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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. -- 6101 IIIEW.-I 0 0 - • wi- N FWI le�-6zs) if] U1'Firee • �1'-'ITU e CICULVIIIIIII TTILIIIII LIM C 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