Hernandez Adrian-January 15-Campaign Finance Report CANDIDATE / OFFICEHOLDER FORM CIOH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 Filer ID 2 Total pages filed:
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3 CANDIDATE/ MS/MRS/MR FIRST MI OFFICE USE ONLY
OFFICEHOLDER Adrian RECEIVED
NAME Date Received
JAN 1 fir 21024 14:17
NICKNAME LAST SUFFIX CITY OF PEARLAND
Hernandez CITY SECRETARY'S OFFICE
4 CANDIDATE 1 ADDRESS/PO BOX, APT!SUITE#' CITY; ZIP CODE Date Hand-delivered or Date Postmarked
OFFICEHOLDER
Receipt# Amount
❑Change of Address Pearland,TX 77584 Date Processed
Date Imaged
5 CAMPAIGN MS/MRS/MR FIRST MI
TREASURER
NAME \I.Q—Or
NICKNAME LAST_ SUFFIX
L
OrtS
6 CAMPAIGN STREET ADDRESS(NO PO BOX PLEASE); APT/SUITE#; CITY, STATE, ZIP CODE
TREASURER
ADDRESS
" .
(Residence or Business)
e"(A)A.C14AfjC q---4-c-$i
7 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
'[ "''
TYPE El January 15 El 30th day before election Runoff 0 15th day after campaign treasurer
appointment(officeholder only)
El July 15 ❑ 8th day before election El Exceeded modified 0 Final Report(Attach C/OH-FR)
reporting limit
9 PERIOD Month Day Year Month Day Year
COVERED 07/01/2023 THROUGH 12/31/2023
10 ELECTION ELECTION DATE ELECTION TYPE
Month Day Year Ei Primary ❑'Runoff Other
General El 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 CIOH
SUPPORT & TOTALS COVER SHEET PG 2
2 of 8
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
EI 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 $ 0.00
(OTHER THAN PLEDGES,LOANS,OR GUARANTEES OF LOANS)
EXPENDITURE 3. TOTAL UNITEMIZED POLITICAL EXPENDITURES 0.00
TOTALS
4 TOTAL POLITICAL EXPENDITURES 10,441.18
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF THE 0 00
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 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.
► ,r
,�,�p11YPVAi� GLADIS SANCHEZ
•'' Notary Public,State of Texas
`� �4� Comm.Expires 02-24-2024
u,°F, `` Notary ID 130553701
eholder
AFFIX NOTARY STAMP/SEAL ABOVE
Sworn to and subscribed before me,by the said ,"G �r i 4W vtari ces,. ,this the 3 42' day
of L\clytwil, ,20 Z,M ,to certify which,witness my hand and seal of office.
4 1 felarbr
S. :tore of oo icer adminietrerg tegn me of officer lack istering it e f oftdrcinis g oath
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SUBTOTALS - CIOH FORM CIOH
COVER SHEET PG 3`
3 of 8
18 FILER NAME 19 Filer ID
Hernandez,Adrian
20 SCHEDULE SUBTOTALS
NAME OF SCHEDULE SUBTOTAL AMOUNT
1. ❑ SCHEDULE Al. MONETARY POLITICAL CONTRIBUTIONS $
2. El SCHEDULE A2: NON-MONETARY(IN-KIND)POLITICAL CONTRIBUTIONS $
3. 111 SCHEDULE B: PLEDGED CONTRIBUTIONS $
4 SCHEDULE E. LOANS $
5. SCHEDULE Fl. POLITICAL EXPENDITURES FROM POLITICAL CONTRIBUTIONS $ 6,220.59
6. El SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $
7 El 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 $ 4,220.59
10. ❑ SCHEDULE H: PAYMENT FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $
11. ❑ SCHEDULE I NON-POLITICAL EXPENDITURES FROM POLITICAL CONTRIBUTIONS $
12. SCHEDULE K.INTEREST,CREDITS,GAINS,REFUNDS,AND CONTRIBUTIONS RETURNED
TO FILER
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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. 1/1 Rpt: 4/8 Hernandez,Adrian
4 Date 5 Payee name
07/12/2023 Hernandez,Adrian
6 Amount($) 7 Payee address; City; State; Zip Code
$2,000.00 12501 Broadway St
Pearland,TX 77584
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Loan Repayment/Reimbursement Check if travel outside of Texas.Complete Schedule T
EXPENDITURE
Check if Austin,TX,officeholder living expense
Reimbursement to OH
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
08/12/2023 Hernandez,Adrian
Amount($) Payee address; City State; Zip Code
$3,720.59 12501 Broadway St
Pearland,TX 77584
PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Loan Repayment/Reimbursement El Check if travel outside of Texas.Complete Schedule T
EXPENDITURE
❑Check if Austin,TX,officeholder living expense
Reimbursement.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
08/02/2023 Visionary Outreach
Amount($) Payee address; City; State; Zip Code
$500.00 2615 S Main St
Stafford,TX 77477
PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description
OF Advertising Expense ❑Check if travel outside of Texas.Complete Schedule T
EXPENDITURE
Check if Austin,TX,officeholder living expense
2024 Pearland Juneteenth advertisement.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
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POLITICAL EXPENDITURES FROM PERSONAL FUNDS
SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID
Sch: 1/3 Rpt:5/8 Hernandez,Adrian
4 Date 5 Payee name
08/11/2023 Best Donuts
6 Amount($) 7 Payee address; City; State; Zip Code
$100 00 9430 Broadway St#140
Reimbursement from
EIpolitical contributions
intended Pearland,TX 77584
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description Check if travel outside of Texas. Complete Schedule T
OF Advertising Expense Check if Austin,TX,officeholder living expense
EXPENDITURE
Advertising on donut boxes.
