipt tt
Amount S
7 EA N
Date Processed
NICKNAME
LAST SUFFIX
Date Imagea
STREET ADDRESS (NO PO BOX PLEASE) APT; SUITE n _
, ITV
STATE: ZIP CODE
6 6 z C 2 w 6s _'PR
----
C#00a-T.SG./ 9
AREA CODE
PHONE NUMBER L k T L I;SION
t '16 y
January 15
Ll July 15
Month
ELECTION DATE
Month Day
OFFICE HELD of any)
yoo -5Z9-7
Exceeded Modified
30th day before election
Runoff
8th day before election
Day Year
j
1 10 1
Year Primary
21
General
El
Exceeded Modified
Reporting Umit
Month
THROUGH
3
`
ELECTION TYPE
Runoff
Other
Descno w
Special
13 OFFICE SOUGHT (if knowni
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
THE CANDIDATE I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
CONSF,NT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
ta)MMI'TEE TYPE I COMMITTEE NAME
„GENERAL COMMITTEE ADDRESS
SPECIFIC COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
GO TO PAGE 2
Fortis provided by Texas Ethics Commission www.ethics.state,Ix.us Revised 8/17/2020
15th day after campaign
treasurer appointment
(Officeholder Only)
Final Report (Attach ClOH - FR)
Day
Year
2Z
Z1
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
THE CANDIDATE I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
CONSF,NT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
ta)MMI'TEE TYPE I COMMITTEE NAME
„GENERAL COMMITTEE ADDRESS
SPECIFIC COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
GO TO PAGE 2
Fortis provided by Texas Ethics Commission www.ethics.state,Ix.us Revised 8/17/2020
CANDIDATE / OFFICEHOLDER
CAMPAIGN FINANCE REPORT
15 NAME
FORM C/OH
COVER SHEET PIG 2
16 Filer 10 (Ethics Commission Filers)
17 CONTRIBUTION I TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
1 7 A i, s, PLEDGES, LOANS, OR GUARANTEES OF LOANS. OR
CONTRIBUTIONS MADE ELECTRONICALLY)
2, TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) $ lJ
EXPf NG)ITURE
'OTALS 3, TOTAL UNITEMIZED POLITICAL EXPENDITURE. $
4 TOTAL POLITICAL EXPENDITURES $ 31
CONTRIBUTION
5 TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY $ q O_
BALANCE
OF REPORTING PERIOD
TSTANDINCi 6, TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
L0AN T(,)TALS 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
squired to be reported by me under Title 15, Election Code.
Signature of Candidate or Officeholder
Please complete either option below:
1 Affidavit
"41
TIFFA14Y LIGHT
.-_Notaly Public, State of Texas
Comm. Expires 09-12.2022
-TAMP; S
%r, , 1 ARV S
EAL o
Notary ID 13171693-6
KIM - 'J* Ze'r V161K'% V1%
v'' I f�) 11,d subscribed before me by VIA 11V\ —this the day of
to ;'.,eqify which, witness my hand and seal of office
T,
'tennq oath Printed name of of icer administering oath Title of officer administering oath
(2) Unsworn Declaration
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)
www.ethics.state,tx.us Revised 8/1712020