HERNANDEZ, ADRIAN_APRIL 22 2021_CAMPAIGN FINANCE REPORT •
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CANDIDATE 1 OFFICEHOLDER FORM CIOH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 Filer ID 2 Total pages filed:'
The CIOH Instruction Guide explains how to complete this form. • .
17
3 CANDIDATE/ MS/MRS/MR FIRST MI OFFICE USE ONLY
OFFICEHOLDER . Adrian
NAME Date Received
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NICKNAME LAST SUFFIX 4I"`mil
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Hernandez ,/�
4 CANDIDATE/ ADDRESS/PO BOX; APT/SUITE#; CITY; ZIP CODE Date Hand•detiv red r Date!^�o�stmmanarked l/J'i�
OFFICEHOLDER • ? �21
MAILING
ADDRESS Receipt# mount
❑Change of Address Pearland,TX 77588 •
Date Processed
•
Date Imaged
5 CAMPAIGN MS/MRS/MR FIRST MI
TREASURER
NAME Veronica
NICKNAME LAST SUFFIX
Longoria
6- CAMPAIGN STREET ADDRESS(NO PO BOX PLEASE); APT/SUITE#; CITY; STATE; ZIP CODE
TREASURER
ADDRESS
(Residence or Business)
Pearland,TX 77584
7 CAMPAIGN AREA CODE PHONE NUMBER , EXTENSION
TREASURER
PHONE ( •
8 REPORT
TYPE January 15 ❑ 30th day before election El Runoff 15th day after campaign treasurer
appointment(officeholder only)
July 15 ❑X 8th day before election El Exceeded modified El Final Report(Attach C/OH-FR)
reporting limit
9 PERIOD Month Day Year Month Day Year
COVERED 03/23/2021 THROUGH 04/21/2021
•
10 ELECTION ELECTION DATE ELECTION TYPE
•
Month Day Year Primary El Runoff El Other
05/01/2021
❑X General Special
•
•
11 OFFICE OFFICE HELD(if any) 12 OFFICE SOUGHT(if known) •
Pearland City Council Position 4 Brazoria Pearland City Council Position 4
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CANDIDATE / OFFICEHOLDER REPORT: FORM C/OH
SUPPORT & TOTALS COVER SHEET PG 2
2 of 17
13 C/OH NAME Hernandez,Adrian 14 Filer ID •
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15 NOTICE This box is for notice of political contributions accepted or political expenditures made by political committees to support the
FROM candidate/officeholder.These expenditures may have been made without the candidate's or officeholder's knowledge or
POLITICAL consent.Candidates and officeholders are required to report this information only if they receive notice of such expenditures.
COMMITTEE(S)
EI Additional Pages • COMMITTEE TYPE COMMITTEE NAME
▪ GENERAL
COMMITTEE ADDRESS
▪ SPECIFIC
COMMITTEE CAMPAIGN TREASURER NAME
•
COMMITTEE CAMPAIGN TREASURER ADDRESS
- 16 CONTRIBUTION 1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS(OTHER THAN PLEDGES,LOANS,
TOTALS OR GUARANTEES OF LOANS,OR CONTRIBUTIONS MADE ELECTRONICALLY) , $ 0.00
2. TOTAL POLITICAL CONTRIBUTIONS $ • 4,890.42
(OTHER THAN PLEDGES,LOANS,OR GUARANTEES OF LOANS)
EXPENDITURE 3. TOTAL UNITEMIZED POLITICAL EXPENDITURES 0.00
TOTALS
4. TOTAL POLITICAL EXPENDITURES $ 9,630.02
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF THE 3,192.94 •
BALANCE REPORTING PERIOD
OUTSTANDING 6. , TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY 3,115.28
LOAN TOTALS OF THE REPORTING PERIOD
17 AFFADAVIT
•
I swear,or affirm,under penalty of perjury,that the accompanying report is
true andlcorrect and includes all information required to be reported by me
under Title 15,Election Code.
