Texas > Statewide > Ethics Commission
State-County Chair Campaign Finance Report SC C-OH - Texas
| State-County Chair 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) STATE / COUNTY CHAIR CAMPAIGN FINANCE REPORT 1 ACCOUNT # The SC C/OH Instruction Guide explains how to complete this form. 3 NAME MS / MRS / MR FIRST (Ethics Commission Filers) SC C/OH COVER SHEET PG 1 FORM 2 Total pages filed: MI OFFICE USE ONLY Date Received NICKNAME LAST SUFFIX 4 ADDRESS change of address ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE 5 CANDIDATE PHONE AREA CODE PHONE NUMBER EXTENSION ( ) FIRST MI 6 CAMPAIGN TREASURER NAME 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 convention / election July 15 8th day before convention / election 10 PERIOD COVERED Month Day Year Month Day THROUGH 11 CONVENTION / ELECTION DATE Month Day Year 12 OFFICE SOUGHT 13 POLITICAL PARTY COUNTY (If Applicable) 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 Processed Date Imaged ZIP CODE Runoff Final report (Attach SC C/OH - FR) Year STATE CHAIR COUNTY CHAIR Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) STATE / COUNTY CHAIR CAMPAIGN FINANCE REPORT: SUPPORT & TOTALS 14 FILER NAME FORM SC C/OH PG COVER SHEET 2 15 ACCOUNT # (Ethics Commission Filers) 16 NOTICE FROM POLITICAL COMMITTEE(S) ·· This box is for notice of political expenditures by political committees to support the candidate. These expenditures may have been made without the candidate's knowledge or consent. Candidates 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 $100 OR LESS, UNLESS ITEMIZED 4. CONTRIBUTION BALANCE OUTSTANDING LOAN TOTALS 18 AFFIDAVIT TOTAL POLITICAL EXPENDITURES 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY OF THE REPORTING PERIOD TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE LAST DAY OF THE REPORTING PERIOD 6. I swear, or affirm, under penalty of perjury, that the accompanying report is true and correct and includes all information required to be reported by me under Title 15, Election Code. Signature of Candidate AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said _____________________________________, ___________ day this the of _____________, 20 _____ , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath www.ethics.state.tx.us Revised 09/28/2011 American LegalNet, Inc. www.FormsWorkFlow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) POLITICAL CONTRIBUTIONS OTHER THAN PLEDGES OR LOANS The Instruction Guide explains how to complete this form. 2 FILER NAME 1 3 SCHEDULE A Total pages Schedule A: ACCOUNT # (Ethics Commission Filers) 4 Date 5 Full name of contributor out-of-state PAC (ID#:_________________________) 7 Amount of contribution ($) 8 In-kind contribution description (if applicable) 6 Contributor address; City; State; Zip Code 9 Principal occupation / Job title (See Instructions) 10 Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#:_________________________) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) (If travel outside of Texas, complete Schedule T) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#:_________________________) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#:_________________________) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) (If travel outside of Texas, complete Schedule T) Employer (See Instructions) Date Full name of contributor out-of-state PAC (ID#:_________________________) Contributor address; City; State; Zip Code Principal occupation / Job title (See Instructions) (If travel outside of Texas, complete Schedule T) Employer (See Instructions) 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 ($) In-kind contribution description (if applicable) Amount of contribution ($) In-kind contribution description (if applicable) (If travel outside of Texas, complete Schedule T) Amount of contribution ($) In-kind contribution description (if applicable) Amount of contribution ($) In-kind contribution description (if applicable) 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 1 3 SCHEDULE B The Instruction Guide explains how to complete this form. 2 FILER NAME Total pages this Schedule B: ACCOUNT # (Ethics Commission Filers) 4 5 Date TOTAL OF UNITEMIZED PLEDGES: 6 8 Amount of $ 9 In-kind description (if applicable) Full name of pledgor out-of-state PAC (ID#:___________________________) pledge ($) 7 Pledgor address; City; State; Zip Code 10 Principal occupation / Job title (See Instructions) 11 Employer (See Instructions) Date Full name of pledgor out-of-state PAC (ID#:___________________________) Pledgor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of pledgor out-of-state PAC (ID#:___________________________) Pledgor address; City; State; Zip Code Principal occupation / Job title (See Instructions) Employer (See Instructions) Date Full name of pledgor out-of-state PAC (ID#:___________________________)
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