Loading...
Eric Beam ACTA FormTexas Ethics Commission P.O. Box 12070 Austin, Texas 78711 -2070 (512) 463 -5800 (TDD 1'.- 800 - 735 -2989) www.ethics.state.tx.us Revised 07/14/2010 AMEND NT: APPOINTMENT OFA / FOR CTA 1 CAMPAIGN TREASURED BYA CANDIDATE PG 1 1 CANDIDATE Erl NAME 2 ACCOUNT # 3 Total pages filed: See ACTH Instruction Guide for detailed instructions. Use this form for changes to existing information on /y. Do not provide information previously disclosed. 4 CANDIDATE NEW I MS/MRS ) FIRST MI OFFICE USE ONLY NAME A Date Received °r� L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NICKNAME SUFFIX LAST 5 CANDIDATE NEW ADDRESS /PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE MAILING S �Z y �,N! I °% fA +",�f��U'r� c` -( i0j) ADDRESS Dale Hand - delivered or Postmarked �J Date Processed 6 CANDIDATE NEW AREA CODE PHONE NUMBER EXTENSION PHONE Date Imaged 7 OFFICE HELD NEW (if any) 8 OFFICE NEW SOUGHT (if known) C) 7 9 CAMPAIGN NEW MS M MR FIRST MI NICKNAME LAST SUFFIX TREASURER NAME ,�y� // t0 ����, � �•Ire, Jam, 10 CAMPAIGN NEW STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE TREASURER STREET } J �j S70 c,✓`^e(jcct, C / dJse,k 1`ht z IoVA ADDRESS J (residence or business) 11 CAMPAIGN NEW AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE l ll 3,p6- � 9 i 12 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 Code. I am aware of the restrictions in title 15 of the Election Code on contributions from corporations and labor organizations. /ter /�_ - -2 Signature of Candidate Date Signed GO TO PAGE 2 www.ethics.state.tx.us Revised 07/14/2010