Connie Baker January 2021 Semi-Annual FORM CIOH
CANDIDATE / OFFICEHOLDER COVER SHEET PG 1
CAMPAIGN FINANCE REPORT
1 Filer ID(Ethics Commission Filers) 2 Total pages filed:
The C/OH Instruction Guide explains how to complete this form.
3 CANDIDATE/
MS/MRS M FIRST MI OFFICE USE ONLY
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OFFICEHOLDER fl n I
NAME ..........................................LSUFFIX
...... Date
.......................
NICKNAME LA T
RECEIVED
4 CANDIDATE/ . ADDRESS I Po Box APT/SUITE#; CITY; STATE; ZIP CODE IAN 12
2021
OFFICEHOLDER ( C� j1� b
MAILING 6, '3 �� I f��Q r r c t3 J V
ADDRESS City Manager's/City
x ���O �-7 Secretary's Office
❑ Change of Address
5 CANDIDATE/ AREA CODE PHONE NUMBER EXTENSION Date Hand-delivered or Date Postmarked
OFFICEHOLDER
PHONE ��l 7 L Q �j
/ "( Receipt# Amount$
6 CAMPAIGN MS/MR /MR FIRST :dl
TREASURER Date Processed
NAME �. r r
NICKNAME LAST SUFFIX
Date Imaged
7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT/SUrrE#, CITY; STATE; ZIP CODE
TREASURER r / 1l� �� l (e t 0
ADDRESS 1
(Residence or Business)
8 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER PHONE �. 4 ri
9 REPORT TYPE (�7 January 15 30th day before election Runoff 15th day after campaign
K� treasurer appointment
(Officeholder Only)
El July 15 El 8th day before election Exceeded Modified ❑ Final Report(Attach C/OH-FIR)
Reporting Limit
10 PERIOD Month Day Year Month Day Year
COVERED
/ ' / ) 6 THROUGH r-)- 3 / /"-?,Q.;)-(,
11 ELECTION ELECTION DATE ELECTION TYPE
Month Day Year ❑ Primary ❑ Runoff Other
Description j )�/�
__,! Z ❑ General ❑ Special �V /.-�•
12 OFFICE OFFICE HELD (if any) D-e n -�o n , % 13 OFFICE SOUGHT (if known)
0_I+L 0Mnet
14 NOTICE FROM THIS Bd IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO SUPPORT
POLITICAL THE CANDIDATE/OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATES OR OFFICEHOLDERS KNOWLEDGE OR
CONS£Nr: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
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 8/17/2020
CANDIDATE / OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
15 C/OH NAME q
n ( e 16 Filer ID (Ethics Commission Filers)
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17 CONTRIBUTION 1. TOTAL UNITEMIZED POLITICAL CONTRIBUTIONS (OTHER THAN
TOTALS PLEDGES, LOANS, OR GUARANTEES OF LOANS, OR $
CONTRIBUTIONS MADE ELECTRONICALLY)
2. TOTAL POLITICAL CONTRIBUTIONS $
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANS)
. . . . . . . . . . . . . . . . . . .
EXPENDITURE 3. TOTAL UNITEMIZED POLITICAL EXPENDITURE.
TOTALS $
4. TOTAL POLITICAL EXPENDITURES $ �
CONTRIBUTION 5. TOTAL POLITICAL CONTRIBUTIONS MAINTAINED AS OF THE LAST DAY /
BALANCE OF REPORTING PERIOD
OUTSTANDING 6. TOTAL PRINCIPAL AMOUNT OF ALL OUTSTANDING LOANS AS OF THE
LOAN TOTALS LAST DAY OF THE REPORTING PERIOD $ �—
18 SIGNATURE 1 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
Please complete either option below:
`"11"''1 ROSA A. RIOS
(1)Affidavit �o "'Notary Public,State of Texas
`��. '4 Comm. Expires 05-23-2024
Notary ID 8760780
NOTARY STAMP/SEAL
Sworn to and subscribed before me by `_.�IvlwlO > 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 fficer administering oath
(2) Unsworn Declaration ,
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 8/17/2020