George Ferrie 30th Day Before Special Election 2020 UNSWORN DECLARATION FORM UD
Attach this unswom declaration to the front of any OFF1lCF-U3EON Y
campaign finance report or personal financial statement in "RECEIVED
lieu of a notarized signature. See Tex. Civil Practice and
Remedies Code § 132.001. 51010
City Manager's/City
1 FILER ID: Secretary's Office
(Ethics Commission filers)
f_ Method Delivery_
2 NAME OF FILER
(PLMETYPEORPR �f f(` Gate Processed
3 TYPE OF FILER CANDi E/OFFICEHOLDER V' POLITICAL COMMITTEE
j JUDICIAL CANDIDATE/OFFICEHOLDER POLITICAL PARTY
LPERSONAL FINANCIAL STATEMENT STATE/COUNTY CHAIR
DIRECT CAMPAIGN EXPENDITURE
4 TYPE OF REPORT k-� W
5 DUE DATE
6 UNSWORN DECLARATION: '
My name is - ,�+��� �' and my date of birth i Boom
My Address is 1 � "►' leky\ I .—USA. - -•
(street) (city) (state) (zip code) (country)
I swear,or affirm, under penalty of perjury that the information in the attached report is in all things true and correct,
and includes all information required to be reported by me under Title 15,Election Code,or Chapter 572,
Government Code.
✓ �Executed in County,State of I-ej "'" ,on th day of .20016 -
Si nature of Filer/Committee Representative
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 7/9/2020
CANDIDATE/OFFICEHOLDER FORM CIOH
CAMPAIGN FINANCE REPORT COVER SHEET PG 1
1 Filer ID(Eua s Conmiasnn Filers) 2 Total pages filed
The C/OH Instruction Guide explains how to complete this form,
3 CANDIDATE/ !MRS f MR FIRST MI
OFFICEHOLDER j� OFFICE USE ONLY
NAME ((//���[! Acw . Date Received
NICKNAME ( t �/"� LAST SUFFIX
�f �JCC�0 C�-, [Secretary's
IVED
$ CANDIDATE f ADORESS 1 PO BOX; APT/SUITE C; CITY; STATE; ZIP CCD=
OFFICEHOLDER `t ` f�f(' —��j 51020
MAILING Y L� -V�IVI/tU, �- �t l t�
ADDRESS '��/���}} er's f City
Change o1 Address { � %J �IL C)q Office
5 CANDIDATE/ AREA CODE PHONE Pce
EXTENSION
POHFOIICEHOLDER r 981 ) qQ01,
pate Har��vered ar Date Postmarked
,� Z
6 CAMPAIGN M n+RStPAR FIRST MI Receipt# Amount s
TREASURER f
NAME ` . . . . ` . . . . . . . . . pate Processed
NICKNAME K
LAS jP4 SUFFIXF� Date Imaged
7 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE), APT!SUITE x, CITY; STATE; ZIP CODE
TREASURER JAN C1av I,oU, Q �, `—k -(� O�t
ADDRESS
(Residence or Business)
8 CAMPAIGN AREA CODE` PHO(NEE}NUMBER 4 y EXTENSION
TREASU
PHONE RER -{`ib J IY�Y ALI'$
S REPORT TYPE
January 15 3 th day before election Runoff 15th day after campaign
treasurer appointment
(officeholder Only)
El y 15 8th day bet.w oecliorr ExmcAryt 5 4 Hmir Final Report(Aaach CtoH-FR)
10 PERIOD Month Day Year Month Day Year
COVERED O-4 'D �D THROUGH U1 ON Q
11 ELECTION ELECTION DATE / ELECTION TYPE �—
Month Day Year IL'L—dYf-.ry EJ Runoff Other
Description
General ElSpacial
12 OFFICE '7FICE HELD (N any) /1\�3OFFFII(CA}ES+1O�lUGGHT ref known)
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
CANDIDATE /OFFICEHOLDER FORM C/OH
CAMPAIGN FINANCE REPORT COVER SHEET PG 2
14 C/01-11 NAME f Filer 113 (Ethics Commission Filers)
16 NOTICE FROM THIS BOX IS FOR NOTICE OF POLITICAL CONTRIBUTIONS ACCEPTED OR POLITICAL EXPENDITURES MADE BY POLITICAL COMMITTEES TO
POLITICAL SUPPORT THE CANDIDATE/OFFICEHOLDER. THESE EXPENDITURES MAY HAVE BEEN MADE WITHOUT THE CANDIDATE'S OR OFFICEHOLDER'S
COMMITTEE(S) KJVOWLEDGE OR CONSENT. CANDIDATES AND OFFICEHOLDERS ARE REQUIRED TO REPORT THIS INFORMATION ONLY IF THEY RECEIvE NOTICE
OF SUCH EXPENDITURES.
