Hedspetch, Mader, treas. appt., 8-16-17Texas Ethics Commission
P.O. Box 12070
Austin, Texas 78711-2070
512) 463-5800
DD 1-800-735-2989
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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NICKNAME LAST SUFFIX
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OFFICE USE ONLY
Acct #
Da e Re
.
ved
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3
CANDIDATE
MAILING
ADDRESS
ADDRESS / PO BOX; APT / SUITE #; I CITY; STATE; ZIP CODE
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4
CANDIDATE
PHONE
AREA CODE PHONE NUMBER EXTENSION
WO ) /33 8 -393-3
Da H14 d •osrked
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esfed 14 I
5
OFFICE
HELD
(if any)
Le) I 61 P7
6
OFFICE
SOUGHT
(if known)
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Ci- eaiiial
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7
CAMPAIGN
TREASURER
NAME
MS/MRS/MR FIRST MI NICKNAME LAST SUFFIX
x` I/
ns. Made - P1/457Eral
8
CAMPAIGN
TREASURER
RESS
(residence or business)
STREET ADDRESS (NO PO BOX PLEASE), APT / SUITE #; CITY; STATE; ZIP CODE
11
j/rsViLL(7x4s ]r,
3?ADDSTREET / 2- AVE.
2
9
CAMPAIGN
TREASURER
PHONE
AREA CODE PHONE NUMBER EXTENSION
WD) 5)3e-3933
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.
d!PelA/ ` 16 /,o1/
Signat re o Ca idate Date igned
GO TO PAGE 2
www.ethics.state.tx.us
Revised 07/14/2010