McCaskill ACT 2022APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
CANDIDATEBY A PG
See CTA Instruction Guide for detailed instructions;
1 Total pages filed:
2 -CANDIDATE
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OFFICE USE ONLY
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Filer ID #
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NICKNAME ...LAST .SUFFIX
Dat eo i uwfED
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JAN 19 202
OFFICE OF CITY SECRETARY
3 CANDIDATE
ADDRESS ! PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
MAILING
ADDRESS
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Date Hand -delivered or Postmarked
ReeeiptiP Amount$
4 CANDIDATE
.AREA CODE PHONE NUMBER: : EXTENSION
PHONE
Date Processed
5 OFFICE
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Date Imaged
HELD
(if any)fI_`�
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6 OFFICE
SOUGHT
(if known)
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7 CAMPAIGN
MS RS MR FIRST MI NICKNAME LAST SUFFIX
TREASURER
NAME
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8 CAMPAIGN
STREET ADDRESS; APT? SUITE it; CITY; STATE; ZIP CODE
TREASURER
STREETU
t
ADDRESS
(residence or business)
9 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
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 corporations and labor organizations.
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Signature of Candidate Date Signed
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1(2022