HERNANDEZ, ADRIAN_JULY 15 2020_CAMPAIGN FINANCE REPORTCANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT
COVER SHEET PG 1
1
Filer ID (Ethics Commission Filers)
2 Total pages filed: 4
The C/OH Instruction Guide
explains how to complete this form.
3 CANDIDATE/
MS / MRS / MR FIRST
MI
OFFICEHOLDER
Mr. Adrian M
OFFICE USE ONLY
NAME
. . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . .
Date Received
NICKNAME LAST
SUFFIX
Hernandez
4 CANDIDATE/
ADDRESS / PO BOX; APT / SUITE #, CITY; STATE; ZIP CODE
OFFICEHOLDER
MAILING
Pearland, TX 77584
ADDRESS
❑ Change of Address
5 CANDIDATE/
AREA CODE PHONE NUMBER
EXTENSION
OFFICEHOLDER
Date Hand-delivered or Date Postmarked
PHONE
0-7I,5 /Q
6 CAMPAIGN
MS / MRS / MR FIRST
MI
Receipt #
Amount $
TREASURER
Mrs. Veronica
Date Processed
NAME
. . . . . . . . . . . . . . . .
NICKNAME LAST
SUFFIX
Longoria
Date Imaged
7 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE
#; CITY:
STATE, ZIP CODE
TREASURER
ADDRESS
Pearland, TX 77584
(Residence or Business)
8 CAMPAIGN
AREA CODE PHONE NUMBER
EXTENSION
TREASURER
/
PHONE
9 REPORT TYPE
January 15 F 30th day before election Runoff
15th day after campaign
treasurer appointment
(Officeholder Only)
IZI July 15 ❑ 8th day before election
❑ Exceeded $500 limit
Final Report (Attach C/OH - FR)
10 PERIOD
Month Day Year
Month
Day Year
COVERED
Jan 16, 2020
July 1.4,
2020
THROUGH
11 ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
❑ Primary
❑ Runoff ❑ Other
Description
❑ General
❑ Special
12 OFFICE
OFFICE HELD (if any)
13 OFFICE SOUGHT (if known)
Pearland City Council Position 4
GO TOPAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
CANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C/OH NAME ADRIAN M HERNANDEZ
15 Filer ID (Ethics Commission Filers)
16 NOTICE FROM
THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICAL
SUPPORT THE CANDIDATE I OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDERS
COMMITTEE(S)
KNOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIVE NOTICE
OF SUCH EXPENDITURES.
COMMITTEE TYPE
COMMITTEE NAME
❑ GENERAL
COMMITTEE ADDRESS
SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION
1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
0
TOTALS
PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR
$
CONTRIBUTIONS MADE ELECTRONICALLY), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS$
0
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
$ 365.00
TOTAEXPELS
UNLESS ITEMIZED
UNLESS
4. TOTAL POLITICAL EXPENDITURES
$ 365.00
TION
BCONTRIB
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$ 19.22
OF REPORTING PERIOD
OUTSTANDING
6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
793.00
LOAN TOTALS
LAST DAY OF THE REPORTING PERIOD
$
18 AFFIDAVIT
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
AFFIX NOTARY STAMP / SEALABOVE
Sworn to and subscribed before me, by the said 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
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
Forms provided by Texas Ethics Commission www. ethics. state.tx.us Revised 9/26/2019
SUBTOTALS
- C/OH FORM C/OH
COVER SHEET PG 3
19
FILER NAME Adrian M Hernandez
20 Filer ID (Ethics Commission Filers)
21
SCHEDULE SUBTOTALS
NAME OF SCHEDULE
SUBTOTAL
AMOUNT
1.
11
SCHEDULEAI:
MONETARY POLITICAL CONTRIBUTIONS
$
2.
F-1
SCHEDULE A2:
NON -MONETARY (IN-KIND) POLITICAL CONTRIBUTIONS
$
3.
