160712 - Appointment of Campaign Treasurer - John Nichols Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
AMENDMENT: APPOINTMENTOFA FORMACTA
CAMPAIGN TREASURER BYA CANDIDATE PG 1
1 CANDIDATE--__ 2 ACCOUNT# 3 Total pages filed:
NAME �� �2 y 6 `�J C 4 Z _�7
See ACTA Instruction Guide for detailed instructions.
Use this form for changes to existing information only. Do not provide information previously disclosed.
4 CANDIDATE NEW MS/MRS/MR FIRST MI 1
NAME OFFICE USE ONLY
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date Receive+4 A N L)
NICKNAME LAST SUFFIX ��,��, ®®®®®® --
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5 CANDIDATE NEW ADDRESS/PO BOX; APT/SUITE#; CITY; STATE; ZIP CODE ®� ��
MAILING
REW
ADDRESS
Date Hand-delivered or Postmarked
Date Processed
6 CANDIDATE NEW AREA CODE PHONE NUMBER EXTENSION
PHONE ( l Date Imaged
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7 OFFICE HELD NEW
(if any)
g OFFICE NEW
SOUGHT q
(If known)
9 CAMPAIGN NEW MS/MRS/MR Y FIRST MI NICKNAME LAST SUFFIX
NAME
URER
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10 CAMPAIGN
NEW STREET ADDRESS (NO PO BOX PLEASE); APT/SUITE#; CITY; STATE; ZIP CODECCOO/DE
TREASURER If
STREET N�'��� c-
(rADDREesidence or b bus �, G l G E? j.•� "� A �' / X\ ! (, G
11 CAMPAIGN NEW AREA CODE PHONE NUMBER EXTENSION
TREASURER (
PHONE 91"1
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12 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.
am aware of the restrictions in title 15 of the Election Code on contributions
from rpo tions an0!-1 bor orclaniZations.
ev
Signature of Candidate Date Signed
GO TO PACE 2
www.ethics.state.tx.us Revised 07/14/2010