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HomeMy WebLinkAbout241028 -- Campaign Finance Report -- Valen CepakCANDIDATE / OFFICEHOLDER FORM C/OH CAMPAIGN FINANCE REPORT COVER SHEET PG 1 The C/OH Instruction Guide explains how to complete this form. 3 CANDIDATE / OFFICEHOLDER NAME 4 CANDIDATE / OFFICEHOLDER MAILING ADDRESS II Change of Address 5 CANDIDATE/ OFFICEHOLDER PHONE 6 CAMPAIGN TREASURER NAME 7 CAMPAIGN TREASURER ADDRESS (Residence or Business) 8 CAMPAIGN TREASURER PHONE 9 REPORT TYPE 10 PERIOD COVERED 11 ELECTION 12 OFFICE 14 NOTICE FROM POLITICAL COMMITTEE(S) Additional Pages MS / MRS / MR 1 Filer ID (Ethics Commission Filers) 2 Total pages filed: FIRST Valen MI L NICKNAME LAST ADDRESS / PO BOX; Cepak SUFFIX APT / SUITE #; CITY; STATE; ZIP CODE AREA CODE ( ) MS / MRS / MR PHONE NUMBER EXTENSION FIRST L• uis MI NICKNAME LAST Foncerrada PascalsuFFlx STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; 1900 Dartmouth St AREA CODE PHONE NUMBER ( ) January 15 July 15 Month f1 OFFICE USE ONLY Date Received Date Hand -delivered or Date Postmarked Receipt # Date Processed Date Imaged Amount $ CITY; STATE; ZIP CODE College Station TX EXTENSION 30th day before election 1 Runoff 8th day before election Day Year 10 / 7 / 2024 THROUGH Exceeded Modified Reporting Limit 77840 15th day after campaign treasurer appointment (Officeholder Only) Final Report (Attach C/OH - FR) Month Day Year 10/28/ 24 ELECTION DATE ELECTION TYPE Month Day Year 11 / 05/24 OFFICE HELD (if any) Primary General Runoff Special Other Description 13 OFFICE SOUGHT (if known) 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 TYPE ❑ GENERAL ❑ SPECIFIC COMMITTEE NAME COMMITTEE ADDRESS COMMITTEE CAMPAIGN TREASURER NAME COMMITTEE CAMPAIGN TREASURER ADDRESS Forms provided by Texas Ethics Commission GO TO PAGE 2 www.ethics.state.tx.us Revised 1/1/2024 CANDIDATE / OFFICEHOLDER FORM C/OH CAMPAIGN FINANCE REPORT 15 C/OH NAME VALEN CEPAK 17 CONTRIBUTION TOTALS EXPENDITURE TOTALS CONTRIBUTION BALANCE OUTSTANDING LOAN TOTALS 1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR CONTRIBUTIONS MADE ELECTRONICALLY) 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) 3. TOTAL UNITEMIZED POLITICAL EXPENDITURE. 4. TOTAL POLITICAL EXPENDITURES COVER SHEET PG 2 16 Filer ID (Ethics Commission Filers) 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF REPORTING PERIOD $ 552.00 $ 1,302.00 $ 316.00 $ 967.00 $ 335.00 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE 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 Off holder Please complete either option below: (1) Affidavit NOTARY STAMP/SEAL Sworn to and subscribed before me by 20 , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath this the day of Title of officer administering oath OR (2) Unsworn Declaration My name is VALEN CEPAK My address is 301 MANUEL UNIT B (street) Executed in BRAZOS County, State of TEXAS , on the 7 , and my date of birth is 09/24/1998 COLLEGE STATION TX 77840 USA (city) (state) (zip code) (country) day of OCTOBER 2024 (month) (year) Forms provided by Texas Ethics Comm Reset Form Signature of Candidate/Officeholder (Declarant) Reset Page Revised 1/1/2024 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. SUBTOTALS - C/OH FORM C/OH COVER SHEET PG 3 19 FILER NAME VALEN CEPAK 21 SCHEDULE SUBTOTALS NAME OF SCHEDULE ▪ SCHEDULE Al : MONETARY POLITICAL CONTRIBUTIONS SCHEDULE A2: NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS SCHEDULE B: PLEDGED CONTRIBUTIONS SCHEDULE E: LOANS ▪ SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F2: UNPAID INCURRED OBLIGATIONS SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH SCHEDULE I: NON -POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS 20 Filer ID (Ethics Commission Filers) SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED TO FILER SUBTOTAL AMOUNT $ 1,042.00 $ 0.00 $ 531.67 $ $ $ Forms provided by Texas Ethics Commit ista Reset Form 1 Reset Page Revised 1/1/2024 MONETARY POLITICAL CONTRIBUTIONS If the requested information is not applicable, DO NOT include this page in the report. The Instruction Guide explains how to complete this form. SCHEDULE Al 1 Total pages Schedule Al: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) Valen Cepak 4 Date 5 Full name of contributor James Lund out-of-state PAC (ID#: 10/24/2024 6 Contributor address; City; State; Zip Code ) 7 Amount of contribution ($) 