11
SCHEDULE B:
PLEDGED CONTRIBUTIONS
$
4.
Fx_1
SCHEDULE E:
LOANS
$ 375.00
5.
E
SCHEDULE F1:
POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
6-
El
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
$
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 9/26/2019
MONETARY POLITICAL
CONTRIBUTIONS SCHEDULE Al
The Instruction Guide explains how to complete this form.
1 Total pages Schedule All:
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
4 Date
5 Full name of contributor
. . . . . . . . . . . . . . . . .
6 Contributor address;
❑ out-of-state PAC (ID#: )
. . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
7 Amount of contribution ($)
8 Principal occupation / Job title (See Instructions)
9 Employer (See Instructions)
Date
Full name of contributor
. . . . . . . . . . . . . . . . .
Contributor address;
❑ out-of-state PAC (ID#: )
. . . . . . . . . . . . . . . . . . . . .
City; State, Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor
. . . . . . . . . . . . . . . . .
Contributor address;
❑ out-of-state PAC (ID#: )
. . . . . . . . . . . . . . . . . . . . .
City; State; Zip Code
Amount of contribution ($)
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor
Contributor address;
❑ out-of-state PAC (ID#: )
City; State; Zip Code
Amount of contribution ($)
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.ethCs.state.tx.us Revised 9/26/2019
NON -MONETARY (IN-KIND) POLITICAL
CONTRIBUTIONS SCHEDULE A2
The Instruction Guide explains how to complete this form.
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#: 1
7 Contributor address; City; State; Zip Code
8 Amount of 9 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
Amount of In-kind contribution
Contribution $ description
❑ Check if travel outside of Texas. Complete Schedule T.
Principal occupation / Job title (FOR NON -JUDICIAL) (See Instructions)
Employer (FOR NON-JUDICIAL)(See Instructions)
Contributor's principal occupation (FOR JUDICIAL)
Contributor's job title (FOR JUDICIAL) (See Instructions)
Contributor's employer/law firm (FOR JUDICIAL)
Law firm of contributor's 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 9/26/2019
PLEDGED CONTRIBUTIONS SCHEDULE B
1 Total pages Schedule B:
The Instruction Guide explains how to complete this form.
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#:
g Amount 9 In-kind contribution
of Pledge $ description
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 Pledgor address; City; State; Zip Code
❑ 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 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)
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 9/26/2019
LOANS SCHEDULE E
The Instruction Guide explains how to complete this form.
1 Total pages Schedule E: 1
2 FILER NAME Adrian M Hernandez
3 Filer ID (Ethics Commission Filers)
4 TOTAL OF UNITEMIZED LOANS
375.00
5 Date of loan
7 Nameoflender ❑ out-of-state PAC (ID#:
9 Loan Amount($)
Feb 5, 2020
Adrian M Hernandez
. . . . . . . . . . . . I .........................
8 Lender address; City; State; Zip Code
375.00
6 Is lender
10 Interest rate
a financial
1431 Crystal Lake Cir E
0
Institution?
Pearland, TX 77584
11 Maturity date
Y W
n/a
12 Principal occupation / Job title (See Instructions)
13 Employer (see Instructions)
14 Description of Collateral
15
❑ Check if personal funds were deposited into political
none
account (See Instructions)
16 GUARANTOR
17 Nameofguarantor
19 Amount Guaranteed($)
INFORMATION
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18 Guarantor address; City, State; Zip Code
El not applicable
20 Principal Occupation (See Instructions)
21 Employer (See Instructions)
Date of loan
Name of lender ❑ out-of-state PAC (ID#: )
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lender address; City, State, Zip Code
Loan Amount ($)
Is lender
Interest rate
a financial
Institution?
Maturity date
Y N
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Description of Collateral
❑ Check if personal funds were deposited into political
❑ none
account (See Instructions)
GUARANTOR
Name of guarantor
Amount Guaranteed ($)
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 9/26/2019