Signature of Candidate or Officeholder
AFFIX NOTARY STAMP/SEAL ABOVE
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 Printed name of officer administering Title of officer administering oath
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SUBTOTALS -,C/OH FORM C/OH
COVER SHEET PG 3
3 of 17
18 FILER NAME 19 Filer ID •
Hernandez,Adrian
20 SCHEDULE SUBTOTALS
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NAME OF SCHEDULE SUBTOTAL AMOUNT
1. SCHEDULE Al: MONETARY POLITICAL CONTRIBUTIONS $ 4,890.42
2. SCHEDULE A2: NON-MONETARY(IN-KIND)POLITICAL CONTRIBUTIONS $
3. ❑X SCHEDULE B: PLEDGED CONTRIBUTIONS $ 1,000.00
4. � SCHEDULE E: LOANS •
$
5. El SCHEDULE Fl: POLITICAL EXPENDITURES FROM POLITICAL CONTRIBUTIONS $ 7,236.50 ,
6. X❑ SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $ 250.00
7. ❑ SCHEDULE F3: PURCHASE OF INVESTMENTS FROM POLITICAL CONTRIBUTIONS• $
8. SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $
9. X❑ SCHEDULE G: POLITICAL EXPENDITURES FROM PERSONAL FUNDS $ 2,143.52
10. SCHEDULE H: PAYMENT FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $
11. ❑ SCHEDULE I:NON-POLITICAL EXPENDITURES FROM POLITICAL CONTRIBUTIONS $
❑ SCHEDULE K:INTEREST,CREDITS,GAINS,REFUNDS,AND CONTRIBUTIONS RETURNED
12. 0.23
X TO FILER $
' 1
Forms provided by Texas Ethics Commission www.ethics:state.tx.us Version V1.1.eeb5f84f
1 I ,
MONETARY POLITICAL CONTRIBUTIONS
SCHEDULE Al
1 Total pages Schedule Al:
• The Instruction Guide explains how to complete this form. Sch: 1/3 Rpt:4/17
2 FILER NAME 3 Filer ID
Hernandez,Adrian •
4 Date 5 Full name of contributor El out-of-state PAC(ID#: ) 7 Amount of Contribution-(6) •
04/13/2021 AACS Investments LLC $1,000.00
6 Contributor address; City;State;Zip Code
PO Box 742
Pearland,TX 77588
8 Principal occupation/Job title(See Instructions) 9 Employer(See Instructions)
Date Full name of contributor out-of-state PAC(ID#: ) Amount of Contribution($)
04/12/2021 . Anya, Hernandez $100.00
Contributor address; City;State;Zip Code
1634 Dusty Ridge
Missouri City,TX 77459 •
•
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of contributor out-of-state PAC(ID#: ) Amount of Contribution($)
04/09/2021 Bob, Lewis $100.00
• Contributor address; City;State;Zip Code
2236 N Galveston Avenue
Pearland,TX 77581
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Self-Employed BHHS
Date Full name of contributor El out-of-state PAC(ID#: ) Amount of Contribution($)
04/21/2021 Bob, Lewis $20.21
Contributor address; City;State;Zip Code
2236 N Galveston Avenue
Pearland,TX 77581
Principal occupation/Job title(See Instructions) • Employer(See Instructions)
Self-Employed BHHS
Date Full name of contributor El out-of-state PAC(ID#: • ) Amount of Contribution($)
04/16/2021 Brian,Wilmer $300.00
Contributor address; City;State;Zip Code
7824 Jordan Street
Manvel,TX 77578 ,
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Park Manager Discovery Green Conservancy
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Forms provided by Texas Ethics,Commission www.ethics.state.tx.us . Version V1.1.eeb5f84
•
MONETARY POLITICAL CONTRIBUTIONS
SCHEDULE Al
1 Total pages Schedule Al:
The Instruction Guide explains how to complete this form. Sch:2/3 Rpt:5/17
2 FILER NAME 3 Filer ID
Hernandez,Adrian
4 Date 5 Full name.of contributor El out-ofstate PAC(ID#: ) 7• Amount of Contribution($)
04/19/2021 Cindy, Simpson $50.00
6 Contributor address; City;State;Zip Code
12406 Oakline Dr
Pearland,TX 77581
8 Principal occupation/Job title(See Instructions) 9 Employer(See Instructions)
Retired
Date Full name of contributor out-of-state PAC(ID#: ) Amount of Contribution($)
