Revised //201 Forms provided by Texas Ethics Commission www.ethics.state.tx.us APPOINTMENT OF A CAMPAIGNTREASURER BY A JUDICIAL CANDIDATE FORM JCTAPG 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 107MS/MRS/MRFIRSTMINICKNAMELASTSUFFIXSee JCTA Instruction Guide for detailed instructions.Date Processed 1Total pages filed:OFFICE HELD(if any)OFFICE SOUGHT(if known)CAMPAIGNTREASURERNAMEJUDICIALCANDIDATEMAILINGADDRESSJUDICIALCANDIDATENAMECAMPAIGNTREASURERSTREETADDRESS(Residence or business)CAMPAIGNTREASURERPHONECANDIDATESIGNATURENICKNAMELASTSUFFIXFiler ID # Date Imaged 4AREA CODEPHONE NUMBEREXTENSION()JUDICIALCANDIDATEPHONE Date Hand-delivered or PostmarkedDate Received Signature of CandidateI 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 ofthe Election Code.I am aware of the restrictions in title 15 of the Election Code on contributionsfrom corporations and labor organizations.Date Signed Receipt # Amount $ American LegalNet, Inc. www.FormsWorkFlow.com Revised //201 Forms provided by Texas Ethics Commission www.ethics.state.tx.us FORM JCTAPG JUDICIAL CANDIDATE MODIFIEDREPORTING DECLARATION13JUDICIALCANDIDATENAME 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.I understand that I am required to file semiannual reports, telegramreports, and special-session reports, if applicable, regardless of theamount of the contributions I accept or the expenditures I make.225225This declaration must be filed no later than the 30th day before thefirst election to which the declaration applies. 225225COMPLETE THIS SECTION ONLY IF YOU ARE CHOOSING MODIFIEDREPORTING. PLEASE READ THE EXPLANATION OF MODIFIEDREPORTING IN THE INSTRUCTIONS TO THIS FORM.225225The 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.) 14 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