C COMMITTEE NAME OMMITTEE TYPE
I
DGENERAL
COMMITTEE ADDRESS
0sPEcI=jC
COMMITTEE CAMPAIGN TREASURER NAME
Additional Pages
COMMITTEE CAMPAIGN TREASURER ADDRESS
17 CONTRIBUTION i 1. TOTAL POLITICAL CONTRIBUTIONS OF$50 OR LESS (OTHER THAN
TOTALS PLEDGES, LOANS,OR GUARANTEES OF LOANS, OR 15T
CONTRIBUTIONS MADE ELECTRONICALLY), UNLESS ITEMIZED
2. TOTAL POLITICAL CONTRIBUTIONS
I
(OTHER THAN PLEDGES, LOANS, OR GUARANTEES OF LOANSJ $
EXPENDITURE i
TOTALS 3. TOTAL POLITICAL EXPENDITURES OF $100 OR LESS,
$
UNLESS ITEMIZED
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 AFFIDAVIT
I swear,or affirm,under penalty of perjury,that the accompanying report is
true and correct and l s all information required to be reported by me
under Title I 5_-1-_rG-er6n Code.
ure of Candidate or Officeholder
AFFIX NOTARY STAMP/SEALAROVE
Sworn to and subscribed before me,by the said this the
day of 20 to certify which,witness my hand and seat of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.s*ate.tx.us Revised 9/26,120 1 n.
SUBTOTALS - C/OH FORM C/OH
COVER SHEET PG 3
19 FILER NAME 20 Filer ID(Ethics Commission Filers)
21 SCHEDULE SUBTOTALS SUBTOTAL
NAME OF SCHEDULE AMOUNT
1 SCHEDULE At: MONETARY POLITICAL CONTRIBUTIONS $ 1
2. SCHEDULE A2: NON-MONETARY(IN-KIND)POLITICAL CONTRIBUTIONS $
3. SCHEDULE B: PLEDGED CONTRIBUTIONS $
4. El SCHEDULE E: LOANS $
5. SCHEDULE F1: POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $ n
6. 11 SCHEDULE F2: UNPAID INCURRED OBLIGATIONS $
7- SCHEDULE F3: PURCHASE OF INVESTMENTS MADE FROM POLITICAL CONTRIBUTIONS $
8. SCHEDULE F4: EXPENDITURES MADE BY CREDIT CARD $
9. SCHEDULE G: POLITICAL EXPENDITURES MADE FROM PERSONAL FUNDS $
10. ❑ SCHEDULE H: PAYMENT MADE FROM POLITICAL CONTRIBUTIONS TO A BUSINESS OF C/OH $
11. SCHEDULE 1: NON-POLITICAL EXPENDITURES MADE FROM POLITICAL CONTRIBUTIONS $
12. ❑ SCHEDULE K: INTEREST, CREDITS, GAINS, REFUNDS, AND CONTRIBUTIONS RETURNED $
TO FILER
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
The Instruction Guide explains how to complete this form. 1 Total pages Schedule At:
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
C �
4 Date 5 Full name of co ributor ❑out-of-state PAC(ID#: 7 Amount of contribution ($)
i���0�1rISI1
6 Contributor address; City; State, Zip Code 1�
8 Principal occupation/Job title(See Instructions) g Employer (See Instructions)
Date Full name of contributor ❑out-of-state PAC(ID#:_ ) Amount of contribution ($)
Contributor address; City; State; Zip CodeAl u *N""p Ur'l*I wz)
Principal occupation/Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor ❑out-of-state PAC(ID#: ) Amount of contribution ($)
dRli�llab Qr A\" . mvc�� I&
arv'
Contributor address; City; State; Zip Code
5luo 119%1
Principal occupation/Job title(See Instructions) Employer (See Instructions)
Date Full name of c tfri�butQor ❑out-of-state PAC(ID#: } Amount of contribution ($)
Contributor address; City; State; Zip Code I D�
In
Principal occupation/Job title(See Inst ctions) 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.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
