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3. ACTA-Appointment of a Campaign Tresurer by a Candidate AMENDMENT: APPOINTMENT OF A CAMPAIGN TREASURER BY A CANDIDATE FORM ACTA PG 1 1 CANDIDATE NAME 2 FILER ID # 3 Total pages filed: See ACTA Instruction Guide for detailed instructions. Use this form for changes to existing information only. Do not provide information previously disclosed. OFFICE USE ONLY Date Received Date Hand-delivered or Postmarked Receipt # Amount $ Date Processed Date Imaged 4 CANDIDATE NAME NEW MS / MRS / MR FIRST MI �� NICKNAME LAST SUFFIX 5 CANDIDATE MAILING ADDRESS NEW ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE 6 CANDIDATE PHONE NEW AREA CODE PHONE NUMBER EXTENSION ( ) ( ) 7 OFFICE HELD (if any) NEW 8 OFFICE SOUGHT (if known) NEW 9 CAMPAIGN TREASURER NAME NEW MS / MRS / MR FIRST MI NICKNAME LAST SUFFIX 10 CAMPAIGN TREASURER STREET ADDRESS (residence or business) NEW STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE 11 CAMPAIGN TREASURER PHONE NEW AREA CODE PHONE NUMBER EXTENSION 12 CANDIDATE SIGNATURE I am aware of the Nepotism Law, Chapter 573 of the Texas Government Cod 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 e. � ���������������������������������� GO TO PAGE 2 Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2024 FORM ACTA PG 2 AMENDMENT: CANDIDATE MODIFIED REPORTING DECLARATION 13 CANDIDATE NAME 14 MODIFIED REPORTING DECLARATION NEW COMPLETE THIS SECTION ONLY IF YOU ARE CHOOSING MODIFIED REPORTING •• 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 party may NOT choose modified reporting. •• I do not intend to accept more than $1,080 in political contributions or make more than $1,080 in political expenditures (excluding filing fees) in connection with any future election within the election cycle. 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 which declaration applies Signature of Candidate This appointment is effective on the date it is filed with the appropriate filing authority. TEC Filers may send this form to the TEC electronically at treasappoint@ethics.state.tx.us or mail to Texas Ethics Commission P.O. Box 12070 Austin, TX 78711-2070 Non-TEC Filers must file this form with the local filing authority DO NOT SEND TO TEC For more information about where to file go to: https://www.ethics.state.tx.us/filinginfo/QuickFileAReport.php Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2024