HomeMy WebLinkAbout2021 Tompkins semi July CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT 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:Z,
3 CANDIDATE/ MS/MRS/MR FIRST MI
OFFICE USE ONLY
OFFICEHOLDER
NAME /°...................C/1.P.. .......................�.......... Date Received
NICKNAME yAST SUFFIX
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4 CANDIDATE/ ADDRESS !PO BOX; APT/SUITE#; CITY; STATE; ZIP CODE D
OFFICEHOLDER
MAILING JUL 0 1 2021
ADDRESS I(_�� S, ��y
❑ Change of Address w ✓ 7 CITY OF E U
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION
Date Hand-delivered or Date Postmarked
OFFICEHOLDER b
PHONE (0I7 ) -207( O��
Receipt# Amount $
6 CAMPAIGN MS/MRS/MR FIRST MI
TREASURER A/1 11�1 Date Processed
/k
NAME .................................................................................
NICKNAME LAST SUFFIX
Date Imaged
�rit S
7 CAMPAIGN STREET ADDRESS (NO PO BOX PL ASE); APT/SUITE#; CITY; STATE; ZIP CODE
TREASURER
ADDRESS /r,,
(Residence or Business) r �% (// /'C f ((�(• ��j(i(�fjr �(O a! 6
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE /4('?
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-FIR)
Reporting Limit
10 PERIOD Month Day Year Month Day Year
COVERED D ( / G r THROUGH o6/36 /Za,2 t
11 ELECTION ELECTION DATE G- ELECTION TYPE
Month Day Year ❑ Primary ❑ Runoff ❑ Other
Description
❑ General ❑ 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
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 NAME-.f� 16 Filer ID (Ethics Commission Filers)
V efe 1a /c>m ks�)
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)
. . . . . . . . . . . . . . . . . . .
END
TOTALS ITURE 3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
4. TOTAL POLITICAL EXPENDITURES $
. . . . . . . . . . . . . . . . . . .
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY / s-4
BALANCE OF REPORTING PERIOD $ 1p �• �—
. . . . . . . . . . . . . . . . . .
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.
gnatur f Candidate or Officeholder
Please complete either option below:
`"""'�� LINDSAY WELLS
N� '{ p4 i1
P
(1)Affidavit =? �"Notary Public, State of Texas
%rz Comm. Expires 05-02-2023
OF
Notary Notary ID 128603536
NOTARY STAMP/SEAL
Swom to and subscribed before me by this the day of
2 � 1 to certi whi witness my hand an l ffic
and seae.
1. O
nature of offic stering oa Printed name 114jicer administering oath Title of o ficer dministering 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) (year)
Signature of Candidate/Officeholder (Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020