CHAVARRIA MONA_30 DAY BEFORE ELECTION_CAMPAIGN FINANCE REPORT CANDIDATE / OFFICEHOLDER FORM C/OH
REPORTCAMPAIGN FINANCE 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.
3 CANDIDATE/ MS/MRS/MR FIRST MI
OFFICEHOLDER "�, � OFFICE USE ONLY
NAME ....... 1 t..I. ..\................. .....I.......
Date Received
NICKNAME `� LAST SUFFIX
4 CANDIDATE/ ADDRESS /PO BOX; APT I SUITE#; CITY; STATE; ZIP CODE
OFFICEHOLDER NOILI '" 0 °1
CITY OF. ' ',NLAND
ADDRESS
❑ Change of Address raw y � CITY',XCRETA tY", FIC3.1'
5 CANDIDATE/ AREA CODE NUMBER
// EXTENSION Dale Hand-delivered or Date Postmarked
OFFICEHOLDER
PHONE —
Receipt# Amount$
6 CAMPAIGN MS/MRS I MR MI
TREASURER "' `Y� Date Processed
NAME ........................I.......... ..............................
NICKNAME LAST SUFFIX Dale Imaged
7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT/SUIITE#; 1 Y; STATE; CODE
ADDRESSEASURER \ - '� Cn �G1 Y1(�� )__ 1y��d'
(Residence or Business)
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
9 REPOR I-TYPE ❑ January 15 30th day before election El Runoff El
151h day after campaign
treasurer appointment
(Officeholder Only)
El July 15 El 8th day before election Exceeded Modified Final Report(Attach C/OH-FR)
Reporting Limit
10 PERIOD Month Day Year � `�, Month Day Year
COVERED I t / o j jl ACT'—✓ THROUGH
11 ELECTION ELECTION DATE C� ELECTION TYPE
Month Day Year ❑ Primary ❑ Runoff ❑ Other
Description
i /\ ❑ General Special —
12 OFFICE OFFICE HELD (if any) 1/l 13 OFFICE SOUGHT (if known)
14 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL THE CANDIDATE I 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
SPECIFIC COMMITTEE CAMPAIGN TREASURER NAME
COMMITTEE CAMPAIGN TREASURER ADDRESS
GO TO PAVE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/15/2022
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
15 C/01-1 NAME 16 Filer ID (Ethics Commission Filers)
17 CONTRIBUTION 1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR $
CONTRIBUTIONS MADE ELECTRONICALLY)
2. TOTAL POLITICAL CONTRIBUTIONS $
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
. . . . . . . . . . . . . . . .
EXPENDITURE 3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
TOTALS $
4. TOTAL POLITICAL EXPENDITURES $
. . . . . . . . . . . . .
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
BALANCE OF REPORTING PERIOD $ 114
. . . . . . . . . . . . .
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ k
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.
RYCCA 'HL)'M: �71,,UNG
Notary P �Aic, 'State of Texas
Z
c ornrn, "x E pires 02-14-2027 Signature of Candidate or Officeholder
Notary iD 134200229
Please complete either option below:
(1)Affidavit
NOTARY STAMP/SEAL
Sworn to and subscribed before me by this the day oftimph
2 - . rfif hich��ijtn , hand and seal of office.
— 0 e i y my an
c�
C1 e, ei
7ignatfre of officer adminktering oath Pri'ntJd name of officer administering oath Title of ofAqer Fadministering oath
(2) Unsworn Declaration
My name is and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
Executed in County, State of on the day of 20_.
