Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 APPOINTMENT OF A CAMPAIGN TREASURER BY A CANDIDATE FORM 1 See CTA Instruction Guide for detailed instructions. MS / MRS / MR 2 FIRST CTA PG 1 Total pages filed: MI OFFICE USE ONLY CANDIDATE NAME Acct. # ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ SUFFIX ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ADDRESS / PO BOX; APT / SUITE #; CITY; AREA CODE PHONE NUMBER STATE; ○ LAST ○ NICKNAME 3 1-800-325-8506 Date Received ZIP CODE CANDIDATE MAILING ADDRESS 4 CANDIDATE PHONE 5 ( EXTENSION HD/PM ) Date Processed Date Imaged OFFICE HELD (if any) 6 OFFICE SOUGHT (if known) MS/MRS/MR 7 FIRST MI NICKNAME LAST SUFFIX CAMPAIGN TREASURER NAME STREET ADDRESS (NO PO BOX PLEASE); 8 APT / SUITE #; CITY; STATE; ZIP CODE CAMPAIGN TREASURER STREET ADDRESS (Residence or business) AREA CODE 9 PHONE NUMBER EXTENSION CAMPAIGN TREASURER PHONE ( CANDIDATE SIGNATURE I am aware of the Nepotism Law, Chapter 573 of the Texas Government Code. ) 10 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 Printed on recycled paper (Revised 01/14/2004) American LegalNet, Inc. www.USCourtForms.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 CANDIDATE MODIFIED REPORTING DECLARATION 1-800-325-8506 FORM CTA PG 2 11 CANDIDATE NAME 12 MODIFIED REPORTING DECLARATION 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 and candidates for county chair of a political party may NOT choose modified reporting. •• I do not intend to accept more than $500 in political contributions or make more than $500 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. Printed on recycled paper (Revised 01/14/2004) American LegalNet, Inc. www.USCourtForms.com