Chavarria Mona-July 15-Campaign Finance Report____
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The
C/OH
Instruction
Guide
explains
how
to
complete
this
form.
1
Filer
ID
(Ethics
Commission
Filers)
2
Total
pages
filed:
MS
/
MRS
MR
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of
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AREA
CODE
PHONE
NUMBER
EXTENSION
6
CANDIDATE/
Date
Nand
delivered
or Date
Postmarked
OFFICEHOLDER
in
)
—
o
CAMPAIGN
MS
/
MRS
/
MR
FIRST
MI
Receipt
#
Amount
$
,
TREASURER
ce
Date
Processed
NA
M
E
1
NICKNAME
LAST
SUFFIX
\ t..4.0\
Date
Imaged
7
CAMPAIGN
STREET
ADDRESS
(NO
PO
BOX
PLEASE);
APT
/ SUIT
It;
CITY;
STATE;
ZIP
CODE
TREASURER
efa%1‘
or
Business)
CAMPAIGN
AREA
CODE
PHONE
NUMBER
EXTENSION
8
TREASURER
PHONE(6)•C61--
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TYPE
1
I
January
15
30th
day
before
election
Runoff
15th
day
after
campaign
treasurer
(Officeholder
appointment
Only)
July
15
8th
day
before
election
Exceeded
Modified
Final
Report
(Attach
C/OH
-
FR)
Reporting
Limit
10
PERIOD
Month
Day
Year
Month
Day
Year
COVERED
.�
/
/
THROUGH
/O/
'
—„L
ELECTION
DATE
ELECTION
TYPE
11
ELECTION
Month
Day
Year
❑
Primary
Runoff
Other
Description
/
/
General
Special
12
OFFICE
HELD
(if
any)
13
OFFICE
SOUGHT
(if
known)
OFFICE
(7
C\CA
R
''S
3
--%
1C-03
THIS
BOX
IS FOR
NOTICE
OF
POLITICAL
CONTRIBUTIONS
ACCEPTED
OR
POLITICAL
EXPENDITURES
MADE
BY
POLITICAL
COMMITTEES
la.
NOTICE
FROM
TO SUPPORT
THE
CANDIDATE
/
OFFICEHOLDER.
THESE
EXPENDITURES
MAY
HAVE
BEEN
WIDE
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)
COMMITTEE
TYPE
COMMITTEE
NAME
GENERAL
COMMITTEE
ADDRESS
Additional
Pages
n
SPECIFIC
COMMITTEE
CAMPAIGN
TREASURER
NAME
COMMITTEE
CAMPAIGN
TREASURER
ADDRESS
GO
TO
PAGE
2
Forms provided by Texas Ethics Commission
www.ethics.state.tx.us
Revised 1/1/2024
CANDIDATI d OEHCEHOLDER FORM C/OH
CAMPAIGN HISJANCE REPORT
COVER SE MET PG 2
16 C/OH NAME
16 Filer ID (Ethics Commission Filers)
17 CONTRIBUTION
TOTALS
EXPENDITURE
TOTALS
CONTRIBUTION
BALANCE
OUTSTANDING
LOAN 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)
3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
4. TOTAL POLITICAL EXPENDITURES
5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY
OF REPORTING PERIOD
6 TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LAST DAY OF THE REPORTING PERIOD
tyzi,
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.
(1) Affidavit
Signature oTCandidate or Officeholder
Please ccn nphto 'o�t,Gior ��,�:����,o� l�� E- c foknf!
RYCCA HEYDE PILLING
°.� a'<6 Notary Public, State of Texas
• 4; Comm. Expires 02-14-2027
''� an �� Notary ID 134200229
NOTARY STAMP/SEAL
Sworn to and subscribed before me by Ha VIN &Cita \awl a
tc certify whi
ure of officer administering oath
(2) Unsworn Declaration
f1
ss my hand an heal of office.
C,Ca. He
Printed name of officer administering oath
this the ,23Cd day of Say
I4
Titl • of officer adminis
7
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 1 /1 /2024