Fillable Form 4: b~."c p 1 APPOINTMENT BY TREASURER (Tom Green County)

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Form 4: b~."c p 1 APPOINTMENT BY TREASURER (Tom Green County)

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Texas
Ethics
Commission
PO
Box
12070
Austin
Texas
78711-2070
(512)
463-5800
(TOO
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.
MS
I
MRS
't!Jj)
FIRST
MI
2
CANDIDATE
NAME
~,(~
p
.:::rr.'
4
b~.·"c
. . . . . . .
....
. . . .
NICKNAME
LAST
SUFFIX
~C;~.~
ADDRESS I
PO
BOX:
APT I SUITE
#:
CITY; STATE: ZIP CODE
3
CANDIDATE
MAILING
ADDRESS
/
C//
l'
A~"?4.,i",
y~je:l
~~~~;;:
?~J"
AREA CODE
PHONE NUMBER
"EXTENSION
PHONE
4
CANDIDATE
(3'~)
c?/.2-
-/fcH'-
5
OFFICE
HELD
(if
any)
"::;;'4'J~
...
;,
'It!'
~;e-
~,Je'
,,¢~~t!
A'/2
6
OFFICE
SOUGHT
(if
known)
FIRST
MI
NICKNAME
M~/MR
7
CAMPAIGN
TREASURER
NAME
OFFICE
USE
ONLY
Acct. #
Date Received
NOV
12
2013
Dale Hand-delivered or Poslmarked
Date Processed
Dale
Imaged
LAST SUFFIX
~,/~
~G;,'.:
STREET ADDRESS (NO
PO
BOX PLEASE).
APT
I SUITE #. CITY: STATE: ZIP CODE
8
CAMPAIGN
TREASURER
STREET
ADDRESS
(residence
or
business)
.---
/#/7
ad?'4-/':'#
~
~
s;.,7
~~~#
/~
;7~J?t:r-
AREA CODE
PHONE NUMBER
EXTENSION
~
9
CAMPAIGN
TREASURER
PHONE
(.72r)
.2.2-?-
.:rY.27
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
corporations
and
labor
organizations.
....
~
~~
LL/:L/J
/
Signature
of
Candidate
Date
Signed
GOTO
PAGE
2
www.elhics.slale.lx.us
Revised 07/14/2010
INFORMATION NOT DISPLAYED
INFORMATION NOT DISPLAYED
INFORMATION NOT DISPLAYED
INFORMATION NOT DISPLAYED
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Form 4: b.c p 1 APPOINTMENT BY TREASURER (Tom Green County)

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Completed 9 August 2020

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