Williamson ACT 2016Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE PG 1
See CTA Instruction Guide for detailed instructions.
1 Total pages filed:
2 CANDIDATE
MS/MRS FIRST MI
OFFICE USE ONLY
NAME
M Ar_
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Acct #
.....................................
NICKNAME LAST SUFFIX
Date Received RECEIVED
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3 CANDIDATE
MAILING
ADDRESS/PO BOX; APT / SUITE AV, CITY; STATE; ZIP CODE
los CA�sr1-E %loth Q2-
JAN 2 2 2016
ADDRESS
OFFICE OF CITY SECRE
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
Date Hand -delivered or Postmarked
PHONE
f17) 607_ — 13'1'1
Date Processed
5 HELD FFICE
/Q/` I....% 11 7 /q.� y
Date Imaged
(if any)
lDu.
6 OFFICE
SOUGHT
(if known)
7 CAMPAIGN
MFZ5WR FIRST MI NICKNAME LAST SUFFIX
TREASURER
NAME
n Som
Alm
8 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
TREASURER
70.E c&rI E 4cic- D/L
STREET
ADDRESS
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/O�.r�` d%�� 7^�/ -7V0 Z
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(residence or business)
9 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
` (I
10 CANDIDATE
SIGNATURE
I am aware of the Nepotism Law, Chapter 573 of the Texas Government Code.
I am aware of my responsibility to file timely reports as required by title 15 of
the Election Code.
I am aware of the restrictions in title 15 of the Election Code on contributions
from corpora 'o sand labor organizations.
Signature of Candidate Date Signed
GO TO PAGE 2
vnww. et h i Ds . s to t e. t x. u s
Revised 07/14/2010
'ARY
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
CANDIDATE MODIFIED FORM CTA
REPORTING DECLARATION PG 2
11 CANDIDATE
NAME
12 MODIFIED
REPORTING
COMPLETE THIS SECTION ONLY IF YOU ARE
DECLARATION
CHOOSING MODIFIED REPORTING
•• This declaration must be filed no later than the 30th day before
the first election to which the declaration applies. ••
.. •• The modified reporting option is valid for one election cycle only. ••
(M election cycle includes a primary election, a general election, and any related runoffs.)
•• Candidates for the office of state chair of a political party
may NOT choose modified reporting. ••
I do not intend to accept more than $500 in political contributions or
make more than $500 in political expenditures (excluding filing fees)
in connection with any future election within the election cycle.
I understand that if either one of those limits is exceeded, I will be
required to file pre-election reports and, if necessary, a runoff
report.
Year of election(s) orelection cycle to Signature of Candidate
which declaration applies
This appointment is effective on the date it is filed with the appropriate filing authority.
www.ethics.state.tx.us Revised 07/14/2010