HomeMy WebLinkAboutJohn Dobiyanski 011520147
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FIRST
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LAST
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APT I SUITE 11;
!Ja"Annual
Month DI!y Year
I / I /z OO~
Month
I
ua-1inal Disposition
ltROJ2H
TOTAL AMOUNT OF UNEXPENDED POLITICAL CONTRIBUTIONS AS OF
DEC 31 OF THE PREVIOUS YEAR.
1. $ 39. qJ
2. TOTAL AMOUNT OF INTEREST AND OTHER INCOME EARNED ON
UNEXPEN)ED POLITICAL CONTRIBUTIONS DURING THE PREVIOUS
YEAR
$ o
SUFFIX
MI
STATE; ZIPCODE
Day Year
/IS/ZDtt/
.
2 CANDIDATE I
OFFICEHOLDER
NAME
3 CANDIDATE I
OFFICEHOLDER
ADDRESS
D change of address
4 REPORT
TYPE
6 PERIOD
COVERED
6 TOTALS
Texas Ethics Commission p.o. Box 12070 Austin, Texas 78711-2070 512 463-5800 01-800-735-2989
CANDIDATE I OFFICEHOLDER DORIGINAL FORM C/OH-UC
REPORT OF UNEXPENDED CONTRIBUTIONS COVER SHEET PG 1
1 ACCOUNT # (EltIb Commisoion rllers)
The C/OH·UC Instnlotion Gu ide explains how to oomplete this form.
AFFIDAVlT
r swear, or affirm, under penalty of perjury, that the accompanying
report is true and correct and inoludes all information required to be
reported me under Title 15, Election Code.
Signature of Candidate or Officeholde
....UCJ:
1 J
._ • ...AfFIX ~ARY STAMP I SEAL ABOVE ..-
Sworn to and subscribed before me, by the said -6 0V\,{\ ~()\d \~ (A \fl0'¥:'\ . this the _15 day
of d:(r\Y\ ,20 --l.1--.,to certify which,witness my hand and seal of office.
Title 0:;:::re ofofficera~oath
Revised 06/30/2006www.ethics.state.tx.us
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512)463-5800 ITDD 1-800-735-2989)
•
C/OH REPORT OF UNEXPENDED CONTRIBUTIONS
EXPENDITURES
8 C/OH NAMEJat I\.. W~ ~ (I (J)ob (LtCMl Jt:'
10 Date 11 Payee name
.C/)/(;~. C~~ . f.t.t G......()-f . . .0q l'1 12 Payee address; City; Slate; Zip Code
911 //p S+t<.t fJ f()~, ~-f. /00
fh c. f:h (\~'" 7ekl< J 7.16)0
14 PUIlJOSe of expenditure
o/..e.. pie +c un eJCft!-(\d~£ e,() {\ ff'(·J<..J +/01\ .s
(If travel outside of Texas, complete Sclledule T) (See Instruction Guide)
Date Payee name
. . . . . . . . .. . ...
Payee address; City; State: Zip Code
PUllJOse of expenditure
(If travel outside of Texas, complete Scnedule 1') (See Instruction Guide)
Date Payee name
. . . . . . . . . . . . ... . . . . . . .
Payee address; City; Slate; Zip Code
Purpose ofexpenditure
(If travel outside of Texas, complete Schedule 1') (See Instruction Guide)
Dale Payee name
. . . . . . . . .. . . . , . . . . . . . .
Payee address; City; Slate; Zip Code
PUllJOse of eJq>9nditure
(If travel outside of Texas, complete Schedule 1') (See Instruction Guide)
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED
FORM C/OH-UC
DORIGINAL PG2
9 ACCOUNTIJ(EIhic;sCommissWnfile",)
13 Amount
($)
..... . ·.. ..
3 S1. C; I
16
Is expenditure a contribution 0 Yes
to a candidate, officeholder, or
polillcal commillee? ~No
Amount
(S~ ~T}
C.........
;l::» ~
-U1 .,
~
:::E: m ..16
Is expenditure a contribution ~
to a candidate. officeholder, or 0 Yes
Nopolitical committee?
Amount
($)
. .. ..· .
16
Is expenditure a contribution 0 Yes
to a candidate. officeholder, or
Nopolitical committee? 0
Amount
($)
. . ·. ..
16 IIs expenditure a contribution D Yes
to a candidate, officeholder, or
Nopolitical committee? 0
Revised 06/30/2006www.ethics.state.tx.us