This document is an Appointment of a Campaign Treasurer Form filed with the Texas Ethics Commission. It contains basic information about a candidate running for office including their name, address, the office sought, and the name and contact information of the appointed campaign treasurer. At the bottom, the candidate signs to affirm that they are aware of campaign finance laws regarding nepotism, filing reports, and restrictions on corporate and labor contributions. The form is 2 pages and was filed with the Texas Ethics Commission on February 24, 2015.

1. Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711- 2070 512) 463-5800 ( TDD 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/ EARN FIRST
MI
MI
OFFICE USE ONLY
NAME
t//
Acct. #
NICKNAME LAST SUFFIX
V1
Date Received
wJ,,,„`^,
RECEIVED
3 CANDIDATE ADDRESS / PO BOX; APT/ SUITE#; CITY; STATE; ZIP CODE
MAILING
ADDRESS Z FEB 24 2015
x- 9-5 CITY SECRETARY
4 CANDIDATE AREA CODE PHONE NUMBER EXTENSION
Date Hand- delivered or Postmarked
PHONE
Y) 7 3 - - S Date Processed
5 OFFICE
J
Date Imaged
HELD
if any)
6 OFFICE
SOUGHT
if known) A'‘-
C/ 1
7 CAMPAIGN
MS/ MRS/ MR FIRST MI NICKNAME LAST SUFFIX
TREASURER
NAME
8 CAMPAIGN
STREET ADDRESS ( NO PO BOX PLEASE);- APT/ SUITE S; ITY; STATE; ZIP CODE
TREASURER
STREET V
AN1r.
ADDRESS
I
Q
residence or business) A
9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE Zt
t/ ' -5 7 S S (2- 2-)
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 awa of th- restrictions in title 15 of the Election Code on contributions
from c• porati. ns and labor organizations.
Signature of Candidate Date Signed
GO TO PAGE 2
www. ethics. state. tx. us
Revised 07/ 14/ 2010