HomeMy WebLinkAbout170815 - Appointment of Campaign Treasurer - Dallas Shipp 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/MR FIRST MI OFFICE USE ONLY
NAME ink a�
� / I AccL#
NICKNAME LAST SUFFIX
Date Received
ADDRESS /PO BOX; APT/SUITE#; CITY; STATE; ZIP CODE o. ',°� xq" �. �•--
3 CANDIDATE ���� '= ""
MAILING /�
ADDRESS 7o (//O P0.4-3.e.niez-/�Q 61 AUG 1 5 2017
.St,L 1 ��i 7 7 gi/s,
BY: Z." Ur
4 CANDIDATE AREA CODE PHONE NUMBER EXTENSION Date Hand-delivered or Postmarked
PHONE
c?.7` t� ) ��q r (3 0 Date Processed
5 OFFICE ) i Date Imaged
HELD
(if any)
6 OFFICE / / n/
SOUGHT 6// 51/P VA L- ► C./s 60-(7)/ l I !C1t 3
7 CAMPAIGN MS/MRS/MR FIRST MI NICKNAME LAST SUFFIX
TREASURER
Re_INAME �/ ( bee-c-A-
8 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT/SUITE#; CITY; STATE; ZIP CODE
TREASURER n ��/ / / / �} (/
STREET �)0 �/ (41 e(a-,1-p1 C.. >//s2 C e �.'tu�l�t�� ) 7 Y) _/�_1
ADDRESS J
(residence or business)
9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER -'7 �^PHONE (771 ) �7 ! lJ,5-9 /�/
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 porations and labor organizations.
g AC-17
Signature�or Can 44 ) Date Signed
GO TO PAGE 2
www.ethics.state.tx.us Revised 07/14/2010
Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
CANDIDATE MODIFIED FORM CTA
REPORTING DECLARATION PG 2
11 CANDIDATE
NAME
12 MODIFIED REPORTING COMPLETE THIS SECTION ONLY IF YOU ARE
DECLARATION 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
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 Signature of Candidate
which declaration applies
This appointment is effective on the date it is filed with the appropriate filing authority.
www.ethics.state.tx.us Revised 07/14/2010