2 Form CTA - Appointment of a Campaign TreasurerTexas Ethics Commission
P.O. Box 12070 Austin, Texas 78711-2070 (512)463-5800 JDD 1-800-735-2989)
APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE
PG 1
1 Total pages filed:
See CTA Instruction Guide for detailed instructions.
2 CANDIDATE
MS / MRS / MR FIRST MI OFFICE USE ONLY
NAME
NICKNAME LAST SUFFIX
Date Received
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
3 CANDIDATE
MAILING
ADDRESS
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION Date Hand-delivered or Postmarked
PHONE
Date Processed
5 OFFICE
Date Imaged
HELD
6 OFFICE
SOUGHT
(if known)
7 CAMPAIGN
MS/MRS/MR FIRST MI NICKNAME LAST SUFFIX
TREASURER
NAME
8 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT SUITE #; CITY; STATE; ZIP CODE
TREASURER
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.
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
MUMNUMMIN • of
This declaration must be filed no later than the 30th day befo
the first election to which the declaration applies. -- I
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 pocal parl
may NOT choose modified reporting. --
MIT oacceA1Tr7l(=1=1;F5#TT1F_ff •1 • 1
I, O(IS01-
make more than $500 in political expenditures (excluding filing fees)
connection with any future election within the election cycle.
I understand that if either one • those limits is exceeded, I will •
required to file pre-election reports and, if necessary, a runoff
report.
Year of election(s) or election cycle to
which declaration applies
111THIPPI11115191111 FIER 11:11 111! 11111911 !1 !111 1111111
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Signature of Candidate
www,ethics,state.tx,us Revised 07/14/2010