HERNANDEZ, ADRIAN_JULY 15 2021_CAMPAIGN FINANCE REPORT 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.
12
3 CANDIDATE/ MS/MRS/MR FIRST MI OFFICE USE ONLY
OFFICEHOLDER ' Adrian
NAME Date Received
Judy IE121)21
NICKNAME LAST SUFFIX
Hernandez
4 CANDIDATE/ ADDRESS./PO BOX; APT/SUITE#; CITY; ZIP CODE D e Hand-delivered Date Postmarked
OFFICEHOLDER
Receipt# Amount
❑Change.of Address Pearland,TX 77584
Date Processed
Date Imaged 1 l 4 ge:V 1,
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 Ei 30th day before election 111 Runoff 15th day after campaign treasurer
appointment(officeholder only)
El July 15 8th day before election Exceeded modified D Final Report(Attach C/OH-FR)
• reporting limit
9 PERIOD Month Day Year Month Day Year
•
COVERED 04/22/2021 THROUGH 06/30/2021
10 ELECTION ELECTION DATE ELECTION TYPE
Month Day Year Primary Runoff Other
•
General Special
11 OFFICE OFFICE HELD(if any) 12 OFFICE SOUGHT(if known)
Pearland City Council Position 4 Brazoria
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CANDIDATE 1 OFFICEHOLDER REPORT: FORM C/OH
SUPPORT & TOTALS COVER SHEET PG 2
2of12
13 C/OH NAME • Hernandez,Adrian 14 Filer ID
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)
❑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 3,950.00
(OTHER THAN PLEDGES,LOANS,OR GUARANTEES OF LOANS)
EXPENDITURE 3. TOTAL UNITEMIZED POLITICAL EXPENDITURES 0.00
TOTALS
4. TOTAL POLITICAL EXPENDITURES $ 5,096.43
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF THE 3,035.66
BALANCE REPORTING PERIOD
•
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF\THE LAST DAY 0.00
LOAN TOTALS OF THE REPORTING PERIOD
• 17 AFFADAVIT
I swear,or affirm,under penalty of perjury,tha a•_. .m.anying report is
true and correct and includes a 'a ion required to be re..•.-d by me
under Title 15,E :•e.
o. R
Notary ENIEE ID#13204KROSS2519 44r4
' A': My Commission Expires
''tom ' June 6,2023 /
, Signature of Candidate. a ice.- .er
AFFIX NOTARY STAMP/SEAL ABOVE Ie I
Sworn to and subscribed before me,by the said nd (1V\ t'i[��}' i,n' ,this the 1 day
J of UIC) ,20 9-1 ,to certify which,witness my hand and seal'of office.
16A57i— 1Q"M`e-e 16Y1)SS LJ D'ta9 uloi��
ignature of officer administering Printed name of officer administering Title f officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.83d66148
SUBTOTALS - C/OH FORM CIOH
COVER SHEET PG 3
3 of 12
18 FILER NAME 19 Filer ID
Hernandez,Adrian
20 SCHEDULE SUBTOTALS
NAME OF SCHEDULE SUBTOTAL AMOUNT
1. z SCHEDULE Al: MONETARY POLITICAL CONTRIBUTIONS $ 3,950.00
2. El SCHEDULE A2: NON-MONETARY(IN-KIND)POLITICAL CONTRIBUTIONS $
3. 0 SCHEDULE B: PLEDGED CONTRIBUTIONS $
4. El SCHEDULE E: LOANS $
5. D SCHEDULE Fl: POLITICAL EXPENDITURES FROM POLITICAL CONTRIBUTIONS $ 4,126.57
6. � SCHEDULE F2: UNPAID INCURRED OBLIGATIONS • $
7. 1=1 SCHEDULE F3: PURCHASE OF INVESTMENTS FROM POLITICAL CONTRIBUTIONS $
8. ❑ SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $
9. El SCHEDULE G: POLITICAL EXPENDITURES FROM PERSONAL FUNDS $ 969.86
10. EI SCHEDULE H: PAYMENT FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $
11. El SCHEDULE I:NON-POLITICAL EXPENDITURES FROM POLITICAL CONTRIBUTIONS $
12. SCHEDULE K:INTEREST,CREDITS,GAINS,REFUNDS,AND CONTRIBUTIONS RETURNED 0.19
TO FILER $
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.83d66L48
MONETARY POLITICAL CONTRIBUTIONS
SCHEDULE Al
