Allen, Ronald, treas. appt., 8-8-17Texas Ethics Commission
P.O. Box 12070
Austin. Texas 78711-2070
512) 463-5800
DD 1-800-735-2
www.ethics.state.tx.us
Revised 07/14/2010
APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE PG 1
See CTA Instruction Guide for detailed instructions.
1 Total pages filed:
2
CANDIDATE
NAME
MS/MRS/MR FIRST MI
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Mg' n���L
NICKNAME LAST SUFFIX
ICIL LEP
OFFICE USE ONLY
Acct. #
Date Received
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3
CANDIDATE
MAILING
ADDRESSaMidr44
ADDRESS / PO BOX; APT /SUITE #; CITY; STATE; ZIP CODE
1 7744P10fl
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4
CANDIDATE
PHONE
AREA CODE PHO NUMBER EXTENSION
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Dat=I essed
TO 51X11.7
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OFFICE
HELD
(if any)
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6
OFFICE
SOUGHT
(if known)
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7
CAMPAIGN
TREASURER
NAME
MS/MRS/MR FIRST MI NICKNAME LAST SUFFIX
( .
8
CAMPAIGN
TREASURER
STREET
ADDRESS
(residence or business)
STREET ADDRESS (NO PO BOX PLEASE), APT / SUITE #; CITY; STATE;
ZIP CODE
7 73 it -0
; —, o 13►, (ot
9
CAMPAIGN
TREASURER
PHONE
AREA CODE PHON NUMBER EXTENSION
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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.
s'�l?
/Date
Signature of Candidate Signed
GO TO PAGE 2
www.ethics.state.tx.us
Revised 07/14/2010