Smith ACT 2022APPOINTMENT CAMPAIGNFORM CTA
BY A CANDIDATE PG 1
See CTA instruction Guide for detailed instructions.
1 Total pages filed:
2 CANDIDATE
MSt Rs `MR FIRST MI
OFFICE USE ONLY
NAME
Filer @ ft
NICKNAME LAST SUFFIX
D. e. ..
SM
JAN 19 2022
3 CANDIDATE
MAILINGlob
ADDRESS ; PO BOX; APT I SUITE #; CITY; STATE, ZIP CODE
-6 ey
OFFICE OF CITY SECRETARY
ADDRESS
Date Hand -delivered or Postmarked
4 CANDIDATE :
AREA CODE PHONE NUMBER EXTENSION
Receipt# Amount $
PHONE
�... VI 0
/j
7
Date Processed
i �+
Date Imaged
5 OFFICE
HELD
Mice q IC.&4wA6 c,
(if any)
6 OFFICE
SOUGHT
known)
(if
7 CAMPAIGN
MS/MR FIRST MI NICKNAME LAST .SUFFIX
1.•/
TREASURER
NAME
p4cw e
H CAMPAIGN
TREASURER
STREET ADDRESS; APT +' SUITE #; CITY; STATE; ZIP CODE
STREET
asi 0
ADDRESS
(residence or business)
ti^
-7(o0q9_
9 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
471)
10 CANDIDATE
SIGNATURE
I am aware of the Nepotism Law, Chapter 573 of the Texas Government Code.
am aware of my responsibility to file timely reports as required by title 15 of
the Election Coder
I am aware of the restrictions in title 15 of the Election Code on contributions
from corporations and labor organizations.
— raz-
Signature of Candidate Date Signed
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1f112022