1 Total pages Schedule Al:
The Instruction Guide explains how to complete this form. Sch: 1/2 Rpt:4/12
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($)
04/22/2021 Ardoin, Phil $300.00
6 Contributor address; City;State;Zip Code
1435 Crystal Lake Cir E •
•
Pearland,TX 77584
8 Principal occupation/Job title(See Instructions) 9 Employer(See Instructions)
Retired
Date Full name of contributor Ei out-of-state PAC(ID#: ) Amount of Contribution($)
04/28/2021 Doug, McReaken $1,500.00
Contributor address; City;State;Zip Code
3774 Buckholt St
Pearland,TX 77581
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Self-Employed Self-Employed
Date Full name of contributor El out-of-state PAC(ID#: ) Amount of Contribution($)
05/13/2021 Employees Better Government PAC • $500.00
Contributor address; City;State;Zip Code
18500 N Allied Way
Phoenix,AZ 85054
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Date Full name of contributor EI out-of-state PAC(ID#: ) Amount of Contribution($)
04/26/2021 HOME-PAC $1,000.00
Contributor address; City;State;Zip Code
9511 W Sam Houston Pkwy
•
Houston,TX 77064
Principal occupation/Job title(See Instructions) Employer(See Instructions) •
Date Full name of contributor out-of-state PAC(ID#: ) Amount of Contribution($)
04/26/2021 Hispanic Republicans of Texas $550.00
Contributor address; City;State;Zip Code
3530 Hyridge Dr
•
Austin,TX 78759
Principal occupation/Job title(See Instructions) Employer(See Instructions)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.83d66148
MONETARY POLITICAL CONTRIBUTIONS
SCHEDULE Al
1 Total pages Schedule Al:
The Instruction Guide explains how to complete this form. Sch:2/2 Rpt:5/12
2 FILER NAME 3 Filer ID
Hernandez,Adrian
4 Date 5 Full name of contributor El out-of-state PAC(ID#: ) 7 Amount of Contribution($)
04/23/2021 Ramona,Trevino $100.00
6 Contributor address; City;State;Zip Code
1122 Bobby St
Pearland,TX 77581
8 Principal occupation/Job title(See Instructions) 9 Employer(See Instructions)
Self-Employed Self-Employed
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.83d66148
POLITICAL EXPENDITURES FROM POLITICAL
CONTRIBUTIONS SCHEDULE Fl
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees • Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions/Donations Made By- Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1: 2 FILER NAME 3 Filer ID
Sch: 1/2 Rpt: 6/12 Hernandez,Adrian
4 Date 5 Payee name
04/25/2021 Adrian, Hernandez
6 Amount($) 7 Payee address; City; State; Zip Code
•
$3,115.28 2900 Pearland Pkwy
Apt 11306
Pearland,TX 77581
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Loan Repayment/Reimbursement ❑Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE
Check if Austin,TX,officeholder living expense
Reimbursement for payments from personal funds.
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
05/07/2021 Adrian, Hernandez
Amount($) Payee address; City; State; Zip Code
$972.39 12501 Broadway St
Apt 9113
Pearland,TX 77584
PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Loan Repayment/Reimbursement �Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE
EICheck if Austin,TX,officeholder living expense
Reimbursement for payments from personal funds.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
04/22/2021 Anedot
Amount($) Payee address; City; State; Zip Code
$12.30 1340 Poydras Street.