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Date Payee name
08/03/2023 Dawson HS Band Booster
Amount($) Payee address; City State; Zip Code
$106.84 P 0 Box 84134
Reimbursement from
political contributions
intended Pearland,TX 77584
PURPOSE Category (See Categories listed at the top of this schedule) Description El Check if travel outside of Texas. Complete Schedule T
OF Contributions/Donations Made By Check if Austin,TX,officeholder living expense
EXPENDITURE Candidate/Officeholder/Political Committee
Donation
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Date Payee name
08/12/2023 First Church of Pearland
Amount($) Payee address; City State; Zip Code
$2,062.65 1850 Broadway St
Reimbursement from
Elpolitical contributions
intended Pearland,TX 77581
PURPOSE Category (See Categories listed at the top of this schedule) Description Check if travel outside of Texas. Complete Schedule T
OF Contributions/Donations Made By Check if Austin,TX,officeholder living expense
EXPENDITURE Candidate/Officeholder/Political Committee
Donation to Second Chances Ministry
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
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POLITICAL EXPENDITURES FROM PERSONAL FUNDS
SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expepse Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID
Sch:2/3 Rpt: 6/8 Hernandez,Adrian
4 Date 5 Payee name
08/12/2023 Keep Texas Beautiful
6 Amount($) 7 Payee address; City. State; Zip Code
$250.00 8850 Business Park Drive
Reimbursement from Ste 200
Eipolitical contributions
intended Austin,TX 78759
8 PURPOSE (a)Category (See Categories listed at the top of this schedule) (b) Description El Check if travel outside of Texas. Complete Schedule T
OF Contributions/Donations Made By 0Check if Austin,TX,officeholder living expense
EXPENDITURE Candidate/Officeholder/Political Committee
Donation
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Date Payee name
07/12/2023 Pearland Lions Club
Amount($) Payee address; City. State; Zip Code
$500.00 3350 S Main St
Reimbursement from
political contributions
intended Pearland,TX 77581
PURPOSE Category (See Categories listed at the top of this schedule) Description ❑Check if travel outside of Texas. Complete Schedule T
OF Advertising Expense 0 Check if Austin,TX,officeholder living expense
EXPENDITURE
Lions Club 75th Anniversary Sponsorship AD
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
Date Payee name
08/09/2023 PersonalizationMall.com
Amount($) Payee address; City; State; Zip Code
$951.10 51 Shore Dr
Reimbursement from
Eipolitical contributions
intended Burr Ridge, IL 60527
PURPOSE Category (See Categories listed at the top of this schedule) Description El Check if travel outside of Texas. Complete Schedule T
OF Gift/Awards/Memorials Expense 0 Check if Austin,TX,officeholder living expense
EXPENDITURE
Appreciation gifts for campaign volunteers.
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
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POLITICAL EXPENDITURES FROM PERSONAL FUNDS
SCHEDULE G
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
AccountinglBanking Fees Office Overhead/Rental Expense Transportation Equipment&Related Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel in District
Contributions/Donations Made By Gift/Awards/Memorials Expense Printing Expense Travel Out of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor OTHER(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule G: 2 FILER NAME 3 Filer ID
Sch.3/3 Rpt:7/8 Hernandez,Adrian
4 Date 5 Payee name
08/12/2023 Recycling Alliance of Texas
6 Amount($) 7 Payee address; City; State; Zip Code
$250.00 PO Box 142274
Reimbursement from
political contributions
intended Austin,TX 78714
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 Contributions/Donations Made By Check if Austin,TX,officeholder living expense
EXPENDITURE Candidate/Officeholder/Political Committee
Donation.
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit
C/OH
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FORM C/OH - FR
The Instruction Guide explains how to complete this form.
**Complete only if"Report Type" on page 1 is marked "Final Report" ** Page 8 of 8
1 C/OH NAME 2 Filer ID
Hernandez,Adrian meetadrian@live.com
3 SIGNATURE
I do not expect any further political contributions or political expenditures in connection with my candidacy I understand that designating a report
as a final report terminates my campaign treasurer appointment.I also understand that I may not accept any campaign contributions or make any
campaign expenditures without a campaign treasurer appointment on file.
Signature of Candidate/Officeholder
4 FILER WHO IS NOT AN OFFICEHOLDER
**Complete A&B below only if you are not an officeholder**
A CAMPAIGN FUNDS
Check only one:
❑ I do not have unexpended contributions or unexpended interest or income earned from political contributions.
ElI have unexpended contributions or unexpended interest or income earned from political contributions. I understand that I may not
convert unexpended political contributions or unexpended interest or income earned on political contributions to personal use. I also
understand that I must file an annual report of unexpended contributions and that I may not retain unexpended contributions or
unexpended interest or income earned on political contributions longer than six years after filing this report. Further,I understand that I
must dispose of unexpended political contributions and unexpended interest or income earned on political contributions in accordance
with the requirements of Election Code 254.204
B ASSETS
Check only one:
❑ I do not retain assets purchased with political contributions or interest or other income from political contributions.
▪ I do retain assets purchased with political contributions or interest or other income from political contrubutions. I understand that I may not
convert assets purchased with political contributions or interest or other income from political contributions to personal use. I also
understand that I must dispose of assets purchased with political contributions in accordance with the requirements of Election Code,
254.204
Signature of Candidate
5 OFFICEHOLDER
"Complete this section only if you are an officeholder**
�X I am aware that I remain subject to filing requirements applicable to an officeholder who does not have a campaign treasurer on file. I am
also aware that I will be required to file reports of unexpended contributions if,after filing the last required report as an officeholder, I
retain political contributions,interest or other income from politicial contributions,or assets purchased with political contributions or
interest or other income from political contributions.
Signature of Officeholder
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