HomeMy WebLinkAboutMike Gould - January 2022 CANDIDATE /
CAMPAIGN FINANC REPORTR ORIGINALFORM C/OH
COVER SHEET PG 1
1 Filer ID(Ethics Commission Filers) 2 Total es fil
The C/OH Instruction Guide explains how to complete this form.
3 CANDIDATE/ MS/MRS/MR FIRST MI O �ttt rlrri4
OFFICEHOLDER Mr Michael ,moo !..'..•.. `'�,
Date f�Qc4'51 ` "
NICKNAME LAST SUFFIX
Mike Gould r'
L 'cA � , A. t O
4 CANDIDATE/ ADDRESS /PO BOX; APT/SUITE#, CITY; STATE; ZIP CODE — .'` :0 •
OFFICEHOLDER 1550 W Plano Pkwy, #2228 Plano, TX 75075 til - _
MAILING
ADDRESS ,. o� 0 '
Change of Address /i,�1111r711 tutu
•
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION
OFFICEHOLDER D Hand-delivered orate P st Scz.44._
PHONE (469 ) 332-8334 OI, / . a007A
Receipt# Amount
6 CAMPAIGN MS/MRS/MR FIRST MI
TREASURER Ms. Lan t� qqq �^/(�
NAME �c�,Pr9sed�o�
NICKNAME LAST SUFFIX /
Buttery Date Imaged
7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT/SUITE#; CITY STATE; ZIP CODE
TREASURER 3212 N Jupiter Rd, Ste 109, Garland, TX 75044
ADDRESS
(Residence or Business)
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE ( 972 ) 998-8287
9 REPORT TYPE January 15 30th day before election Runoff 15th day after campaign
treasurer appointment
(Officeholder Only)
July 15 8th day before election I Exceeded Modified Final Report(Attach C/OH-FR)
Reporting Limit
10 PERIOD Month Day Year Month Day Year
COVERED 10 11 21 THROUGH 1 j 18 / 22
11 ELECTION ELECTION DATE ELECTION TYPE
• Pnmary Runoff Other
Month Day Year Description
3 / 1 / 22 General Special
12 OFFICE OFFICE HELD (if any) 13 OFFICE SOUGHT (if known)
Collin County District Clef
CO N
14 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEE TO SUPPORT
'S OR OFFICE OLDER'S K EDGE OR
THE CANDIDATE/OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE
POLITICAL
CONSENT.CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTI OF SUCH E DITURES.
COMMITTEE(S)
COMMITTEE TYPE COMMITTEE NAME ---
GENERAL COMMITTEE ADDRESS —Lj
Additional Pages
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME •r,
N
N
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 16 Filer ID (Ethics Commission Filers)
Mike Gould
17 CONTRIBUTION 1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS,OR $ 0.00
CONTRIBUTIONS MADE ELECTRONICALLY)
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) 0.00
EXPENDITURE 3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
TOTALS $ 0.00
4. TOTAL POLITICAL EXPENDITURES $ 2, 147. 10
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE OF REPORTING PERIOD $ 60.00
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE 2 ZOO.00
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
NOTARY STAMP/SEAL
Sworn to and subscribed before me by this the day of
20 , to certify which,witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
OR
(2)Unsworn Declaration
My name is Michael Gould , and my date of birth is July 12, 1968
My address is 1550 W Plano Pkwy, #2228 , Plano , TX , 75075 , USA
•
(street) (city) (state) (zip code) (country)
Executed in Collin County,State of Texas ,on the 18th day of January 2022
(year)
Signature of Candidate/Officeholder(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
SUBTOTALS - C/OH FORM C/OH
COVER SHEET PG 3
19 FILER NAME 20 Filer ID(Ethics Commission Filers)
Mike Gould
21 SCHEDULE SUBTOTALS SUBTOTAL
NAME OF SCHEDULE AMOUNT
1. SCHEDULE Al: MONETARY POLITICAL CONTRIBUTIONS $
2. SCHEDULEA2: NON-MONETARY(IN-KIND)POLITICAL CONTRIBUTIONS $
3. SCHEDULE B: PLEDGED CONTRIBUTIONS $
4. MI SCHEDULE E: LOANS $ 2,200.00
5. SCHEDULE Fl: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $
6. SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $
7. SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $
8. SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $
9. • SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS $ 2,147.10
10. SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $
11. SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $
12. SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS,AND CONTRIBUTIONS RETURNED $
TO FILER
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule Al:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Full name of contributor out-of-state PAC(ID# ) 7 Amount of contribution ($)
6 Contributor address; City; State; Zip Code
8 Principal occupation/Job title(See Instructions) g Employer(See Instructions)
Date Full name of contributor out-of-state PAC(ID# Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of contributor out-of-state PAC(ID# ) Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of contributor out-of-state PAC(ID# ) Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation/Job title(See Instructions) Employer(See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC,please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
NON-MONETARY (IN-KIND) POLITICAL
CONTRIBUTIONS SCHEDULE A2
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form.