Ste 1770
New Orleans, LA 70112
PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Fees 0 Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE
Check if Austin,TX,officeholder living expense
, Processing Fees
•
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.83d66148
POLITICAL EXPENDITURES FROM POLITICAL SCHEDULE Fl
CONTRIBUTIONS
EXPENDITURE CATEGORIES FOR BOX 8(a) •
Advertising Expense Event Expense • Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions!Donations Made By- Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1: 2 FILER NAME 3 Filer ID
Sch:2/2 Rpt: 7/12 Hernandez,Adrian
4 Date 5 Payee name
04/23/2021 Anedot
6 Amount($) 7 Payee address; City; State; Zip Code
$4.30 1340 Poydras Street
Ste 1770
- New Orleans, LA 70112 •
•
8 PURPOSE (a)category (See Categories listed at the top of this schedule) (b) Description
OF Fees ❑Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE ❑Check if Austin,TX,officeholder living expense
Processing fees.
•
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure—to benefit C/OH
Date Payee name
04/26/2021 Anedot •
Amount($) Payee address; City; • State; Zip Code
$22.30 1340 Poydras Street
Ste 1770
New Orleans, LA 70112
•PURPOSE (a)Category (See categories listed at the top of this schedule) (b) Description
OF Fees Check if travel outside of Texas.Complete Schedule T.
EXPENDITURE. ❑Check if Austin,TX,officeholder living expense
Processing fees.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH !
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Forms provided by Texas Ethics-Commission www.ethics.state.tx.us Version V1.1:183d66148
•
POLITICAL EXPENDITURES FROM PERSONAL FUNDS
SCHEDULE G
•
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions/Donations Made By- Gift/Awards/Memorials Expense Printing Expense , Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID
Sch: 1/4 Rpt:8/12 (Hernandez,Adrian
4 Date 5 Payee name
04/28/2021 Ace Hardware
6 Amount($) 7 Payee address; City; State; Zip Code
$25.96 2027 N Main St
Reimbursement from
political contributions
Intended Pearland,TX 77581
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description Check if travel outside of Texas. Complete Schedule T.
OF Polling Expense ❑Check if Austin,'TX,officeholder living expense
EXPENDITURE
Zip ties and a knife for putting out signs. •
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH •
Date Payee name
04/23/2021 Facebook
Amount($) Payee address; City; State; Zip Code
$35.00 1 Hacker Way
•
Reimbursement from
political contributions
intended Menlo Park, CA 94025
PURPOSE Category (See Categories listed at the top of this schedule) Description ❑Check if travel outside of Texas. Complete Schedule T.
OF Advertising Expense IDCheck if Austin,TX,officeholder living expense
EXPENDITURE
• Facebook advertising.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
•
Date Payee name
04/25/2021 Facebook
Amount($) Payee address; City; State; Zip Code
$50.00 1 Hacker Way
Reimbursement from
X political contributions
intended • Menlo Park, CA 94025 •-
PURPOSE Category (See Categories listed at the top of this schedule) Description 0 Check if travel outside of Texas. Complete Schedule T.
OF Advertising Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
Facebook advertising.
, Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH •
•
•
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.83d66148
•
POLITICAL EXPENDITURES FROM PERSONAL FUNDS
SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions/Donations Made By- Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID
•
Sch:2/4 Rpt:9/12 Hernandez,Adrian
4 Date 5 Payee name
04/30/2021 Facebook
6 Amount($) 7 Payee address; City; State; Zip Code
$75.00 1 Hacker Way
Reimbursement from •
political contributions
intended . . Menlo Park, CA 94025
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description El Check if travel outside of Texas. Complete Schedule T.
OF Advertising Expense ElCheck if Austin,TX,officeholder living expense
EXPENDITURE
Facebook advertising.
9 Complete ONLY if direct• Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Date Payee name
05/01/2021 Facebook •
•
Amount($) Payee address; City; State; Zip Code
$125.00 1 Hacker Way
Reimbursement from
political contributions
intended Menlo Park,CA 94025
PURPOSE Category (See Categories listed at the top at this schedule) Description ❑Check if travel outside of Texas. Complete Schedule T.
OF Advertising Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
Facebook advertising.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Date Payee name
05/02/2021 Facebook
Amount($) Payee address; City; State; Zip Code
$70.41 1 Hacker Way
Reimbursement from
JJpolitical contributions
intended Menlo Park,CA 94025
PURPOSE Category (See Categories listed at the top of this schedule) Description EI Check if travel outside of Texas. Complete Schedule T. .
