FAIRDOSI TIFFANY_APRIL 7 2022_CAMPAIGN FINANCE REPORTCANDIDATE / OFFICEHOLDER
FORM C/OH
CAMPAIGN
FINANCE REPORT
COVER SHEET PG 1
The C/OH Instruction Guide explains how to complete this form.
1 Filer ID (Ethics Commission Filers)
2 Total pages filed:
3
CANDIDATE /
OFFICEHOLDER
MS MRS MR FIRST MI
.F I F F /1 W�
OFFICE USE ONLY
NAME
.....................................
Date Received
NICKNAME � LAST � � � � SUFFIX
RECEIVE
APR 0 7 2022
4 CANDIDATE /
OFFICEHOLDER
MAILING
ADDRESS
ADDRESS / PO BOX; APT / UITE #; CITY; STATE; ZIP CODE
`-' `
Tk
j%(lAC i II
Change of Address
-
ell� �� 4
CITY OF PEARLAND
ITY SECRETARY'
6
CANDIDATE/
OFFICEHOLDER
PHONE
AREA CODE PHONE NUMBER EXTENSION
��
Dale Hand -delivered or Date Postmarked
Receipt #
Amount $
6 CAMPAIGN
�
MS / MRS IC i FIRST MI
TREASURER
NAME........................................................................
SCETXT
NICKNAME LAST SUFFIX
Date Processed
_ 1
Date Imaged
7
CAMPAIGN
TREASURER
ADDRESS
STREETADDRESS (NO PO,, BOX � PLE9ASSE,,); APT / SUIT�
�e �
(Residence or Business)
8
CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
9
REPORT TYPE
January 15 30th day before election Runoff
15th day after campaign
treasurer appointment
(Officeholder Only)
July 15 8th day before election W Exceeded Modified
I t I Reporting Limit
Final Report (Attach C/oH - FR)
10
PERIOD
Month Day Year Month
Day Year
COVERED
THROUGH Li
Q
!�
11
ELECTION
ELECTION DATE
ELECTION TYPE
Month Day Year
Primary Runoff Other
Description
5 / fI /ZV?� Z.
(General Special
12
OFFICE
OFFICE HELD (f any)
13 OFFICE SOUGHT Cifknown)
14
NOTICE FROM
POLITICAL
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(S)
COMMITTEE TYPE
COMMITTEE NAME
GENERAL
COMMITTEE ADDRESS
Additional Pages
COMMITTEE CAMPAIGN TREASURER NAME
SPECIFIC
COMMITTEE CAMPAIGN TREASURER ADDRESS
GO TO PAGE 2
Forms provided by Texas Ethics Commission wwrw.ethics.state.tx.us Revised 8/17/2020
MONETARY POLITICAL CONTRIBUTIONS
SCHEDULE Al
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 At:
2 FILER NAME �,
►
3 Filer
ID (Ethics Commission
Filers)
V�I'D
4 Date
6`Full name ut r ut-of-state PAC QD#: i
7 Amount
off contribution
($)
1offcontri
/
.�tl�. Y. `� .�f!......................................
o
Contributor Odress;Sly, City; State; Zip Code
1 X11S;5
`
8 Principal occupation / Job title (See Instructions)
9 Employer (See Instructions)
Date
Full naive of o�o��ntributor` out-of-state PAC OD#: i
Amount of contribution
($)
�11
4,a4a* .Li.S!.1.1.a... V"1V.................................
ID
Contributor address; City; State; Zip Code
�1
(/
23r, I olvwvm �s
Dr X �n qq j
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor out-of-state PAC (ID#: i
Amount of contribution
($)
Z I e7
?-!�.. 1.................................................
l/
Contributor address; City; State; Zip Code
Dr
� 2
2 31 t l �-1 (.en� �v'
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributorout-of-state PAC VD#: )
Amount of contribution
($)
2[2��2✓
Contributor ad res$; City; State; Zip Code
V
r
Principal occupation / Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is outoof-state PAC, please see Instruction guide for additional reporting
requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
MONETARY
POLITICAL CONTRIBUTIONS
SCHEDULE Al
If the requested
information is not applicable, DO NOT include this page in the report.
The Instruction Guide explains how
to complete this form.
1 Total pages Schedule Al:
2CaR NMFT
KA
3 Filer ID (Ethics Commission Filers)
4 Date
5 Fu I namj e of contributor
� out-of-state PAC (ID# _ )
7 Amount of contribution
($)
16
21 22--
6 Contribu r addres
ZZgID "More s C�-
City; State; Zip Code
c
v
8 Principal
occupation / Job title (See Instructions)
_
_
g Employer (See Instructions)
Date
Full name of contributor
❑ out -of -slate PAC (ID#'._ )
Amount of contribution
($)
jjVjqe7
..................................................................
MContr' Lit addrs;
�2l �s-��
City; State; Zip Code
Principal
occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor
❑ out-of-state PAC (ID#: )
Amount of contribution
($)
.............................................................................