I Total pages Schedule A2:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED IN-KIND POLITICAL CONTRIBUTIONS $
5 Date 6 Full name of contributor ❑out-of-state PAC(ID# ) 8 Amount of I y In-kind contribution
Contribution $ I description
7 Contributor address; City; State; Zip Code
Check if travel outside of Texas.Complete Schedule T.
10 Principal occupation/Job title (FOR NON-JUDICIAL)(See Instructions) 11 Employer(FOR NON-JUDICIAL)(See Instructions)
12 Contributors principal occupation (FOR JUDICIAL) 13 Contributors job title(FOR JUDICIAL)(See Instructions)
14 Contributor's employer/law firm(FOR JUDICIAL) 15 Law firm of contributors spouse (if any)(FOR JUDICIAL)
16 If contributor is a child, law firm of parent(s)(if any)(FOR JUDICIAL)
Full name of contributor ❑out-of-state PAC(ID#:
Date ) Amount of In-kind contribution
Contribution $ description
Contributor address; City; State; Zip Code I
Check if travel outside of Texas.Complete Schedule T.
Principal occupation/Job title(FOR NON-JUDICIAL)(See Instructions) Employer(FOR NON-JUDICIAL)(See Instructions)
Contributors principal occupation (FOR JUDICIAL) Contributors job title(FOR JUDICIAL)(See Instructions)
Contributors employer/law firm (FOR JUDICIAL) Law firm of contributors spouse(if any) (FOR JUDICIAL)
If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
PLEDGED CONTRIBUTIONS SCHEDULE B
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule B:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED PLEDGES $
5 Date 6 Full name of pledgor ❑out-of-state PAC(ID#. ) 8 Amount I 9 In-kind contribution
of Pledge$ I description
7 Pledgor address; City; State; Zip Code
I.
Check if travel outside of Texas.Complete Schedule T.
10 Principal occupation/Job title(See Instructions) 11 Employer(See Instructions)
Date Full name of pledgor ❑out-of-state PAC(ID#: ) Amount In-kind contribution
of Pledge$ description
Pledgor address; City; State; Zip Code
Check if travel outside of Texas.Complete Schedule T.
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of pledgor ❑out-of-state PAC(ID#: ) Amount of
In-kind contribution
Pledge$ description
Pledgor address; City; State; Zip Code
Check if travel outside of Texas.Complete Schedule T.
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of pledgor ❑out-of-state PAC(ID#: ) Amount of I In-kind contribution
Pledge$ I description
Pledgor address; City; State; Zip Code
Check if travel outside of Texas.Complete Schedule T.
Principal occupation/Job title(See Instructions) Employer(See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
LOANS SCHEDULE E
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule E:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
Mike Gould
4 TOTAL OF UNITEMIZED LOANS $
5 Date of loan 7 Name of lender ❑out-of-state PAC(ID# ) 9 Loan Amount($)
12/01/2021 Mike Gould 2,100.00
6 Is lender 8 Lender address; City; State; Zip Code 10 Interest rate
a financial 0.00
Institution? 1550 W Plano Pkwy, #2228 Plano, TX 75075
11 Maturity date
Y • N
12 Principal occupation / Job title (See Instructions) 13 Employer (See Instructions)
Manager/Real Estate Self
14 Description of Collateral 15
Check if personal funds were deposited into political
account (See Instructions)
■ none
16 GUARANTOR 17 Name of guarantor 19 Amount Guaranteed($)
INFORMATION
18 Guarantor address; City; State; Zip Code
not applicable
20 Principal Occupation (See Instructions) 21 Employer (See Instructions)
Date of loan Name of lender out-of-state PAC(ID# Loan Amount($)
Is lender Lender address; City; State; Zip Code Interest rate
a financial
Institution?