04/05/2021 Dietrich,Von Biedenfeld • $20.21
Contributor address; City;State;Zip Code
502 E Jefferson Street
West Columbia,TX 77486
Principal'occupation/Job title(See Instructions) Employer(See Instructions)
Professor University of Houston-Downtown
• Date Full name of contributor El out-of-state PAC(ID#: ) - Amount of Contribution($)
03/27/2021 Marilyn, Bullard $200.00
Contributor address; City;State;Zip Code
2411 Walker Court •
Pearland,TX 77581
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Retired
Date Full name of contributor El out-of-state PAC(ID#: ) Amount of Contribution($)
04/19/2021 Mark, Ingram $100.00
Contributor address; City;State;Zip Code
11902 Shore Pointe Drive
Pearland,TX 77584
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Civil Engineer Alliance Transportation Group, Inc
Date Full name of contributor El out-of-state PAC(ID#: ) Amount of Contribution($)
04/02/2021 Pearland Police Officers PAC $500.00
Contributor address; City;State;Zip Code
PO Box 2243
Pearland,TX 77588
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.eeb5f84=
•
MONETARY POLITICAL CONTRIBUTIONS
SCHEDULE Al
1 Total pages Schedule Al:
The Instruction Guide explains how to complete this form. Sch:3/3 Rpt: 6/17
2 FILER NAME • 3 Filer ID
Hernandez,Adrian •
4 Date 5 Full name of contributor ❑out-of-state PAC(ID#: ) 7 Amount of Contribution($)
03/23/2021 Robin, Burgess $100.00
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6 Contributor address; City;State;Zip Code
5406 Meadow Spring Ct
Rosharon,TX 77583
8 Principal occupation/Job title(See Instructions) 9 Employer(See Instructions)
Legal Department City of Houston
Date Full name of contributor El out-of-state PAC(ID#: ) Amount of Contribution($)
03/23/2021 Texas Association of Realtors PAC $2,000.00
Contributor address; City;State;Zip Code
PO Box 2246
Austin,TX 78768
•
Principal occupation/Job title(See Instructions) Employer(See Instructions)
r
Date Full name of contributor out-of-state PAC(ID#: ) Amount of Contribution($)
04/15/2021 Tyler, Burridge $400.00
Contributor address; City;State;Zip Code
6 N Clay 6
•
• Angleton,TX 77515
Principal occupation/Job title(See Instructions) Employer(See Instructions)
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Student
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•
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PLEDGED CONTRIBUTIONS
SCHEDULE B
1 Total pages Schedule B:
The Instruction Guide explains how to complete this form.
Sch: 1/1 Rpt: 7/17
2 FILER NAME 3 Filer ID
•
• Hernandez,Adrian
4 TOTAL OF UNITEMIZED PLEDGES $ 0.00
5 Date 6 Full name of pledgor out-of-state PAC(ID#: ) 8 Amount of 19 In-kind description
HOME-PAC pledge ($) I (If applicable)
7 Pledgor Address; City; State; Zip Code $1,000.00
04/15/2021 9511 W Sam Houston Pkwy N
•
Houston,TX 77064 Check if travel outside of Texas.Complete Schedule T.
10 Principal occupation/Job title(See Instructions) 11 Employer(See Instructions)
.
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•
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.eeb5f84f
POLITICAL EXPENDITURES FROM POLITICAL
CONTRIBUTIONS SCHEDULE Fl
•
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions/Donations Made By- Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1: 2 FILER NAME 3 Filer ID
Sch:1/4 Rpt: 8/17 Hernandez,Adrian
4 Date 5 Payee name
•
03/23/2021 Anedot
6 Amount($) 7 Payee address; City; State; Zip Code
$4.30 1340 Poydras Street
Ste 1770
New Orleans, LA 70112
• 8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Fees Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE
Check if Austin,TX,officeholder living expense
Processing fees.
