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Candidate-Officeholder Report Of Unexpended Contributions C-OH-UC - Texas
| Candidate-Officeholder Report Of Unexpended Contributions 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) CANDIDATE / OFFICEHOLDER REPORT OF UNEXPENDED CONTRIBUTIONS The C/OH-UC Instruction Guide explains how to complete this form. C/OH-UC COVER SHEET PG 1 FORM 1 ACCOUNT # (Ethics Commission filers) 2 CANDIDATE / OFFICEHOLDER NAME MS/MRS/MR FIRST MI OFFICE USE ONLY Date Received NICKNAME LAST SUFFIX 3 CANDIDATE / OFFICEHOLDER ADDRESS Change of Address ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE 4 5 REPORT TYPE Annual PERIOD COVERED Month Day Year Final Disposition Month Day Year Date Imaged THROUGH 6 TOTALS 1. TOTAL AMOUNT OF UNEXPENDED POLITICAL CONTRIBUTIONS AS OF DEC. 31 OF THE PREVIOUS YEAR. 2. TOTAL AMOUNT OF INTEREST AND OTHER INCOME EARNED ON UNEXPENDED POLITICAL CONTRIBUTIONS DURING THE PREVIOUS YEAR. 7 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 ______________________________________, 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 www.ethics.state.tx.us Date Hand-delivered or Date Postmarked Receipt # Amount Date Processed $ $ Revised 06/30/2006 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) C/OH REPORT OF UNEXPENDED CONTRIBUTIONS EXPENDITURES 8 C/OH NAME FORM C/OH-UC PG 2 9 ACCOUNT # (Ethics Commission filers) 10 Date 11 Payee name 13 Amount ($) 12 Payee address; City; State; Zip Code 14 Purpose of expenditure 15 Is expenditure a contribution to a candidate, officeholder, or political committee? (If travel outside of Texas, complete Schedule T) (See Instruction Guide) Date Payee name Amount ($) Payee address; City; State; Zip Code Purpose of expenditure 15 Is expenditure a contribution to a candidate, officeholder, or political committee? (If travel outside of Texas, complete Schedule T) (See Instruction Guide) Date Payee name Amount ($) Payee address; City; State; Zip Code Purpose of expenditure 15 Is expenditure a contribution to a candidate, officeholder, or political committee? (If travel outside of Texas, complete Schedule T) (See Instruction Guide) Date Payee name Amount ($) Payee address; City; State; Zip Code Purpose of expenditure 15 Is expenditure a contribution to a candidate, officeholder, or political committee? (If travel outside of Texas, complete Schedule T) (See Instruction Guide) ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED www.ethics.state.tx.us Revised 06/30/2006 American LegalNet, Inc. www.FormsWorkFlow.com Yes No Yes No Yes No Yes No
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