9193 Hensarling Bryan TX 77840 8 Principal occupation / Job title (See Instructions) Systems Analyst Date 10/22/2024 Full name of contributor Darian Shelton 9 Employer (See Instructions) Bank of America out-of-state PAC (ID#: ) Contributor address; City; State; Zip Code 1173 Natchez Dr. College Station TX 77845 Principal occupation / Job title (See Instructions) Sales Representative Employer (See Instructions) C.C. Creations Date Full name of contributor out-of-state PAC (ID#: 10/22/2024 John Schmid Contributor address; City; State; Zip Code 308 agate dr College Station, TX, 77840 Principal occupation / Job title (See Instructions) Pastor Date Full name of contributor 10/17/2024 TREPAC Employer (See Instructions) Fellowship Church out-of-state PAC (ID#: Contributor address; City; State; Zip Code 1115 San Jacinto Blvd, suite 200, Austin, TX 78701 Principal occupation / Job title (See Instructions) Employer (See Instructions) 200.00 Amount of contribution ($) 50.00 Amount of contribution ($) 42.00 Amount of contribution ($) 750.00 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 Comrr Reset Form s.ste Reset Page Revised 1/1/2024 NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS If the requested information is not applicable, DO NOT include this page in the report. The Instruction Guide explains how to complete this form. SCHEDULE A2 1 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#: 7 Contributor address; City; State; Zip Code 8 Amount of 1 g In -kind contribution Contribution $ description 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 Contributor's principal occupation (FOR JUDICIAL) 13 Contributor's job title (FOR JUDICIAL) (See Instructions) 14 Contributor's employer/law firm (FOR JUDICIAL) 15 Law firm of contributor's spouse (if any) (FOR JUDICIAL) 16 If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL) Date Full name of contributor ❑ out-of-state PAC (ID#: Contributor address; City; State; Zip Code Principal occupation / Job title (FOR NON -JUDICIAL) (See Instructions) Contributor's principal occupation (FOR JUDICIAL) Contributor's employer/law firm (FOR JUDICIAL) If contributor is a child, law firm of parent(s) (if any) (FOR JUDICIAL) Amount of In -kind contribution Contribution $ description Check if travel outside of Texas. Complete Schedule T. Employer (FOR NON-JUDICIAL)(See Instructions) Contributor's job title (FOR JUDICIAL) (See Instructions) Law firm of contributor's spouse (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 Comm Reset Form 3.sta Reset Page Revised 1/1/2024 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. 2 FILER NAME 4 TOTAL OF UNITEMIZED PLEDGES 5 Date 6 Full name of pledgor ❑ out-of-state PAC (ID#: 1 Total pages Schedule B: 3 Filer ID (Ethics Commission Filers) 1 8 Amount I 9 In -kind contribution of Pledge $ description 7 Pledgor address; 10 Principal occupation / Job title (See Instructions) Date City; State; Zip Code Check if travel outside of Texas. Complete Schedule T. 11 Employer (See Instructions) Full name of pledgor ❑ out-of-state PAC (ID#: ) Amount of Pledge $ Pledgor address; Principal occupation / Job title (See Instructions) Date City; State; Zip Code In -kind contribution description Check if travel outside of Texas. Complete Schedule T. Employer (See Instructions) Full name of pledgor ❑ out-of-state PAC (ID#: ) Amount of Pledge $ Pledgor address; Principal occupation / Job title (See Instructions) Date City; State; Zip Code Full name of pledgor ❑ out-of-state PAC (ID#: In -kind contribution description Check if travel outside of Texas. Complete Schedule T. Employer (See Instructions) Pledgor address; Principal occupation / Job title (See Instructions) City; State; Zip Code Amount of Pledge $ In -kind contribution description Check if travel outside of Texas. Complete Schedule T. 