HomeMy WebLinkAbout2023 Tompkins semi JanCANDIDATE / 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:
3 CANDIDATE /
OFFICEHOLDER
NAME....
MIS / MRS / MR F ST MI
��eM�
iI .'.................... .................................................
SUFFIX
NICKNAME I AST SUFFIX
' oJ � 1
OFFICE USE ONLY
Date Received
i IqJd03
4 CANDIDATE /
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
OFFICEHOLDER
MAILING
ADDRESS
/ /<� % O
39 Pc"
❑ Change of Address
I
5 CANDIDATE/
OFFICEPHONE HOLDER
AREA CODE PHONE NUMBER EXTENSION
/ .271
Date Hand -delivered or Date Postmarked
D r
Receipt #
Amount -
6 CAMPAIGN
MS / MRS / MR FIRST MI
TREASURER
NAME0!
C 1+01 i A
......................................................................
Date Processed
NICKNAME LAST SUFFIX
O
fo� ���
Date Imaged
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PL ASE); APT / SUITE #; CITY; STATE; ZIP CODE
TREASURER
ADDRESS
(Residence or Business)
0 5!P ��% v��l �� 0 �U
8 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
✓
9 REPORT TYPE
January 15 30✓th 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
Month Day Year Month Day Year
COVERED
THROUGH
b7 / pl 12 a 2 Z / 2!❑ ,31 ❑ Z v 2 z_
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
/ /
❑ Primary ❑ Runoff ❑ Other
Description
❑ General ❑ Special
12 OFFICE
OFFIC HELD (if any)
13 OFFICE SOUGHT (if known)
CU 1:
14 NOTICE FROM
POLITICAL
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(S)
CONINIITTEE TYPE
COMMITTEE NAME
❑ Additional Pages
GENERAL
COMMITTEE ADDRESS
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 11/15/2022
CANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT
COVER SHEET PG 2
15 C/OH NAME
�p/
16 Filer ID (Ethics Commission Filers)
/ em 1 U •'t
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)
TOTAEXPELS
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
$
...................
4. TOTAL POLITICAL EXPENDITURES
$ /X
J�
CONTRIBUTION
BALANCE
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$ 3.
..................
OF REPORTING PERIOD
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.
Signature of Candidate or Officeholder
Please complete either option below:
(1) Affidavit `�„ ru�r, ttiANi�E C �'t_JfIES
O'pY P.0 .'asll
o i'iowy Public, >r, ita of
"'omm. L• xPires 11 2, 2026
Netary ID 131801914
NOTARY STAM `jam L�
Sworn to and subscribed before me by �%( �� J {�Y1 d �1�� this the ! day of A
, to certify which, witness my hand and seal of Ale.
e-
Signaturb of officer administering oath Printed name of officer administering oath Title of officer a Q inistering 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 11/15/2022