• 9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
04/05/2021 Anedot •
Amount($) Payee address; City; State; Zip Code
$1.11 1340 Poydras Street •
•
Ste 1770
•
New Orleans, LA 70112
PURPOSE (a)Category (See categories listed at the top of this schedule). (b) Description
OF Fees ❑Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE
Check if Austin,TX,officeholder living expense
Processing fees.
Complete ONLY if direct Candidate/Officeholder name • Office sought Office held
expenditure to benefit C/OH
Date Payee name •
04/09/2021 Anedot •
•
Amount($) ' Payee address; City; • State; Zip Code
$4.30 1340 Poydras Street
Ste 1770
New Orleans, LA 70112
PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Fees ❑Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE
Check if Austin,TX,officeholder living expense
Processing fees.
•
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH •
•
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.eeb5f84f
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POLITICAL EXPENDITURES FROM POLITICAL
CONTRIBUTIONS SCHEDULE F1
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EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District,
Contributions/Donations Made By-- Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule Fl: 2 FILER NAME 3 Filer ID
Sch:2/4 Rpt: 9/17 Hernandez,Adrian
4 Date 5 Payee name •
04/12/2021 Anedot •
6 Amount($) 7 Payee address; City; State; Zip Code •
$4.30 1340 Poydras Street
• Ste 1770
New Orleans, LA 70112
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Fees ❑Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE • ❑Check if Austin,TX,officeholder living expense
• Processing fees.
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH ,
Date Payee name (
•
04/15/2021 Anedot
Amount($) • Payee address; City; State; Zip Code
$16.30 1340 Poydras Street
Ste 1770
New Orleans, LA 70112
PURPOSE (a)Category (see Categories listed at the top of this schedule) (b) Description
OF Fees IEl Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE Check if Austin,TX,officeholder living expense •
• Processing fees.
•
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH •
Date Payee name
04/16/2021 Anedot
Amount($) Payee address; City; State; Zip Code
$12.30 1340 Poydras Street
. Ste 1770
New Orleans, LA 70112
PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF •
Fees 0 Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE Check if Austin,TX,officeholder living expense
Processing fees:
•
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.eeb5f84
POLITICAL EXPENDITURES FROM POLITICAL
CONTRIBUTIONS •
SCHEDULE Fl
•
EXPENDITURE CATEGORIES FOR BOX 8(a)
•
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions/Donations Made By- Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salarieslwages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1: 2 FILER NAME 3 Filer ID
Sch:3/4 Rpt: 10/17 Hernandez,Adrian
4 Date 5 Payee name
04/19/2021 Anedot
•
6 Amount($) 7 Payee address; City; . State; Zip Code
• $6.60 1340 Poydras Street
•
Ste 1770
•
New Orleans,LA 70112
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Fees Check if travel outside of Texas.Complete Schedule T. •
EXPENDITURE
Check if Austin,TX,officeholder living expense
Processing fees.
•
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name •
04/21/2021 Anedot
Amount($) Payee address; City; • State; Zip Code
$1.11 1340 Poydras Street
Ste 1770
New Orleans, LA 70112
PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Fees ❑Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE check if Austin,TX,officeholder living expense
Processing fees.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
04/01/2021 Lupe Tortilla
•
Amount($) Payee address; City; State; Zip Code
•
• $250.00 2728 Smith Ranch Rd
Pearland,TX 77584
PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Food/Beverage Expense Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE ❑Check if Austin,TX,officeholder living expense
•
West Pearland Republican Women meeting food
• • sponsorship.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH •
•
•
•
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.eeb5f84f
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•
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POLITICAL EXPENDITURES FROM POLITICAL
CONTRIBUTIONS SCHEDULE Fl
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions/Donations Made By- Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1: 2 FILER NAME 3 Filer ID
Sch:4/4 Rpt: 11/17 Hernandez,Adrian
4 Date 5 Payee name
04/01/2021 Neumann and Company. .
6 Amount($) 7 Payee address; City; State; Zip Code
$4,018.02 5417 Pine St.