MONETARY POLITICAL CONTRIBUTIONS SCHEDULE Al
The Instruction Guide explains how to complete this form. 1 Total pages Schedule At-
2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Date rj Full name of co)tributor ❑out-of-state PAC(ID#: _ ) 7 Amount of contribution ($)
� I
6 Gontributor ress; City; State; Zip Code
N9, b(iosLzL 00�10vn _00-N-1
8 Principal occupation/Job title(See Instructions) g Employer (See Instructions)
�:j
Date Full name of contributor ❑out-of-state PAC(ID#: ) Amount of contribution ($)
jaAA
II T'tor address; City; State; Zip Code
Principal occupation/Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor ❑out-of-state PAC(ID#. 1 Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation/Job title (See Instructions) Employer (See Instructions)
Date Full name of contributor ❑out-of-state PAC (ID#: ) Amount of contribution ($)
Contributor address; City; State; Zip Code
Principal occupation/Job title (See Instructions) 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.
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019
POLITICAL EXPENDITURES MADE
FROM POLITICAL CONTRIBUTIONS SCHEDULE F1
EXPENDITURE CATEGORIES FOR BOX 8(a)
Advertising Expense Event Expense Loan Repayment/Reimbursement Solicitation/Fundraising Expense
Accounting/Banking Fees Office Overhead/Rental Expense Transportation Equipment&Refated Expense
Consulting Expense Food/Beverage Expense Polling Expense Travel In District
Contributions/Donations Made By G'rft/Awards/Memorials Expense Printing Expense Travel Out Of District
Candidate/Officeholder/Political Committee Legal Services Salaries/Wages/Contract Labor Other(enter a category not listed above)
Credit Card Payment
The Instruction Guide explains how to complete this form.
1 Total pages Schedule F1: 2 FILER NAME 3 Filer ID (Ethics Commission Filers)
4 Da ' � rj Payee name
iL
6 Amount ($) 7 Payee address; City; State, Zip Code
.W `a b— 11 e E. 06AW 1A . , r� S) +s �P
8 (a) Category (See Categories ti ed at the top of this schedule) (b) Description
PURPOSE ,^ fV1 6c*-
OF 1 1 lJl
EXPENDITURE
(c) Check if travel outside of Texas.Complete Schedule Check if Austin,TX,officeholder living expense
9 Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
D914P � (ItLIr
Amount ($) Payee a ress; City; State; Zip Code
Category (See Categories listed at the top of this schedule) Description
PURPOSE
OF YYY///a 'C III
EXPENDITURE
Check iif travel outside ofTexas.Complete Schedule T Check if Austin,TX,officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
Date Payee name
_ -- t m NCam_
Amount ($) Payee address; City; State; Zip Code
7 _2� - (S*_
Category (See Categories listed at the top of t schedule) Description
PURPOSE r
OF C
EXPENDITURE V
Check rf travel outside ofTexas.Complete Schedule T Check if Austin,TX, officeholder living expense
Complete ONLY if direct Candidate/Officeholder name Office sought Office held
expenditure to benefit C/OH
ATTACH ADDITIONAL COPIES OF THIS SCHEDULE AS NEEDED
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 9/26/2019