Revised //201 Forms provided by Texas Ethics Commission www.ethics.state.tx.us APPOINTMENT OF A CAMPAIGN TREASURERBY A CANDIDATE FORM CTAPG 1 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 3 8 92AREA CODEPHONE NUMBEREXTENSIONMS / MRS / MRFIRSTMI OFFICE USE ONLY65ADDRESS / PO BOX;APT / SUITE #;CITY;STATE;ZIP CODESTREET ADDRESS (NO PO BOX PLEASE);APT / SUITE #;CITY;STATE;ZIP CODE() GO TO PAGE 2 Signature of CandidateI am aware of my responsibility to file timely reports as required by title 15 ofthe Election Code.I am aware of the restrictions in title 15 of the Election Code on contributionsfrom corporations and labor organizations.107MS/MRS/MRFIRSTMINICKNAMELASTSUFFIXSee CTA Instruction Guide for detailed instructions.Date Processed 1Total pages filed:CAMPAIGNTREASURERNAMECANDIDATEMAILINGADDRESSCANDIDATENAMECAMPAIGNTREASURERSTREETADDRESSCAMPAIGNTREASURERPHONECANDIDATESIGNATUREI am aware of the Nepotism Law, Chapter 573 of the Texas Government Code.NICKNAMELASTSUFFIXFiler ID # Date Imaged 4AREA CODEPHONE NUMBEREXTENSION()CANDIDATEPHONE Date Hand-delivered or PostmarkedDate ReceivedDate Signed (residence or business)OFFICESOUGHT(if known)OFFICEHELD(if any) Receipt #Amount $ American LegalNet, Inc. www.FormsWorkFlow.com Revised //201 Forms provided by Texas Ethics Commission www.ethics.state.tx.usCANDIDATE MODIFIEDREPORTING DECLARATIONFORM CTAPG 2 This appointment is effective on the date it is filed with the appropriate filing authority. 11CANDIDATENAME Signature of CandidateMODIFIEDREPORTINGDECLARATION Year of election(s) or election cycle towhich declaration appliesI do not intend to accept more than $500 in political contributions ormake 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 berequired to file pre-election reports and, if necessary, a runoffreport.225225This declaration must be filed no later than the 30th day beforethe first election to which the declaration applies. 225225COMPLETE THIS SECTION ONLY IF YOU ARECHOOSING MODIFIED REPORTING225225The modified reporting option is valid for one election cycle only. 225225(An election cycle includes a primary election, a general election, and any related runoffs.) 12225225Candidates for the office of state chair of a political partymay NOT choose modified reporting. 225225 TEC Filers may send this form to the TEC electronically at treasappoint@ethics.state.tx.us or mail to Texas Ethics CommissionP.O. Box 12070Austin, TX 78711-2070 Non-TEC Filers must file this form with the local filing authority DO NOT SEND TO TECFor more information about where to file go to: American LegalNet, Inc. www.FormsWorkFlow.com