Bellaire,TX 77401
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Printing Expense ❑Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE.
Check if Austin,TX,officeholder living expense
Ballot by mail applications and door hangers.
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name •
04/15/2021 Neumann and Company
Amount($) Payee address; City; State; Zip Code
$2,918.16 5417 Pine St.
•
Bellaire,TX 77401
• PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF • Printing Expense Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE
Check if Austin,TX,officeholder living expense
Campaign awareness mailer.
Complete ONLY if direct Candidate/Officeholder name Office sought- Office held
expenditure to benefit C/OH
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•
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.eeb5f84f
1
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UNPAID INCURRED OBLIGATIONS
SCHEDULE F2
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 F2: 2 FILER NAME 3 Filer ID
Sch:1/1 Rpt: 12/17 Hernandez,Adrian
4 TOTAL OF UNITEMIZED UNPAID INCURRED OBLIGATIONS $
5 Date • 6 Payee name
04/19/2021 Hugh, Patton
7 Amount($) 8 Payee address; City; State; Zip Code
$250.00 2905 Manvel Rd
•
Pearland,TX 77584 •
9 TYPE OF
�X
EXPENDITURE Political Non-Political
•
10 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b)Description
• OF Event Expense Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE Check if Austin,TX,officeholder living expense
Crawfish boil sponsorship.
•
11 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
•
•
•
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.eeb5f84f
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POLITICAL EXPENDITURES FROM PERSONAL FUNDS •
SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense• Food/Beverage Expense Polling Expense Travel in District
Contributions/Donations Made By- Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
• The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID
Sch: 1/4 Rpt:13/17 Hernandez,Adrian
4 Date 5 Payee name • l
04/18/2021 Academy
6 Amount($) 7 Payee address; City; State; Zip,Code
$129.82 2804 Business Center Dr
Reimbursement from
political contributions
intended Pearland,TX 77584 •
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description Check if travel outside of Texas. Complete Schedule T.
OF Polling Expense Check If Austin,TX,officeholder living expense
EXPENDITURE
Canopies and weights for polling locations.
•
9 Complete ONLY if direct Candidate/Officeholder name Office sought - Office held
expenditure to benefit •
C/OH
Date Payee name •
04/04/2021 Brazoria County Young Republicans
Amount($) Payee address; City; State; Zip Code
$500.00 11200 BROADWAY ST •
Reimbursement from #2111
political contributions
Intended Pearland,TX 77584 •
PURPOSE Category (See Categories listed at the top of this schedule) Description Check if travel outside of Texas. Complete Schedule T.
OF Advertising Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
Election guide ad.
Complete ONLY if direct Candidate/Officeholder name Office sought • Office held
, expenditure to benefit
C/OH
Date Payee name
03/30/2021 Community Impact
Amount($) Payee address; City; State; Zip Code
$1,230.00 3600 E. Palm Valley Blvd
Reimbursement from Box 3
Elpolitical contributions •
intended Round Rock,TX 78665
• PURPOSE Category (See Categories listed at the top of this schedule) Description Ei Check if travel outside of Texas. Complete Schedule T.
OF Advertising Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
Ad is April print edition and online edition.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.eeb5f84f
•
POLITICAL EXPENDITURES FROM PERSONAL FUNDS
SCHEDULE G
, EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense 'Event Expense Loan RepaymenUReimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense .Travel in District
Contributions/Donations Made By- Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services SalarieslWages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID
•
Sch:2/4 Rpt: 14/17 Hernandez,Adrian •
4 Date 5 Payee name •
04/15/2021 Facebook
6 Amount($) 7 Payee address; City; State; Zip Code
$25.00 1 Hacker Way
Reimbursement from
political contributions
intended Menlo Park,CA 94025
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description ❑Check if travel outside of Texas. Complete Schedule T.
OF Advertising Expense ❑Check if Austin,TX,officeholder IMng expense •
EXPENDITURE
Facebook advertising.
