HomeMy WebLinkAbout221014 -- Campaign Finance Report -- Jacob RandolphCANDIDATE I OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
The C/OH Instruction Guid e explains how to complete this form . 1 1
Fi ler I D (Ethics Commission Filers) 2 Tota l pages filed: ~
3 CANDIDATE/ MS I MR S I MR FIR ST M l
OFF ICEHOLDER ..... J.~c o.? L OFFICE USE ONLY
NAME .. .. ................. ... . ... . .................. . .... Date Received
NICKNAME R~s~~ e>f p h SUFFIX
4 CANDIDATE/ ADDRESS I PO BOX: APT I SU ITE #: CITY; STATE : ZIP CODE RECEIVED
OFFICEHOLDER (\
0 C hange of Address 12: ac, pt1\.
5 CAND I DATE/ AREA CODE PHONE NUMBER EXTE NSION Date Hand-deli vered or Date Po stm ark ed
OFF ICEHOLDER ( PHONE
Receipt # I Amount $
6 CAMPA IGN MS I MR S I MR FIRST Ml
TREASURER Jc.c,o b L,
NAME ..... ..... .... .... .... .. ....... ...... . ................... . ..... ............ . .. Date Processed
NI CKNAME LA ST SUFF IX
~Ol/{\J <J(f h Date Im aged
7 CAMPAIGN STREET ADDRESS (N O PO BOX PLEASE): APT I SU IT E #: CITY: STATE ; ZIP CODE
TREASURER ADDRESS . (Residence or Business)
8 CAMPAIGN AREA CO DE PHONE NUM BER EXTENS ION
TREASURER )
9 REPORT TYPE D January 15 ~ 30th day before election D Runoff D 15th day after campa ign
trea surer appointment
(O fficeholder On ly)
D July 15 D 8th day before election D Exceeded Modified D Final Report (Attach C/PH -FR)
Reporting Limit
10 PER IOD Month Day Year Month Day 'Yea r
COVERED ? / ri /dJ'~d-.10. /I L( / ).Od-~· THROUGH
11 ELECTION ELE CTION DAT E ELECT ION TYPE ' •. I
Month Day Year 0 Primary 0 Runoff D Other
Description
tf / cl /lo"dJ ~Gene ra l D S pecial
12 OFF ICE OFF ICE HELD (if any) 113 o/vt;~~ ;: known)
~
14 NOTI CE FROM TH IS BOX IS FOR NOT ICE OF POLITI CA L CONTR IBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLIT ICAL COMMITTEES TO SUPPORT
POLITICAL THE CAND IDATE I OFF ICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITNOUT THE CANDIDATE'S OR OFFICEHOLDER'S KNOWLEDGE OR
CONSENT. CANDIDATES AND OFF ICEHOLDERS ARE REQUIR ED TO REPORT THIS INFORMATI ON ONLY IF THEY RECEIVE NOT ICE OF SUCH EXPEND ITURES .
COMM ITTEE(S)
COMM ITTEE TYPE COMM ITTEE NAME
0 GE NERAL
CO MMITTE E ADDRESS
0 Add itiona l Pages
O sPEc 1F1c CO MM ITT EE CAMPAIGN TREASURER NAME
CO MM ITT EE CA M PA IG N TREAS U RER ADDRESS
GO TO PAGE 2
Forms provid ed by Texas Eth ics Comm iss ion www.ethics.state.tx .us Revised 8/171 2020
CANDIDATE I OFFICEHOLDER
CAMPAIGN FINANCE REPORT
FORM C/OH
COVER SHEET PG 2
15 C/OH NAME 16 Fi ler ID (Ethics Commission Fi lers)
17 CONTRIBUTION 1 .
TOTALS
2.
...................
EXPEND ITURE 3. TOTALS
4.
...................
CONTRIBUTION 5.
BALANCE
. . . . . . . . . . . . . . . . . .
OUTSTANDING 6.
LOAN TOTALS
TOTAL UNITEMIZED POLITICAL CONTR IBUTI ONS (OTHER THAN
PLEDGES , LOANS , OR GUARANTEES OF LOANS , OR
CON TRI BUTIONS MADE ELECTRON I CALLY)
TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
TOT AL UNITEMIZED POLITI CA L EXPENDITURE .
TOTAL POLITICAL EXPENDITURES
TOTAL POLITICAL CONTR I BUT I ONS MAINTA I NED AS OF THE LAST DAY
OF REPORTING PERIOD
TOTAL PR IN CIPAL A MOUNT OF AL L OUTSTAND IN G LOAN S AS OF THE
LAST DAY OF THE REPORTING PERIOD
$ 0
$ 0
$ 0
$ 0
$ 0
$ 0
18 S I GNATUR E I swear. or affirm , und er penalty of perjury, that th e accompa nying report is tru e and correct and includes all information
Please complete either option below:
JACKIE RANGEL
Notary Public • State of Texas
IOI 13268326-5
My Comm. Exptres 09-18-2024
NOTARY STAMP /SEAL
Sworn to and subscribed before me by _U~Of.~t{J __ b_~/~--.... t~ll_Jt~t:i_tJ_J.,.tJ~h~--thi s th e
I II-/ day of {}f!;:f; be.,r·
(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)
Sign ature of Cand id ate/Office hold er (Declarant)
Forms prov ided by Texas Ethi cs Commiss ion 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)
Jc cob i Ko11/1d0 ttJ ~
(!
21 SCHEDULE SUBTOTALS SUBTOTAL
NAME OF SCHEDULE AMOUNT
i. D SCHEDULE Ai: MONETARY POLITICAL CONTRIBUTIONS $ r?J
2. D SCHEDULE A2: NON-MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS $ 0
3. D SCHEDULE B: PLEDGED CONTRIBUTIONS $ 0
4. D SCHEDULE E: LOANS $ ()
~
5. D SCHEDULE Fi: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ ()
6. D SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $ 0
7. D SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $ ()
~
8. D SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $ ()
~
9. D SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS $ ()
iO. D SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $ ()
i 1. D SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ ()
12. D SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED $ 0 TO FILER
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A1
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 SchedLile A 1:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date 5 Full name of contributor 0 out-of-state PAC (ID#· ) 7 Amount of contribution ($)
,,,,,,,,,,,, ........... . ...........
6 Contributor address; City; State; Zip Code
8 Principal occupation I Job title (See Instructions) 9 Employer (See Instructions)
Date Full name of contributor 0 out-of-state PAC (ID#: ) Amount of contribution ($)
... ··················· ······· ......... ....... .......... ..... .......
Contributor address, City; State: Zip Code
Principal occupation I Job title (See Instructions) Employer (See Instructions)
---
Date Full name of contributor 0 out-of-state PAC (ID#: ) Amount of contribution ($)
.. ············ ······ . ,,,,,,, ······· ...... ...... . . . . . . . ''''' ........
Contributor address; City; State; Zip Code
Principal occupation I Job title (See Instructions) Employer (See Instructions)
~·
Date Full name of contributor 0 out-of-state PAC (ID# ) Amount of contribution ($)
......... .... . . . . . . . . ········ ... .... .... . ..... . ....... .......
Contributor address; City; State; Zip Code
-.-·-.. ~---~o•~AO~"''~-''"-~
Pr111c1pal occupation I Job title (See lnstructione) 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 811712020