HomeMy WebLinkAbout2022 Tompkins semi JulyCANDIDATE / 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
/ �G./�p f4
441
OFFICE USE ONLY
NAME..
......................................r..'............
NICKNAME LAST SUFFIX
Date ec i d
/
.1'L 2022
4 CANDIDATE /
ADDRESS / PO BOX; APT / SUITE #, CITY; STATE, ZIP CODE
OFFICEHOLDER
MAILING
ADDRESS
/ (p� (eg,-
CITY OF EULESS
❑ Change of Address
�' {�i�j�
5 CANDIDATE/
AREA CODE PHCIP4 NUMBER EXTENSION
Date Hand -delivered or Date Postmarked
POFFICEHOLDER
HONE
n � I �G��
/ p! (
Receipt #
Amount $
6 CAMPAIGN
TREASURER
MIS / MRS / MR FIRST MI
A•..•••••••............•••
Date Processed
r..
NAME
0...............
NICKNAME LAST SUFFIX
Date Imaged
//
, rm
, !C
7 CAMPAIGN
STREETADDRESS (NO PO BOX LEASE); APT / SUITE #; CITY;
STATE, ZIP CODE
TREASURER
ADDRESS
%/
C! �/ Or A' (eS
�j� (�
ql O`Y"
(Residence or Business)
( %i� I ( k
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
pC J�
\�
9 REPORT TYPE
January 15 30thhdday before election Runoff
15th day after campaign
treasurer appointment
uly 15 8th day before election Exceeded Modified
(Officeholder Only)
Final Report (Attach C/OH - FR)
SSSSSS����� Reporting Limit
10 PERIOD
Month Day Year Month
Day Year
COVERED
v L n n THROUGH 4 4,/ 30
O ( / �� / 270 L
11 ELECTION
ELECTION DATE
ELECTION TYPE
❑ Primary ❑ Runoff ❑ Other
Month Day Year
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 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 NAE �
eIn .(°� 4S
16 Filer ID (Ethics Commission Filers)
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)
Pi)
j�
EXPENDITURE
TOTALS
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
4. TOTAL POLITICAL EXPENDITURES
$
...................
CONTRIBUTION
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
BALANCE
OF REPORTING PERIOD
OUTSTANDING
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
q,
$
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 Co
gnature of Candidate
7 /
or Officeholder
Please complete either option below:
JACOUELINE ROSS
1N;iY .�,V6 �i
(1) Affidavit a° Notary Public, State of Texas
01-18-2026
Comm. Expires
Notary ID 133538661
NOTARY STAMP / SEALSworn
to to and subscribed before me by , 'o-".� D ?'l this the 61
day of
20 Jo certify w ' h, witness my hand and seal f'office.
P"-s
e `..�,
No f
Signat e o icer administering oath Printed name of officer administering oath
•
Title of officer Aministering oath
(2) Unsworn Declaration
My name is and my date of birth is
My address is
1
(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