Contributor address;
City; State; Zip Code
Principal
occupation / Job title (See Instructions)
Employer (See Instructions)
Date
Full name of contributor
out-of-state PAC (ID# )
Amount of contribution
($)
..................................................................................
Contributor address;
City; State; Zip Code
Principal
occupation / .Job title (See Instructions)
Employer (See Instructions)
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
If contributor is out-of-state PAC, please see Instruction guide for additional reporting requirements.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
POLITICAL
EXPENDITURES
L FUN®
SCHEDULE
If the requested information is not applicable, DO NOT include
this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Adverfising Expense
Event Expense Loan Repayment/Reimbursement SolicitationIFundraising Expense
Accounting/Banking
Fees Office Overhead/Rental Expense Transportation Equipment & Related Expense
Consulting Expense
Food/Beverage Expense Polling
Expense Travel In District
Contributons/Donations Made
By Gift/Awards/Memorials Expense Printing
Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services SalariesNVages/ContractLabor Other (enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G:
2 FILER N E
3 Filer ID (Ethics Commission Filers)
_
T
4 Date
6 Payee name
6 ArlLount
tq (onGG��($)
zPRelmbursementfrom
7 Payee �aC) 7
�
City; State; Zip Code
lV
� -- 1H
CAP
political contributions
intended
8
PUROPOSE
(a) Category (See Categories listed at the top of this schedule)
(b) Description
4
10 \'ess C
EXPENDITURE
(c) Check if travel outside of Texas. Complete Schedule
Check if Austin, TX, officeholder living expense
9
Complete ONLY if direct
Can idat / Officeholder name
I
+01
Office sought Office held
/� r , 1 P
expenditure to benefit C/OH
�e
1 1,
I (i"N,nIl/,
o
�6 �
�
D to
��I
Payee name ,n
�1 t� \V
` \�
Amount
®�
PI ayoe�ddr ; ,� �� C' i�
City; State; Zip Code
/ lRJ
C'
e mbursemtom
trib
political contributions
intended
Category(See Categories listed at the top of this schedule)
Description
PURPOSE
OF`i�V
t Y l
T
EXPENDITURE
Chec if travel outside of Texas. Complete Scheduler.
eck if Austin, TX, officeholder living expense
C idate / Officeholder name
Complete ONLY if direct -
expenditure to benefit ClOH (flfl7w
Office sought Office held
ya L W t
o
Date
�l
Payee name
2�
)[11060o-t
r
Amount ($)
I D ()0
Payee addre s;
� �2
City; State; Zip Code
.
Reimbursementfrom
political contributions
intended
Category (See Categories listed at the top of this schedule)
Description
PURPOSE
OF
�V 'v" t Vv e
i7
tkud
t �'�
NqboEXPENDITURE
Check iftravelo eofTexas,CompleteScheduleT
Check if Austin, TX, officeholder living expense
Complete P.M if direct
CarAidate / Officeholder name
Office sought Office held
expenditure to benefit C/OH
i�
ATTACH A ITIONAL COPIES OF THIS
SC DULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
CANDIDATE/OFFICEHOLDER
FORM C/OH
CAMPAIGN FINANCE T COVER SHEET PG 2
16 C/OH NAME - ', —
rry / Fp I rz DDS 1
16 Filer
ID (Ethics Commission Filers)
17 CONTRIBUTION
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)
$
EXPENDITURE
TOTALS
3.
TOTAL UNITEMIZED POLITICAL EXPENDITURE.
$
4.
TOTAL POLITICAL EXPENDITURES
$ /� C),P3 5�
CONTRIBUTION
5.
TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
$
BALANCE
OF REPORTING PERIOD
OUTSTANDING
6,
TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
$
LOAN TOTALS
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 Officeholder
Please complete either option below s
(1) Affidavit
NOTARY STAMP/SEAL
Sworn to and subscribed before
me by 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
(2) Utlsworn Declaration
r---r
My name is
and my date of birth is
My address is
(street) (city)
(country)
eel
Executed in rDlV1�l--County, State of on the day of
"'zi,
___—(mon h)r
S nature of Candidate/Z
o der (Dec t
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 8/17/2020
SUBTOTALS -C/OH
COVER
FORM C/OH
SHEET PG 3
18
FILER NAME
20 Filer ID (Ethics Commission Filers)
21
SCHEDULES B TALS
NAME OF SCHOULE
SUBTOTAL
AMOUNT
1 •
SCHEDULEA1: MONETARY POLITICAL CONTRIBUTIONS
$ 40 GJ
2•
SCHEDULE A2: NON -MONETARY (IN -KIND) POLITICAL CONTRIBUTIONS
$
3.
SCHEDULES: PLEDGED CONTRIBUTIONS
$
4.
SCHEDULE E: LOANS
$
5.
SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS
$
6.
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
! vv
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 vrww.ethics.state.tx.us Revised 8/17/2020