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 Coma Reset Form rs.st Reset Page Revised 1/1/2024 POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS If the requested information is not applicable, DO NOT include this page in the report. EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Accounting/Banking Consulting Expense Contributions/Donations Made By Candidate/Officeholder/Political Committee Credit Card Payment Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services Loan Repayment/Reimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor The Instruction Guide explains how to complete this form. 1 Total pages Schedule F1: 2 FILER NAME 4 Date 10/25/24 5 Payee name 6 Amount ($) 7 Payee address; 8 28.82 PURPOSE OF EXPENDITURE 9 Complete ONLY if direct expenditure to benefit C/OH Valen Cepak Home Depot City; 1615 University Dr, College Station, TX, 77840 (a) Category (See Categories listed at the top of this schedule) (c) Campaign signs Check if travel outside of Texas. Complete Schedule T. Candidate / Officeholder name Date Payee name 10/25/24 Exxon Amount ($) Payee address; (b) Description SCHEDULE F1 Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) 3 Filer ID (Ethics Commission Filers) State; Zip Code T post for signs Check if Austin, TX, officeholder living expense Office sought City; 30.07 425 s Texas Ave, College Station, TX 77840 PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH Date Amount ($) PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH Category (See Categories listed at the top of this schedule) Description Campaign travel Gas Check if travel outside of Texas. Complete Schedule T. Candidate / Officeholder name Payee name Payee address; Category (See Categories listed at the top of this schedule) Check if travel outside of Texas. Complete Schedule T. Candidate / Officeholder name Office held State; Zip Code Check if Austin, TX, officeholder living expense Office sought City; Description Office held State; Zip Code Check if Austin, TX, officeholder living expense Office sought Office held ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2024 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) 4 TOTAL OF UNITEMIZED LOANS $ 5 Date of loan 6 Is lender a financial Institution? YFN 7 Name of lender ❑ out-of-state PAC (ID#: 8 Lender address; City; State; Zip Code 12 Principal occupation / Job title (See Instructions) 13 Employer (See Instructions) 14 Description of Collateral 15 none 16 GUARANTOR INFORMATION not applicable 9 Loan Amount ($) 10 Interest rate 11 Maturity date Check if personal funds were deposited into political account (See Instructions) 17 Name of guarantor 19 Amount Guaranteed ($) 18 Guarantor address; 20 Principal Occupation (See Instructions) Date of loan Is lender a financial Institution? r I Y N City; State; Zip Code 21 Employer (See Instructions) Name of lender ❑ out-of-state PAC (ID#: Lender address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Description of Collateral none GUARANTOR INFORMATION not applicable Loan Amount ($) Interest rate Maturity date Check if personal funds were deposited into political account (See Instructions) Name of guarantor Amount Guaranteed ($) Guarantor address; Principal Occupation (See Instructions) City; State; Zip Code 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 Comm Reset Form 3.sta Reset Page Revised 1/1/2024 POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS If the requested information is not applicable, DO NOT include this page in the report. EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Accounting/Banking Consulting Expense Contributions/Donations Made By Candidate/Officeholder/Political Committee Credit Card Payment Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services Loan Repayment/Reimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/Wages/Contract Labor The Instruction Guide explains how to complete this form. 1 Total pages Schedule F1: 2 FILER NAME 4 Date 10/8/24 6 Amount ($) 8 27.80 PURPOSE OF EXPENDITURE 9 Complete ONLY if direct expenditure to benefit C/OH Date 10/22/25 Valen Cepak 5 Payee name Copy Corner 7 Payee address; City; SCHEDULE F1 Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) 3 Filer ID (Ethics Commission Filers) State; Zip Code 2307 TEXAS AVE S, COLLEGE STATION, TX 77840 (a) Category (See Categories listed at the top of this schedule) (b) Description Printing (c) Check if travel outside of Texas. Complete Schedule T. Push Flyers Check if Austin, TX, officeholder living expense Candidate / Officeholder name Office sought Payee name Vista Print Amount ($) Payee address; City; 150.00 275 Wayman St PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH Date 10/23/24 Amount ($) Waltham Category (See Categories listed at the top of this schedule) Description Printing Check if travel outside of Texas. Complete Schedule T. Office held State; Zip Code MA 02451 Campaign stickers Check if