HERNANDEZ, ADRIAN_JANUARY 15 2021_CAMPAIGN FINANCE REPORT CANDIDATE / OFFICEHOLDER 0 FORM C/OH
-CAMPAIGN FINANCE REPORT COVER SHEET PG .1
1 Filer ID (Ethics Commission Filers) 2 Total pages filed:
The C/OH Instruction Guide explains how to complete this form. 6
3 CANDIDATE/ MS/MRS/MR • FIRST MI
OFFICEHOLDER OFFICE USE ONLY
NAME Adrian M Date Received
NICKNAME LAST SUFFIX
Hernandez
4 CANDIDATE/ ADDRESS /PO BOX; APT/SUITE#; CITY; STATE; ZIP CODE
OFFICEHOLDER
MAILING Pearland, TX 77588
ADDRESS
' FR Change of Address
5 CANDIDATE/ AREA CODE PHONE NUMBER • EXTENSION
OFFICEHOLDER Date Hand-delivered or Date Postmarked
PHONE (
6 CAMPAIGN MS/MRS/MR FIRST MI Receipt# Amount$
TREASURER 'Veronica
NAME Date Processed
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 I�
X January 15 I I 30th day before election Runoff - n 15th day after campaign
treasurer appointment
(Officeholder Only)
July 15 I 8th day before election n Exceeded$500 limit I I Final Report(Attach C/OH-FR)
10 PERIOD Month Day Year Month Day Year
COVERED 07 / 15 / 2020 THROUGH 12/31 /2020
11 ELECTION ELECTION DATE ' ELECTION TYPE
Month Day Year ❑ Primary ❑ Runoff rX1Other
Description
❑ General ❑ Special Officeholder Semi-Annual
12 OFFICE OFFICE HELD (if any) 13 OFFICE SOUGHT (if known)
City Council Position 4
GO TOPAGE2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C/OH. NAME 15 Filer ID (Ethics Commission Filers)
Hernandez, Adrian M
16 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICAL SUPPORT THE CANDIDATE/OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S
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
n Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $ 0
2. TOTAL POLITICAL CONTRIBUTIONS
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) $ 900.00
EXPENDITURE 3. TOTAL POLITICAL EXPENDITURES OF$100 OR LESS,
TOTALS UNLESS ITEMIZED $ 0
4. TOTAL POLITICAL EXPENDITURES $ 44.30
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE OF REPORTING PERIOD $ 914.92
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ 793.00
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 9/8/2015
SUBTOTALS - C/OH FORM C/OH
COVER SHEET PG 3
19 FILER NAME 20 Filer ID(Ethics Commission Filers)
Hernandez, Adrian M
21 SCHEDULE SUBTOTALS SUBTOTAL
NAME OF SCHEDULE AMOUNT
1. SCHEDULE A1: MONETARY POLITICAL CONTRIBUTIONS $ 900.00
2. f SCHEDULEA2: NON-MONETARY(IN-KIND)POLITICAL CONTRIBUTIONS $
3. SCHEDULE B: PLEDGED CONTRIBUTIONS $
4. SCHEDULE E: LOANS $
5. X SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ 4.30
6. I I SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $
7. SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $
8. SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $
9. Li SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS $ 40.00
10. n SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $
11. SCHEDULE I: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $
12 n SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS,AND CONTRIBUTIONS $
I I RETURNED TO FILER
•
•
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
The Instruction Guide explains how to complete this form. 1 Total pages Schedule Al:
1
2 FILER NAME
3 Filer ID (Ethics Commission Filers)
Hernandez, Adrian M
4 Date 5 Full name of contributor ❑out-of-state PAC(ID#: ) 7 Amount of contribution ($)
Jim Russ
12/23/2020 6 Contributor address; City; State; Zip Code
750.00
10011 Meadowglen T.n Houston, TX 77047
8 Principal occupation/Job title(See Instructions) g Employer (See Instructions)
Principal EHRA
Date Full name of contributor ❑out-of-state PAC(ID#t: I Amount of contribution ($)
Albert Wei .
12/24/2020 Contributor address; City; State; Zip Code
100.00
2336 Camden Dr. Houston, TX 77021
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Chief Innovation Officer ProUnitas
Date Full name of contributor ❑out-of-state PAC(ID#: I Amount of contribution ($)
Daniel Davis, Jr.
12/30/2020 Contributor address; City; State; Zip Code
50.00
6818 Powell Ln Manvel; TX 77578
Principal occupation/Job title(See Instructions) Employer (See Instructions)
Realtor Remax
Date Full name of contributor ❑out-of-state PAC(ID#: ) Amount of contribution ($)
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 9/8/2015
POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS ' SCHEDULE F1
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 Ft: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
1 Hernandez, Adrian M
4 Date 5 Payee name
12/24/2020 Anedot
6 Amount ($) 7 Payee address; City; State; Zip Code
4.30 1340 Poydras Street Suite 1770 New Orleans LA 70112
8 (a) Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE Check if travel outside of Texas.Complete ScheduleT.
OF ❑Check if Austin,TX,officeholder living expense
EXPENDITURE
Fees (CC Processing)
•
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Category-(See Categories listed at the top of this schedule) Description
PURPOSE ❑Check if travel outside of Texas.Complete ScheduleT.
OF ❑Check if Austin,TX,officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE ❑Check if travel outside of Texas.Complete ScheduleT.
OF Check if Austin,TX,officeholder living expense
EXPENDITURE
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/8/2015
POLITICAL EXPENDITURES
MADE FROM PERSONAL FUNDS SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID (Ethics Commission.Filers)
1 Hernandez, Adrian M •
4 Date 5 Payee name
12/23/2020 USPS
6 Amount ($) 7 Payee address; City; State; Zip Code
40.00
Reimbursementfrom
political contributions
intended
8 (a)Category (See Categories listed at the top of this schedule) (b) Description
PURPOSE ❑Check if travel outside of Texas.Complete Schedule T.
OF
EXPENDITURE Rental Expense (PO Box) ❑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 Payee name
Amount ($) Payee address; City; State; Zip Code
❑
Reimbursementfrom
political contributions
intended
Category(See Categories listed at the top of this schedule) (b) Description
PURPOSE
OF Check if travel outside of Texas.Complete ScheduleT.
EXPENDITURE ❑Check if Austin,TX,officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
❑ Reimbursementfrom
political contributions
intended
Category(See Categories listed at the top of this schedule) (b) Description
PURPOSE �l
OF I I Check if travel outside of Texas.Complete ScheduleT.
EXPENDITURE ❑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 9/8/2015