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Judicial Candidate-Officeholder Campaign Finance Report JC-OH - Texas
| Judicial Candidate-Officeholder Campaign Finance Report Form. This is a Texas form and can be used in Ethics Commission Statewide . |
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Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) JUDICIAL CANDIDATE / OFFICEHOLDER CAMPAIGN FINANCE REPORT 1 ACCOUNT # The JC/OH Instruction Guide explains how to complete this form. 3 CANDIDATE / OFFICEHOLDER NAME JC/OH COVER SHEET PG 1 FORM 2 Total pages filed: (Ethics Commission Filers) MS / MRS / MR FIRST MI OFFICE USE ONLY Date Received NICKNAME LAST SUFFIX 4 CANDIDATE / OFFICEHOLDER MAILING ADDRESS change of address ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE 5 CANDIDATE/ OFFICEHOLDER PHONE 6 CAMPAIGN TREASURER NAME AREA CODE PHONE NUMBER EXTENSION Date Processed ( ) FIRST MI MS / MRS / MR NICKNAME LAST SUFFIX 7 CAMPAIGN TREASURER ADDRESS (residence or business) STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; 8 CAMPAIGN TREASURER PHONE AREA CODE PHONE NUMBER EXTENSION ( ) 9 REPORT TYPE January 15 30th day before election Runoff July 15 8th day before election Exceeded $500 limit 10 PERIOD COVERED Month Day Year Month Day THROUGH 11 ELECTION Month ELECTION DATE Day ELECTION TYPE Year Primary Runoff General Special 12 OFFICE OFFICE HELD (if any) 13 OFFICE SOUGHT (if known) GO TO PAGE 2 www.ethics.state.tx.us Revised 09/28/2011 American LegalNet, Inc. www.FormsWorkFlow.com Date Hand-delivered or Postmarked Receipt # Amount Date Imaged ZIP CODE 15th day after campaign treasurer appointment (officeholder only) Final report (Attach C/OH - FR) Year Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) JUDICIAL CANDIDATE / OFFICEHOLDER REPORT: SUPPORT & TOTALS 14 C/OH NAME JC/OH COVER SHEET PG 2 FORM 15 ACCOUNT # (Ethics Commission Filers) 16 NOTICE FROM POLITICAL COMMITTEE(S) 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 NAME COMMITTEE TYPE GENERAL COMMITTEE ADDRESS SPECIFIC COMMITTEE CAMPAIGN TREASURER NAME additional pages COMMITTEE CAMPAIGN TREASURER ADDRESS 17 CONTRIBUTION TOTALS 1. TOTAL POLITICAL CONTRIBUTIONS OF $50 OR LESS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS), UNLESS ITEMIZED $ $ $ $ $ $ 2. TOTAL POLITICAL CONTRIBUTIONS (OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS) EXPENDITURE TOTALS 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS, UNLESS ITEMIZED 4. CONTRIBUTION BALANCE OUTSTANDING LOAN TOTALS TOTAL POLITICAL EXPENDITURES 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF THE REPORTING PERIOD 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORTING PERIOD 18 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the accompanying report is true and correct and includes all information required to be reported by me under Title 15, Election Code. Signature of Candidate or Officeholder AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said ___________ day _____________________________________, this the of _____________, 20 _______ , to certify which, witness my hand and seal of office. Signature of officer administering oath Print name of officer administering oath Title of officer administering oath www.ethics.state.tx.us Revised 09/28/2011 American LegalNet, Inc. www.FormsWorkFlow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) POLITICAL CONTRIBUTIONS OTHER THAN PLEDGES OR LOANS (JUDICIAL) The Instruction Guide explains how to complete this form. 2 FILER NAME SCHEDULE A (J) 1 Total pages Schedule A(J): 3 ACCOUNT # (Ethics Commission Filers) 4 Date 5 Full name of contributor out-of-state PAC (ID#:__________________________) 7 Amount of contribution ($) 8 In-kind contribution description(if applicable) 6 Contributor address; City; State; Zip Code 9 Contributor's principal occupation 10 Contributor's job title 12 Law firm of contributor's spouse (if any) 11 Contributor's employer/law firm 13 If contributor is a child, law firm of parent(s) (if any) Date Full name of contributor out-of-state PAC (ID#:__________________________) Contributor address; City; State; Zip Code Contributor's principal occupation Contributor's employer/law firm Contributor's job title Law firm of contributor's spouse (if any) If contributor is a child, law firm of parent(s) (if any) Date Full name of contributor out-of-state PAC (ID#:__________________________) Contributor address; City; State; Zip Code Contributor's principal occupation Contributor's employer/law firm Contributor's job title Law firm of contributor's spouse (if any) If contributor is a child, law firm of parent(s) (if any) ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED If contributor is out-of-state PAC, please see instruction guide for additional reporting requirements. www.ethics.state.tx.us (If travel outside of Texas, complete Schedule T) Amount of contribution ($) In-kind contribution description(if applicable) (If travel outside of Texas, complete Schedule T) Amount of contribution ($) In-kind contribution description(if applicable) (If travel outside of Texas, complete Schedule T) Revised 09/28/2011 American LegalNet, Inc. www.FormsWorkFlow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) PLEDGED CONTRIBUTIONS (JUDICIAL) 1 SCHEDULE B (J) The Instruction Guide explains how to complete this form. 2 FILER NAME Total pages Schedule B(J): 3 ACCOUNT # (Ethics Commission Filers) 4 5 TOTAL OF UNITEMIZED PLEDGES: Date 8 $ 9 In-kind description (if applicable) 6 Full name of pledgor out-of-state PAC (ID#:__________________________) Amount of pledge ($) 7 Pledgor address; City; State; Zip Code 10 Pledgor's principal occupation 12 Pledgor's employer/law firm 14 If pledgor is a child, law firm of parent(s) (if any) 11 Pledgor's job title 13 Law firm of pledgor's spouse (if any) Date Full name of pledgor out-of-state PAC (ID#:__________________________) Pledgor address; City; State; Zip Code Pledgor's principal occupation Pledgor's employer/law firm Pledgor's job title Law firm of pledgor's spouse (if any) If pledgor is a child, law firm of parent(s) (if any) Date Full name of pledgor out-of-state PAC (ID#:__________________________) Pledgor address; City; State; Zip Code Ple
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