Revised 1/1/2020
www.ethics.state.tx.us
APPOINTMENT OF A CAMPAIGN TREASURER
BY A CANDIDATE
FORM
CTA
PG
1
3
8
9
2
AREA CODE PHONE NUMBER EXTENSION
MS / MRS / MR FIRST MI
OFFICE USE ONLY
6
5
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
()
GO TO PAGE 2
Signature of Candidate
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.
10
7
MS/MRS/MR FIRST MI NICKNAME LAST SUFFIX
See CTA Instruction Guide for detailed instructions.
Date Processed
1
Total pages filed:
CAMPAIGN
TREASURER
NAME
CANDIDATE
MAILING
ADDRESS
CANDIDATE
NAME
CAMPAIGN
TREASURER
STREET
ADDRESS
CAMPAIGN
TREASURER
PHONE
CANDIDATE
SIGNATURE
I am aware of the Nepotism Law, Chapter 573 of the Texas Government Code.
NICKNAME LAST SUFFIX
Filer ID #
Date Imaged
4
AREA CODE PHONE NUMBER EXTENSION
()
CANDIDATE
PHONE
Receipt #
Date Received
Date Signed
(residence or business)
OFFICE
SOUGHT
(if known)
OFFICE
HELD
(if any)
Date Hand-delivered or Postmarked
Amount $
Forms provided by Texas Ethics Commission
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Revised 1/1/2020
www.ethics.state.tx.us
CANDIDATE MODIFIED
REPORTING DECLARATION
FORM
CTA
PG
2
This appointment is effective on the date it is filed with the appropriate filing authority.
11 CANDIDATE
NAME
Signature of Candidate
MODIFIED
REPORTING
DECLARATION
Year of election(s) or election cycle to
which declaration applies
I do not intend to accept more than $900 in political contributions or
make more than $900 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.
•• This declaration must be filed no later than the 30th day before
the first election to which the declaration applies. ••
COMPLETE THIS SECTION ONLY IF YOU ARE
CHOOSING MODIFIED REPORTING
•• 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.)
12
•• Candidates for the office of state chair of a political party
may NOT choose modified reporting. ••
Forms provided by Texas Ethics Commission
TEC Filers may send this form to the TEC electronically at treasappoint@ethics.state.tx.us
or mail to
Texas Ethics Commission
P.O. Box 12070
Austin, TX 78711-2070
Non-TEC Filers must file this form with the local filing authority
DO NOT SEND TO TEC
For more information about where to file go to:
https://www.ethics.state.tx.us/filinginfo/QuickFileAReport.php
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