OF Advertising Expense ❑Check if Austin,TX,officeholder living expense
EXPENDITURE
Facebook advertising.
•
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.83d66148
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POLITICAL EXPENDITURES FROM PERSONAL FUNDS
SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions/Donations Made By- Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
• The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID
Sch:3/4 Rpt:10/12 Hernandez,Adrian
4 Date 5 Payee name
05/01/2021 Lowe's Home Improvement
6 Amount($) 7 Payee address; City; State; Zip Code
$79.37 2741 Broadway St
Reimbursement from
political contributions
intended Pearland,TX 77581
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description El Check if travel outside of Texas. Complete Schedule T.
OF Polling Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
Plywood as a floor for polling tents to keep volunteers out
of the water from rain.
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Date Payee name
04/24/2021 PJ's Coffee of New Orleans
•
Amount($) Payee address; City; State; Zip Code
$54.12 12640 Broadway St
Reimbursement from
political contributions
intended Pearland,TX 77584
PURPOSE Category (See Categories listed at the top of this schedule) Description D Check if travel outside of Texas. Complete Schedule T.
OF Food/Beverage Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
• Coffee donation for Lions Club clean up event.
•
•
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Date Payee name
05/02/2021 Pearland Neighborhood Center •
Amount($) Payee address; City; State; Zip Code
$20.00 2335 N Texas Ave
Reimbursement from
Epolitical contributions
intended Pearland,TX 77581
PURPOSE Category (See Categories listed at the top of this schedule) Description El Check if travel outside of Texas. Complete Schedule T.
OF Event Expense ElCheck if Austin,TX,officeholder living expense
EXPENDITURE
Pearland Neighborhood Center crawfish fundraiser.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
•
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.83d66148
POLITICAL EXPENDITURES FROM PERSONAL FUNDS
SCHEDULE G
EXPENDITURE CATEGORIES•FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions!Donations Made By- Gitt/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID
Sch:4/4 Rpt: 11/12 • Hernandez,Adrian
4 Date 5 Payee name
04/30/2021 Point Blank Political LLC
6 Amount($) 7 Payee address; City; State; Zip Code
$300.00 330 Crown Oak Centre Dr
Reimbursement from
political contributions
intended Longwood, FL 32750
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description Ei Check if travel outside of Texas. Complete Schedule T.
OF Advertising Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
Robocalling campaign.
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit •
C/OH
•
Date Payee name
05/08/2021 • PoliEngine
Amount($) Payee address; City; State; Zip Code
$35.00 621 NW 12th Ave
Reimbursement from
political contributions
intended Gainesville, FL 32601 •
PURPOSE Category (See Categories listed at the top of this schedule) Description Ei Check if travel outside of Texas. Complete Schedule T.
• OF Advertising Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
Campaign website hosting.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Date Payee name
06/24/2021 West Pearland Republican Women
Amount($) Payee address; City; State; Zip Code
•
I $100.00 8325 Broadway St
Reimbursement from Suite 202
political contributions
intended Pearland,TX 77581
PURPOSE Category (See Categories listed at the top of this schedule) Description Check if travel outside of Texas. Complete Schedule T.
OF Event Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
Proudly Red ticket.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.83d66148
INTEREST, CREDITS, GAINS, REFUNDS, AND
CONTRIBUTIONS RETURNED TO FILER SCHEDULE K
1 Total pages Schedule K:
The Instruction Guide explains how to complete this form. Sch: 1/1 Rpt:12/12
2 FILER NAME 3 Filer ID
Hernandez,Adrian
4 Date 5 Name of person from whom amount is received 8 Amount($)
05/01/2021 JSC Federal Credit Union $0.12
6 Address of person from whom amount is received; City;State;Zip Code
1330 Gemini
•
Houston,TX 77058
7 Purpose for which amount is received Check if political contribution returned to filer
Dividend Credit
Date Name of person from whom amount is received Amount($)
06/01/2021 JSC Federal Credit Union $0.07
Address of person from whom amount is received; City;State;Zip Code
1330 Gemini
Houston,TX 77058
Purpose for which amount is received ❑ Check if political contribution returned to filer
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.83d66148