12 Form ACTA - Amended Appointment of a Campaign Treasurer by a CandidateTexas Ethics Commission
RO. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 JDD 1-800-735-2989)
CAMPAIGN TREASURER BYA CANDIDATE PG
1 CANDIDATE
2 ACCOUNT #
3 Total pages filed:
NAME
See ACTA Instruction Guide for detailed instructions.
Use this form for changes to existing information only. Do not provide information previously disclosed.
4 CANDIDATE
MS/MRS/MR FIRST MI
_NEWJ
OFFICE USE ONLY
NAME
Date Received
NICKNAME LAST SUFFIX
�W ADDRESS/ PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
5 CANDIDATE 2i
MAILING
ADDRESS
Date Hand-delivered or Postmarked
Date Processed
6 CANDIDATE
:E:W:::] AREA CODE PHONE NUMBER EXTENSION
PHONE
Date Imaged
7 OFFICE HELD -LLvv-J
SOUGHT
(if known)
9 CAMPAIGN _LLW_j
MS / MRS I MR FIRST MI NICKNAME LAST SUFFIX
TREASURER
NAME
10 CAMPAIGN _LLW_j
STREET ADDRESS (NO PO BOX PLEASE); APT SUITE #; CITY; STATE; ZIP CODE
TREASURER
STREET
ADDRESS
(residence or business)
11 CAMPAIGN :N:
AREA CODE PHONE NUMBER EXTENSION
�Ew
TREASURER
PHONE
12 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.
Signature of Candidate Date Signed
GO TO PAGE 2
www.ethics.state.tx.us
Revised 07/14/2010
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.
(An election cycle includes a primary election, a general election, and any related runoffs,)
Candidates for the office of state chair of a political parl
may NOT choose modified reporting. --
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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) or election cycle to Signature of Candidate
which declaration applies
www.ethics.state . tx.us Revised 07/14/2010