This document is an Appointment of a Campaign Treasurer Form submitted to the Texas Ethics Commission. It provides information about a candidate running for office, including their name, address, phone number, the office sought, and the name and contact information of the campaign treasurer. At the bottom, the candidate signs to affirm 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 received by the Texas Ethics Commission on January 14, 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 ' I
1 Total pages filed:
See CTA Instruction Guide for detailed instructions.
2 CANDIDATE
MS/ MRS/ MR FIRST MI
OFFICE USE ONLY
NAME
1 IQ TZO(o te
1'
Acct. #
NICKNAME LAST SUFFIX
T`
1.
4 S
Date Received
1` M-
n
RECFIVED
3 CANDIDATE ADDRESS / PO BOX; APT/ SUITE#; CITY; STATE; ZIP CODE
MAILING
Z6's_ W . ( 00, 514,4/ 1 • ' 51-8 Z0 I
ADDRESS JAN 14 2015
M
e1ctHric7'
7; 7s-°69
CITY SECRETARY
4 CANDIDATE AREA CODE PHONE NUMBER EXTENSION
Date Hand- delivered or Postmarked
PHONE
chz ) 349 - 2,s-A
l s Date Processeded
5 OFFICE
Date Imaged
HELD t^ A 4-
14%v104.-
Ci
L 1'1 61.441...t l 001.
I e--
if any)
6 OFFICE I /
SOUGHT A - klv1vl v.( 4h( (_,G v%t: 4 ( w I' -
La 5'L
if known) I
7 CAMPAIGN
MS/ MRS/ MR FIRST MI NICKNAME LAST SUFFIX
TREASURER
NAME lJlw , 2,aPe. R. 4Z45
8 CAMPAIGN
STREET ADDRESS ( NO PO BOX PLEASE); APT/ SUITE#; CITY; STATE; ZIP CODE
TREASURER
s+. 3' C-
STREET 2- - LA.) . LOUIStat
ADDRESS
AA
I f, '7 S, Co 1
re4dence or business)
G 1 1 KH
9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
7-2_ ) 3 _2 s'
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.
UVle.S. i
I ILi- IZo1S
Signature of Candidate Date Signed
GO TO PAGE 2
www. ethics. state. tx. us Revised 07/ 14/ 2010