Austin, TX, officeholder living expense Candidate / Officeholder name Office sought Payee name C.C. CREATIONS Payee address; City; Office held State; Zip Code 294.98 114 HOLLEMAN DRIVE, COLLEGE STATION, TEXAS 77840 PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH Category (See Categories listed at the top of this schedule) Description Campaign Signs Check if travel outside of Texas. Complete Schedule T. Candidate / Officeholder name Signs Check if Austin, TX, officeholder living expense Office sought Office held Forms provided by Texas Ethics Com ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Reset Form cs.s Reset Page Revised 1/1/2024 UNPAID INCURRED OBLIGATIONS 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 Accounting/Banking Fees Office Overhead/Rental Expense Consulting Expense Food/Beverage Expense Polling Expense Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Candidate/Officeholder/Political Committee Legal Services Salaries/VVages/Contract Labor 1 Total pages Schedule F2: The Instruction Guide explains how to complete this form. SCHEDULE F2 Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS $ 5 Date 6 Payee name 7 Amount ($) 8 Payee address; 9 TYPE OF EXPENDITURE 10 PURPOSE OF EXPENDITURE 11 Complete ONLY if direct expenditure to benefit C/OH Date Payee name Amount ($) Payee address; Political n Non -Political City; (a) Category (See Categories listed at the top of this schedule) (b) Description (c) State; Zip Code Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense TYPE OF EXPENDITURE PURPOSE OF EXPENDITURE Candidate / Officeholder name Office sought Office held I- Political Non -Political City; Category (See Categories listed at the top of this schedule) Description State; Zip Code Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name expenditure to benefit C/OH Office sought Office held ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Comi Reset Form cs.s Reset Page Revised 1/1/2024 PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS 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. SCHEDULE F3 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 Date 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 ($) Name of person from whom investment is purchased Address of person from whom investment is purchased; City; State; Zip Code Description of investment Amount of investment ($) ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Commi Reset Form 1.sta Reset Page Revised 1/1/2024 EXPENDITURES MADE BY CREDIT CARD 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 Accounting/Banking Fees Office Overhead/Rental Expense Consulting Expense Food/Beverage Expense Polling Expense Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor SCHEDULE F4 Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) The Instruction Guide explains how to complete this form. USE A NEW PAGE FOR EACH CREDIT CARD ISSUER 1 TOTAL PAGES SCHEDULE F4: 2 FILER NAME 3 FILER ID (Ethics Commission Filers) 4 TOTAL OF UNITEMIZED EXPENDITURES CHARGED TO A CREDIT CARD $ 5 CREDIT CARD ISSUER 6 PAYMENT 7 PAYEE 8 PURPOSE OF EXPENDITURE • Political ▪ Non -Political 9 Complete ONLY if direct expenditure to benefit C/OH Name of financial institution (a) Amount Charged (a) Payee name (b) Date Expenditure Charged (c) Date(s) Credit Card Issuer Paid (b) Payee address; (a) Category (See Categories listed at the top of this schedule) (c) Check if travel outside of Texas. Complete Schedule T. Candidate / Officeholder name PAYMENT (a) Amount Charged PAYEE (a) Payee name PURPOSE OF EXPENDITURE I— Political Non -Political Complete ONLY if direct expenditure to benefit C/OH PAYMENT PAYEE PURPOSE OF EXPENDITURE I— Political ✓ Non -Political (b) Description City, State, Zip Code Check if Austin, TX, officeholder living expense Office Sought Office Held (b) Date Expenditure Charged (c) Date(s) Credit Card Issuer Paid (b) Payee address; (a) Category (See Categories listed at the top of this schedule) (b) Description (c) Check if travel outside of Texas. Complete Schedule T. Candidate / Officeholder name Office Sought (a) Amount Charged (a) Payee name (b) Date Expenditure Charged City, State, Zip Code Check if Austin, TX, officeholder living expense (c) Date(s) Credit Card Issuer Paid (b) Payee address; (a) Category (See Categories listed at the top of this schedule) (c) (b) Description Office Held City, State, Zip