Maturity date
Y • N
Principal occupation / Job title (See Instructions) Employer (See Instructions)
Description of Collateral
Check if personal funds were deposited into political
account (See Instructions)
none
GUARANTOR Name of guarantor Amount Guaranteed($)
INFORMATION
Guarantor address; City; State; Zip Code
not applicable
Principal Occupation (See Instructions) Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If lender is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE Fl
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gdt/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salanes/VVages/Contract Labor Other(entera category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule Fl: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
Mike Gould
4 Date 5 Payee name
12/03/2021 Collin County GOP
6 Amount ($) 7 Payee address; City; State; Zip Code
1 ,2550.00 2963 W 15th Street Plano TX 75075
8 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE Fees Filing Fee
OF
EXPENDITURE
(c) Check if travel outside of Texas.Complete Schedule T. Check if Austin, TX,officeholder living expense
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH Mike Gould Collin County District Clerk
Date Payee name
11/12/2021 Legal Zoom
Amount ($) Payee address; City; State; Zip Code
621 . 10 Legalzoom.com
Category (See Categories listed at the top of this schedule) Description
PURPOSE Legal Services Formation of LLC
OF
EXPENDITURE
Check if travel outside of Texas.Complete Schedule T. Check if Austin,TX, officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Mike Gould Collin County District Clerk
Date Payee name
10/10/2021 Wix.com
Amount ($) Payee address; City; State; Zip Code
40 Namal Tel Aviv,6350671
276.00 Israel
Category (See Categories listed at the top of this schedule) Description
PURPOSE Advertising Expense Website
OF
EXPENDITURE
Check if travel outside of Texas.Complete Schedule T. Check if Austin,TX,officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Mike Gould Collin County District Clerk
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
UNPAID INCURRED OBLIGATIONS SCHEDULE F2
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salanes/Wages/Contract Labor Other(enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F2: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS $
5 Date 6 Payee name
7 Amount ($) 8 Payee address; City; State; Zip Code
9 TYPE OF
EXPENDITURE Political Non-Political
10 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF
EXPENDITURE
(c) CheckiftraveloutsideofTexas.CompleteScheduleT. Check if Austin,TX, officeholder living expense
11 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
TYPE OF
EXPENDITURE h Political I Non-Political
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas.Complete Schedule T. Check if Austin,TX.officeholder living expense
Complete ONLY if direct Candidate /Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
PURCHASE OF INVESTMENTS MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F3
If the requested information is not applicable, DO NOT include this page in the report.
1 Total pages Schedule F3:
The Instruction Guide explains how to complete this form.
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date 5 Name of person from whom investment is purchased
6 Address of person from whom investment is purchased; City; State; Zip Code
7 Description of investment
8 Amount of investment($)
Date Name of person from whom investment is purchased
Address of person from whom investment is purchased; City; State; Zip Code
Description of investment
Amount of investment($)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
EXPENDITURES MADE BY CREDIT CARD SCHEDULE F4
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 10(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other(enter a category not listed above)
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F4: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TOACREDIT CARD $
5 Date 6 Payee name
7 Amount ($) 8 Payee address; City; State; Zip Code
9 TYPE OF
EXPENDITURE Political Non-Political
10 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas.Complete Schedule T. Check if Austin,TX, officeholder living expense
11 Candidate/Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address: City; State; Zip Code
TYPE OF
EXPENDITURE Political Non-Political
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas.Complete Schedule T. Check if Austin,TX,officeholder living expense
Candidate /Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
POLITICAL EXPENDITURES MADE FROM
PERSONAL FUNDS SCHEDULE G
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Payee name
6 Amount ($) 7 Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
8 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas.Complete Schedule T. Check if Austin,TX,officeholder living expense
9 Candidate/Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas.Complete Schedule T. Check if Austin,TX, officeholder living expense
Candidate/Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas.Complete Schedule T. Check if Austin,TX, officeholder living expense
Candidate/Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
PAYMENT MADE FROM POLITICAL CONTRIBUTIONS
TO A BUSINESS OF C/OH SCHEDULE H
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/VVages/Contract Labor Other(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule H: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Business name
6 Amount ($) 7 Business address; City; State; Zip Code
8 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF
EXPENDITURE
(c) Check if travel outside of Texas.Complete Schedule T. Check if Austin,TX,officeholder living expense
9 Complete ONLY if direct Candidate /Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Business name
Amount ($) Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas.Complete Schedule T. Check if Austin,TX, officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Business name
Amount ($) Business address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas.Complete Schedule T. Check if Austin,TX,officeholder living expense
Complete ONLY if direct Candidate /Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
NON-POLITICAL EXPENDITURES
MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form.
1 Total pages Schedule I: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Payee name
6 Amount ($) 7 Payee address; City State Zip Code
8 (a)Category (See instructions for examples of acceptable (b)Description (See instructions regarding type of information
PURPOSE categories.) required.)
OF
EXPENDITURE
Date Payee name
Amount ($) Payee address; City State Zip Code
Category (See instructions for examples of acceptable Description (See instructions regarding type of information
PURPOSE categories.) required.)
OF
EXPENDITURE
Date Payee name
Amount ($) Payee address; City State Zip Code
Category (See instructions for examples of acceptable Description (See instructions regarding type of information
PURPOSE categories.) required.)
