July 6, 2017 Appointment of Campaign TreasurerTexas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1- 800 -735 -2989)
APPOINTMENT OF A CAMPAIGN TREASURER FORM T
Y A CANDIDATE PG 1
1 Total pages filed:
See CTA Instruction Guide for detailed instructions.
2 CANDIDATE
MS / MRS / R� FIRST MI
OFFICE USE ONLY
NAME
Acct. #
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NICKNAME LAST SUFFIX
Dale Received %
'
/ a
3 CANDIDATE
ADDRESS / PO BOX, / SUITE #; CITY; STATE; ZIP CODE
MAILING"
/
ADDRESS
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
Date Hand - delivered or Postmarked
PHONE
Date Processed
5 OFFICE
Date Imaged
HELD
(if any)
6 OFFICE
o r C� -, t 7 C-.e-
SOUGHT
(if known)
7 CAMPAIGN
MSIMR�RR, FIRST MI NICKNAME LAST SUFFIX
TREASURER
C, P,%c-
NAME
8 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #, CITY; STATE; ZIP CODE
�
TREASURER
credo cot wo( -eee� (I `� '4, a c_� � � tit ' fit
STREET
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.
am aware of the restrictions in title 15 of the Election Code on contributions
from corporations and labor organizations.
Signature of Candidate Date Signed
GO TO PACE 2
www.ethics.state.tx.us
Revised 07/14/2010