Smith, Jason, Treasurer Appointment & Modified Reporting, 7-25-14Texas Ethics Commission
P.O. Box 12070
Austin. Texas 78711 -2070
512)463 -5800
TDD 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
mg.. -3RSoN
NICKNAME LAST SUFFIX
S'I`...0T44
OFFICE USE ONLY
Acct. #
Date Received
( ^/
�nd �ostma
1
3
CANDIDATE
MAILING
ADDRESS
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
1
1'Z p8 US-) v•4 LP
IAaurrS \IIUE rTk '1'734.0
4
CANDIDATE
PHONE
AREA CODE PHONE NUMBER EXTENSION
-1(0) vt I)1 O
D.te -deli ered or
Lesse(
d
• ,
rif
I LI
5
O FFICE
HELD
(if any)
1
i , .ged
( DS 1 il
I
6
OFFICE
SOUGHT
(if known)
I-k W-yf'S M I -L : Ct
47J3Qt�' t A-* 1.i•�t,,E Pe�S
7
CAMPAIGN
TREASURER
NAME
MS/MRS/MR FIRST MI NICKNAME LAST SUFFIX
rjM) -r}1
MRs. MVcy L
8
CAMPAIGN
TREASURER
STREET
ADDRESS
(residence or business)
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
l0 1" l Z(LpROMbofZ lye.
i-1U•T'Sv I L-Le 117. ?73 1-+e
9
CAMPAIGN
TREASURER
PHONE
AREA CODE PHONE NUMBER EXTENSION
( "ko ) 5 -71._.aL5
10
CANDIDATE
SIGNATURE
I am aware of the
I am aware of my responsibility
the Election Code.
I am aware of th - restrictions
from cor.. a '.ns
i
i_...p� ,
Nepotism Law, Chapter 573 of the Texas Government Code.
to file timely reports as required by title 15 of
in title 15 of the Election Code on contributions
and _ .ororg_ izations.
7- ZS- /4.1
Signature of Candi.a e Date Signed
GO TO PAGE 2
www.ethics.state.tx.us
Revised 07/14/2010
Texas Ethics Commission
P.O. Box 12070
Austin, Texas 78711 -2070
512)463 -5800
TDD 1- 800 - 735 -2989
CANDIDATE MODIFIED FORM CTA
REPORTING DECLARATION PG 2
11
CANDIDATE
NAME
12
MODIFIED
REPORTING
DECLARATION
COMPLETE THIS SECTION ONLY IF YOU ARE
CHOOSING MODIFIED REPORTING
•• This declaration must be filed no later than the 30th day before
the first election to which the declaration applies. ••
•• 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.)
•• Candidates for the office of state chair of a political party
may NOT choose modified reporting. ••
I do not intend to accept more than $500 in political contributions or
make more than $500 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.
—2..c:1)%4 dr i
Year of election(s) or election cycle to Signature of Candi • ;t
which declaration applies
This appointment is effective on the date it is filed with the appropriate filing authority.
www. ethics. state. tx. us
Revised 07/14/2010