OF
EXPENDITURE
Date Payee name
Amount ($) Payee address; City State Zip Code
Category (See instructions for examples of acceptable Description (See instructions regarding type of information
PURPOSE categories.) required.)
OF
EXPENDITURE
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER SCHEDULE K
If the requested information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how to complete this form. 1 Total pages Schedule K:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Name of person from whom amount is received 8 Amount ($)
6 Address of person from whom amount is received; City; State; Zip Code
7 Purpose for which amount is received Check if political contribution returned to filer
Date Name of person from whom amount is received Amount ($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received Check if political contribution returned to filer
Date Name of person from whom amount is received Amount($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received Check if political contribution returned to filer
Date Name of person from whom amount is received Amount($)
Address of person from whom amount is received; City; State; Zip Code
Purpose for which amount is received Check if political contribution returned to filer
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
IN-KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES SCHEDULE T
FOR TRAVEL OUTSIDE OF TEXAS
If the requested information is not applicable, DO NOT include this page in the report.
1 Total pages Schedule T:
The Instruction Guide explains how to complete this form.
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Name of Contributor/Corporation or Labor Organization/Pledgor/Payee
5 Contribution/Expenditure reported on:
I Schedule A2 Schedule B 7 Schedule B(J) 7 Schedule C2 7 Schedule D Schedule F1
7 Schedule F2 7 Schedule F4 7 Schedule G 7 Schedule H Schedule COH-UC Schedule B-SS
6 Dates of travel 7 Name of person(s)traveling
8 Departure city or name of departure location
9 Destination city or name of destination location
10 Means of transportation 11 Purpose of travel(including name of conference,seminar,or other event)
Name of Contributor/Corporation or Labor Organization/Pledgor/Payee
Contribution/Expenditure reported on:
P Schedule A2 Schedule B 7 Schedule B(J) 7 Schedule C2 7 Schedule D Schedule F1
7 Schedule F2 7 Schedule F4 7 Schedule G 7 Schedule H 7 Schedule COH-UC Schedule B-SS
Dates of travel Name of person(s)traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation Purpose of travel(including name of conference,seminar,or other event)
Name of Contributor/Corporation or Labor Organization/Pledgor/Payee
Contribution/Expenditure reported on:
r Schedule A2 r Schedule B n Schedule B(J) Schedule C2 7 Schedule D P Schedule F1
7 Schedule F2 7 Schedule F4 7 Schedule G Schedule H 7 Schedule COH-UC [ Schedule B-SS
Dates of travel Name of person(s)traveling
Departure city or name of departure location
Destination city or name of destination location
Means of transportation Purpose of travel(including name of conference,seminar,or other event)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
CANDIDATE / OFFICEHOLDER REPORT:
DESIGNATION OF FINAL REPORT FORM C/OH - FR
The Instruction Guide explains how to complete this form.
•• Complete only if"Report Type" on page 1 is marked "Final Report" ••
1 C/OH NAME 2 Filer ID (Ethics Commission Filers)
3 SIGNATURE
I do not expect any further political contributions or political expenditures in connection with my candidacy. I understand that
designating a report as a final report terminates my campaign treasurer appointment. I also understand that I may not accept any
campaign contributions or make any campaign expenditures without a campaign treasurer appointment on file.
Signature of Candidate/Officeholder
4 FILER WHO IS NOT AN OFFICEHOLDER
•• Complete A & B below only if you are not an officeholder. --
A. CAMPAIGN FUNDS
Check only one:
I do not have unexpended contributions or unexpended interest or income earned from political contributions.
I have unexpended contributions or unexpended interest or income earned from political contributions. I understand that
may not convert unexpended political contributions or unexpended interest or income earned on political contributions to
personal use. I also understand that I must file an annual report of unexpended contributions and that I may not retain
unexpended contributions or unexpended interest or income earned on political contributions longer than six years after
filing this final report. Further. I understand that I must dispose of unexpended political contributions and unexpended
interest or income earned on political contributions in accordance with the requirements of Election Code,§254.204.
B. ASSETS
Check only one:
I do not retain assets purchased with political contributions or interest or other income from political contributions.
I do retain assets purchased with political contributions or interest or other income from political contributions. I understand
that I may not convert assets purchased with political contributions or interest or other income from political contributions to
personal use. I also understand that I must dispose of assets purchased with political contributions in accordance with the
requirements of Election Code,§254.204.
Signature of Candidate
5 OFFICEHOLDER
•• Complete this section only if you are an officeholder ••
I am aware that I remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer on
file. I am also aware that I will be required to file reports of unexpended contributions if, after filing the last required report as
an officeholder. I retain political contributions, interest or other income from political contributions, or assets purchased with
political contributions or interest or other income from political contributions.
Signature of Officeholder
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020