Code Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense Complete ONLY if direct Candidate / Officeholder name expenditure to benefit C/OH Office Sought Office Held ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Corr{ Reset Form ics Reset Page Revised 1/1/2024 POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS If the requested information is not applicable, DO NOT include this page in the report. Advertising Expense Accounting/Banking Consulting Expense Contributions/Donations Made By Candidate/Officeholder/Political Committee Credit Card Payment EXPENDITURE CATEGORIES FOR BOX 8(a) Event Expense Fees Food/Beverage Expense Gift/Awards/Memorials Expense Legal Services Loan Repayment/Reimbursement Office Overhead/Rental Expense Polling Expense Printing Expense Salaries/VVages/Contract Labor The Instruction Guide explains how to complete this form. 1 Total pages Schedule G: 2 FILER NAME 4 Date 5 Payee name 6 Amount ($) 7 Payee address; 8 Reimbursement from political contributions intended PURPOSE OF EXPENDITURE (a) Category (See Categories listed at the top of this schedule) (C) Check if travel outside of Texas. Complete Schedule T. 9 Candidate / Officeholder name Complete ONLY if direct expenditure to benefit C/OH Date Payee name Amount ($) Payee address; Reimbursement from political contributions intended PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH Date Amount ($) Reimbursement from political contributions intended PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH Category (See Categories listed at the top of this schedule) Check if travel outside of Texas. Complete Schedule T. Candidate / Officeholder name Payee name Payee address; Category (See Categories listed at the top of this schedule) Check if travel outside of Texas. Complete Schedule T. Candidate / Officeholder name City; (b) Description SCHEDULE G Solicitation/Fundraising Expense Transportation Equipment & Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) 3 Filer ID (Ethics Commission Filers) State; Zip Code Check if Austin, TX, officeholder living expense Office sought Office held City; Description State; Zip Code Check if Austin, TX, officeholder living expense Office sought City; Description Office held State; Zip Code Check if Austin, TX, officeholder living expense Office sought Office held ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Comi Reset Form cs.s Reset Page Revised 1/1/2024 PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH If the requested information is not applicable, DO NOT include this page in the report. EXPENDITURE CATEGORIES FOR BOX 8(a) Advertising Expense Event Expense Loan Repayment/Reimbursement Accounting/Banking Fees Office Overhead/Rental Expense Consulting Expense Food/Beverage Expense Polling Expense Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Candidate/Officeholder/Political Committee Legal Services SalariesNVages/Contract Labor Credit Card Payment The Instruction Guide explains how to complete this form. 1 Total pages Schedule H: 2 FILER NAME 4 Date 6 Amount ($) 8 PURPOSE OF EXPENDITURE SCHEDULE H Solicitation/Fundraising Expense Transportation Equipment& Related Expense Travel In District Travel Out Of District Other (enter a category not listed above) 3 Filer ID (Ethics Commission Filers) 5 Business name 7 Business address; City; State; Zip Code 9 Complete ONLY if direct expenditure to benefit C/OH (a) Category (See Categories listed at the top of this schedule) (b) Description (c) Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense Candidate / Officeholder name Office sought Office held Date Business name Amount ($) Business address; PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH Date Amount ($) PURPOSE OF EXPENDITURE Complete ONLY if direct expenditure to benefit C/OH City; Category (See Categories listed at the top of this schedule) Description State; Zip Code Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense Candidate / Officeholder name Business name Business address; Office sought Office held City; Category (See Categories listed at the top of this schedule) Description State; Zip Code Check if travel outside of Texas. Complete Schedule T. Check if Austin, TX, officeholder living expense Candidate / Officeholder name Office sought Office held Forms provided by Texas Ethics Corn ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Reset