HomeMy WebLinkAbout2021 Tompkins semi Jan CANDIDATE / 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
O FFICEHOLDER Pik (�iireft4 l A OFFICE USE ONLY
NAME
Date Received
NICKNAME LAST SUFFIX
ereD ill 1-3
4
CANDIDATE / ADDRESS / PO BOX; APT / SUITE #• n c5i )j)/2„ �CITY; STATE ; ZIP CODE ' t
O FFICEHOLDERMAILING
/
ADDRESS j o7 5il & " ✓
1 . I�c� (ess , -1; moyf)
Change of Address /
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION
Date Hand-delivered or Date Postmarked
O FFICEHOLDER r 0 i \ ) /
P HONE
Receipt It Amount $
6 CAMPAIGN MS / MRS / MR FIRST MI
TREASURER
NAME `c hors A Date Processed
NICKNAME LAST SUFFIX .
A.
Date Imaged
7 CAMPAIGN STREET ADDRESS (NO PO BOX PL ASE); APT / SUITE #; CITY; STATE ; ZIP CODE
TREASURER
ADDRESS 1 /' O
( Residence or Business ) / O 2 ( yllPi t al &A /e SS r r)C � (O & /
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
P HONE ( Q / 7 ) 0233e 5f/ o
9 REPORT TYPE )' January 15 1 30th day before election Runoff 15th day after campaign
treasurer appointment
(Officeholder Only)
July 15 1 8th day before election Exceeded Modified Final Report (Attach C/OH - FR)
Reporting Limit
10 PERIOD Month Day Year Month Day Year
COVERED b
/ 25— / 207-0 THROUGH l / 3 i / to2 0
11 ELECTION ELECTION DATE ELECTION TYPE
Month Day Year Primary Runoff Other
Description
/ / General Special
12 OFFICE OFFICE HELD (if any) 13 OFFICE SOUGHT (if known)
Co le f; Cl77 (weed P!4rc 2
14 NOTICE FROM THIS BOX IS FOR NOTIC 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
CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE OF SUCH EXPENDITURES.
COMMITTEE (S )
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 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 AME 16 Filer ID ( Ethics Commission Filers )
17 CONTRIBUTION 1 . TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS ( OTHER THAN
TOTALS PLEDGES , LOANS , OR GUARANTEES OF LOANS , OR $ Y
CONTRIBUTIONS MADE ELECTRONICALLY)
2 . TOTAL POLITICAL CONTRIBUTIONS
( OTHER THAN PLEDGES , LOANS , OR GUARANTEES OF LOANS ) 9
TOTAL DITURE 3 . TOTAL UNITEMIZED POLITICAL EXPENDITURE ,
4 . TOTAL POLITICAL EXPENDITURES $ f%
CONTRIBUTION 5 . TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE OF REPORTING PERIOD $ 3 .
OUTSTANDING 6 . TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
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 . /
/
/974—
Sig ature of Ca didate or Officeholder
/
Please complete either option below :
`047,',' KIM SUTTER
stir,. . . . 3- Notary Public , State of Texas
( 1 ) Affidavit � i '�1
'tri't V ;'QE Comm . Expires 08-25-2021
1'ilFfoi``��t Notary ID 10956806
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NOTARY STAMP / SEAL
Sworn to and subscribed before me by Jereterth / / t..4, I�-- ( i 1 j this the day of " LLB "
� 4�tr
20 -r �� �o,certify which , witness my hand and seal o office . 1/4
r
B � /(2 �7 r� -c /r � i ey
' Si. nature of officer administering oath Printed name of officer administering oath Title of officer administering oath
OR
(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 Commission www. ethics . state . tx . us Revised 8/ 17/2020