•
9 Complete ONLY if direct Candidate/Officeholder name Office sought( Office held
expenditure to benefit •
C/OH
Date Payee name
•
04/19/2021 Facebook •
Amount($) Payee address; City; State; Zip Code
$25.00 1 Hacker Way
•
Reimbursement from
political contributions .
intended Menlo Park, CA 94025
PURPOSE Category (See Categories listed at the top of this schedule) Description ❑Check if travel outside of Texas. Complete Schedule T.
OF Advertising Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
Facebook advertising.
• Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Date Payee name •
• 04/21/2021 Facebook
Amount($) Payee address; City; State; Zip Code
$25.00 1 Hacker Way
•
Reimbursement from
Epolitical contributions
intended Menlo Park,CA 94025
PURPOSE Category (See Categories listed at the top of this schedule) Description .0 Check if travel outside of Texas. Complete Schedule T.
OF Advertising Expense ElCheck if Austin,TX,officeholder living expense
EXPENDITURE
Facebook advertising.
•
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
•
C/OH
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.eeb5f84f
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POLITICAL EXPENDITURES FROM PERSONAL FUNDS
SCHEDULE G
' EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions!Donations Made By- Gift/Awards/Memorials Expense Printing Expense • Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form. ,
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID
Sch:3/4 Rpt:15/17 Hernandez,Adrian •
4 Date 5 Payee name
04/18/2021 Natasha,Charles
6 Amount($) 7 •Payee address; City; State; Zip Code
$140.00 2507 Quiet Lake Ct •
•
Reimbursement from •
Elpolitical contributions•
intended Pearland,TX 77584
•
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description El Check if travel outside of Texas. Complete Schedule T.
OF Printing Expense ❑Check if Austin,TX,officeholder living expense •
EXPENDITURE
Custom campaign t-shirts for block walkers.
•
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
•
C/OH
Date Payee name
•
04/08/2021 PoliEngine
Amount($) Payee address; City; State; Zip Code _
$35.00 621 NW 12th Ave
•
Reimbursement from
Elpolitical contributions
intended Gainesville, FL 32601
PURPOSE Category (See Categories listed at the top of this schedule) • Description ❑Check if travel outside of Texas. Complete Schedule T.
OF Advertising Expense Check if Austin,TX,officeholder living expense
EXPENDITURE •
Website hosting. •
Complete ONLY if direct Candidate/Officeholder name • Office sought Office held
expenditure to benefit
C/OH •
Date Payee name •
03/23/2021 Walmart
•
Amount($) Payee address; City; State; Zip Code
$4.30 1710 Broadway St •
Reimbursement from •
❑X political contributions •
intended Pearland,TX 77581
PURPOSE Category (See Categories listed at the top of this schedule) DeSCrlpti0n ❑Check if travel outside of Texas. Complete Schedule T.
OF Polling Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
Zip ties for signs and polling locations.,
•
•
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
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•
•
Forms provided by Texas Ethics Commission www.ethics.state.tx.us • Version V1.1.eeb5f84f
•
POLITICAL EXPENDITURES FROM PERSONAL FUNDS
SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
•
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions/Donations Made By- Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3, Filer ID •
Sch:4/4 Rpt:16/17 Hernandez,Adrian •
4 Date 5 Payee name
04/17/2021 Walmart
•
6 Amount($) 7 Payee address; City; State; Zip Code
$29.40 10505 Broadway St
Reimbursement from •
X' political contributions
intended Pearland,TX 77584
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description ❑Check if travel outside of Texas. Complete Schedule T.
OF Polling Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
Polling canopy decorations.
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.eeb5f84f
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER SCHEDULE K
1 Total pages Schedule K:
The Instruction Guide explains how to complete this form. Sch:1/1 Rpt:17/17
2 FILER NAME 3 Filer ID
Hernandez,Adrian
4 Date 5 Name of person from whom amount is received 8 Amount($)
04/01/2021 JSC Federal Credit Union $0.23
6 Address of person from whom amount is received; City;State;Zip Code
1330 Gemini
Houston,TX 77058
• 7 Purpose for which amount is received ❑ Check if political contribution returned to filer
Interest.
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•
•
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.eeb5f84f