Smither, John, treasurer's appt. - 8-24-15Texas Ethics Commission
P.O. Box 12070
Austin, Texas 78711 -2070
512) 463 -5800
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 pageled
2
CANDIDATE
NAME
MS /MRS /MR FIRST MI
!
M2. `J —T7 Ok•r. (`err
NICKNAME LAST SUFFIX
SrrNI fk e r
OFFICE USE ONLY
Acct.#
Date
ceived
‘% ica4
6-
3
CANDIDATE
MAILING
ADDRESS
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE
I 14 1 b S c•rv- i-LO U S431n
1-1 urd Sville, Tx . .113 9 co
4
CANDIDATE
PHONE
AREA CODE PHONE NUMBER EXTENSION
(73() (,(2 • .5z5O
• - -;� •-deliver . or o marked
MP _
F.50-- -.
5
OFFICE
HELD (if any)
'EtD'' e• fr314
A / v
6
OFFICE
SOUGHT
known)
AA a ` /`/ , or-
7
7
CAMPAIGN
TREASURER
NAME
MS/MRS/MR FIRST MI NICKNAME LAST
Mrs Tiv,� �
SUFFIX
8
CAMPAIGN
TREASURER
STREET
ADDRESS
(residence or business)
STREET ADDRESS (NO PO BOX PLEASE);
L
1 Li ' C. S a. 1
r
H • d n _s v I I l e_
APT / SUITE #; CITY; STATE; ZIP CODE
o +0 /1 Ave
7• 1'73 44 0
9
CAMPAIGN
TREASURER
PHONE
AREA CODE PHONE' NUMBER EXTENSION
( 9 3L) - Z9 1 11-1 l7 G
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.
_�1 g zy rs
ivI gnature of Candidate gned
GO TO PAGE 2
www.ethics.state.tx.us
Revised 07/14/2010