(month) (year)
Signature of Candidate/Officeholder (Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/15/2022
SUBTOTALS - C/OH FORM C/OH
COVER SHEET PG 3
19 FILER NAME 20 File ID(Ethics Commission Filers)
21 SCHEDULE SUBTOTALS SUBTOTAL
NAME OF SCHEDULE AMOUNT
1• SCHEDULEAI: MONETARY POLITICAL CONTRIBUTIONS $
2• ❑ SCHEDULEA2: NON-MONETARY(IN-KIND)POLITICAL CONTRIBUTIONS $
3• SCHEDULE B: PLEDGED CONTRIBUTIONS $
4. El SCHEDULE E: LOANS $
5. SCHEDULE Fl: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $
6. SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $
7• El SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $
8• 0 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 1: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $
12. El SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS,AND CONTRIBUTIONS RETURNED $
TO FILER
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/15/2022
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:
2 FILER NAME 13 Filer ID (Ethics Commission Filers)
\
4 Date 5 Full name of contributor ❑out-of-state PAC(ID#: ) 7 Amount of contribution ($)
v 6 Contributor address; City; State; Zip Code i 00
8 Principal occupation/Job title(See Instructions) 9 Employer(See Instructions)
snp
Date ❑r Full name of contributor out-of-state PAC(ID#: ) Amount of contribution ($)
-V� + 0 t I )
Contributor address; City; State; Zip Code
Principal occupation/Job title(See Instructions) Employer (See Instructions)
n / A n l7'%,
Date Full name o11f,M1 contributor
� \�❑out-of-stale PAC(ID#: ) Amount of contribution ($)
Contributor address; City; State; Zip Code c"' O DO
Principal occupation/Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor ❑out-of-state PAC(ID#: ) Amount of contribution ($)
Contributor address; City; State; Zip Code �t~�
LN
Principal occupation/Job title (See Instructions) Employer ee Instructions) 1
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 11/15/2022
POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS ,
scHEou�E F1
If the requested information is not applicable, DO NOT include this page in the report.
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/FundraisingExpense
Accounfing/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 SalariesA/Vages/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 FI NAME 3 Filer ID (Ethics Commission Filers)
rN Qif�(A
4 Date 5 ayee name _
6 Amount ($) 7 Payee address; City; State; Zip Code
A Q-e t'
p
8 (a) Category(See Categories listed at the lop of this schedule) (b) Description
PURPOSE
OF
EXPENDITURE t n n X p-Q f-\
(c) Ej Check if travel outside of Texas.Complete ScheduleT. Check if Austin,TX,officeholder living expense
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
Category(See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas.Complete Schedule 171 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 ($) Payee address; City; State; Zip Code
Category (See Categories listed at the lop of this schedule) Description
PURPOSE
OF
EXPENDITURE
ElCheck if travel outside of Texas.Complete Schedule Check if Austin,TX,officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/15/2022
POLITICAL EXPENDITURES MADE FROM
PERSONAL FUNDS SCHEDULE G
If the requested information is not applicable, DO NOT include this page in the report,
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan RepaymenUReimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee LegalServices Salades/Wages/Contract Labor Other(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME —__ 3 Filer ID (Ethics Commission Filers)
4 Date 5 Payee name
Amount ($) 7 Payee address; City; State; Zip Code
Reimbursement from
political contributions
intended
8 (a) Category (See Categories listed at the top of this schedule) (b)DescriptionOF <
PURPOSE
EXPENDITURE P('k ✓) � \ r� ()-,,S '
(c) Check if travelou de of Texas.Complete Schedule Check if Austin,TX,officeholder living expense
9 Candidate/Officeholder name Office sought Office held
Complete ONLY if direct
expenditure to benefit C/OH
Date Payee name
\v - I - - -) c'C' 0
Amount ($) Payee address; City; —7— State; Zip Code
Reimbursement from
Elpolitical contributions
intended
ategory (See Categories listed at the top of this schedule) Description
PURPOSE ` c
OF qf \11 � 1�
EXPENDITURE
❑ Check if travel outside of Texas.Complete ScheduleT. Check if Austin,TX,officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
Amount ($) Payee address; City; State; Zip Code
❑ Reimbursement from
political contributions
Intended
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF
EXPENDITURE
Check if travel outside of Texas.Complete ScheduleT. 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 11/15/2022