Form cs.s Reset Page Revised 1/1/2024 NON -POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS 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 4 Date 5 Payee name 6 Amount ($) 7 Payee address; 8 PURPOSE OF EXPENDITURE City SCHEDULE 3 Filer ID (Ethics Commission Filers) State Zip Code (a) Category (See instructions for examples of acceptable (b) Description (See instructions regarding type of information categories.) required.) Date Payee name Amount ($) Payee address; PURPOSE OF EXPENDITURE City State Zip Code Category (See instructions for examples of acceptable Description (See instructions regarding type of information categories.) required.) Date Payee name Amount ($) Payee address; PURPOSE OF EXPENDITURE Date City State Zip Code Category (See instructions for examples of acceptable Description (See instructions regarding type of information categories.) required.) Payee name Amount ($) Payee address; PURPOSE OF EXPENDITURE City State Zip Code Category (See instructions for examples of acceptable Description (See instructions regarding type of information required.) categories.) ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Comi Reset Form cs.s Reset Page Revised 1/1/2024 INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED TO FILER If the requested information is not applicable, DO NOT include this page in the report. The Instruction Guide explains how to complete this form. SCHEDULE K 1 Total pages Schedule K: 2 FILER NAME 3 Filer ID (Ethics Commission Filers) 4 Date Date Date Date 5 Name of person from whom amount is received 6 Address of person from whom amount is received; City; State; Zip Code 8 Amount ($) 7 Purpose for which amount is received Check if political contribution returned to filer Name of person from whom amount is received Address of person from whom amount is received; City; State; Zip Code Amount ($) Purpose for which amount is received Check if political contribution returned to filer Name of person from whom amount is received Address of person from whom amount is received; City; State; Zip Code Purpose for which amount is received Name of person from whom amount is received Amount ($) Check if political contribution returned to filer Amount ($) 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 Comi Reset Form cs.s Revised 1/1/2024 IN -KIND CONTRIBUTIONS OR POLITICAL EXPENDITURES FOR TRAVEL OUTSIDE OF TEXAS If the requested information is not applicable, DO NOT include this page in the report. The Instruction Guide explains how to complete this form. 2 FILER NAME 4 Name of Contributor / Corporation or Labor Organization / Pledgor / Payee SCHEDULE T 1 Total pages Schedule T: 3 Filer ID (Ethics Commission Filers) 5 Contribution / Expenditure reported on: Cj Schedule A2 C Schedule B E Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1 ❑ Schedule F2 ❑ Schedule F4 C Schedule G ❑ 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: ❑ Schedule A2 L Schedule B C Schedule B(J) ❑ Schedule C2 ❑ Schedule D ❑ Schedule F1 ❑ Schedule F2 L Schedule F4 C Schedule G ❑ Schedule H ❑ Schedule COH-UC ❑ Schedule B-SS Dates of travel Means of transportation Name of person(s) traveling Departure city or name of departure location Destination city or name of destination location Purpose of travel (including name of conference, seminar, or other event) Name of Contributor / Corporation or Labor Organization / Pledgor / Payee Contribution / Expenditure reported on: I Schedule A2 ❑ Schedule B ❑ Schedule B(J) Schedule C2 ❑ Schedule D ▪ Schedule F2 n Schedule F4 n Schedule G Schedule H ❑ Schedule COH-UC Dates of travel Means of transportation Name of person(s) traveling Departure city or name of departure location Destination city or name of destination location Purpose of travel (including name of conference, seminar, or other event) I Schedule F1 Schedule B-SS ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED Forms provided by Texas Ethics Coma ' - ^'" cs.e ^`^' Revised 1/1/2024 Reset Form Reset Page CANDIDATE / OFFICEHOLDER REPORT: DESIGNATION OF FINAL REPORT 1 C/OH NAME 3 SIGNATURE 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" •• 2 Filer ID (Ethics Commission Filers) 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 I 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. Forms provided by Texas Ethics Comi Reset Form cs.s Signature of Officeholder Revised 1/1/2024