Loading...
Premkumar, Ramesh - 2023-04-28 (8 Day) ANDIDATE / 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ANDIDATE / 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) . . . . . . . . . . . . . . . . . . . Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . MONETARY POLITICAL CONTRIBUTIONS If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | | | | | | | | | | | | NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | | | | | | | | | | | | | | | | | | | | | | | | | | | | PLEDGED CONTRIBUTIONS If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LOANS If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 expenseCheck if travel outside of Texas. Complete Schedule T. Candidate / Officeholder name Office sought Office heldComplete 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 If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 ($)8 Payee address;City;State; Zip Code 9 TYPE OF EXPENDITURE Political Non-Political 10 PURPOSE OF EXPENDITURE (a)Category (See Categories listed at the top of this schedule)(b)Description (c)Check if travel outside of Texas. Complete Schedule T.Check if Austin, TX, officeholder living expense 11 Complete ONLY if direct Candidate / Officeholder name Office sought Office heldexpenditure to benefit C/OH Date Payee name Amount ($)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 If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 heldComplete ONLY if direct expenditure to benefit C/OH Date Payee name Amount ($) Reimbursement from political contributions intended Payee address;City;State; Zip Code PURPOSE O F EXPENDITURE Category (See Categories listed at the top of this schedule)Description Check if Austin, TX, officeholder living expenseCheck if travel outside of Texas. Complete Schedule T. Candidate / Officeholder name Office sought Office heldComplete ONLY if direct expenditure to benefit C/OH ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Revised 8/17/2020 POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us SCHEDULE H EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Accounting/Banking Consulting Expense Contributions/Donations Made By Candidate/Officeholder/Political Committee Credit Card Payment Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services Loan Repayment/Reimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) The Instruction Guide explains how to complete this form. 1 Total pages Schedule H:2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 Date 5 Business name 6 Amount ($)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 expenseCheck if travel outside of Texas. Complete Schedule T. Candidate / Officeholder name Office sought Office heldComplete 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 If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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 C2Schedule B Schedule GSchedule 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 If the requested information is not applicable, DO NOT include this page in the report. Forms provided by Texas Ethics Commission www.ethics.state.tx.us 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