HomeMy WebLinkAboutTreasurer Appointment-03.17.2015-Georgetown Trans PacTpx;;- Fthirs Commission P.O. Box 12070 Austin. Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
APPOINTMENT OF A CAMPAIGN TREASURER FORM STA
BY A SPECIFIC -PURPOSE COMMITTEE PG
1 Total pages filed:
See STA Instruction Guide for detailed instructions.
2 COMMITTEE
NAME
-1^/ OFFICE USE ONLY
ge, PA
r c 1/1 U
0 r1q Acct. #
3 COMMITTEE
ADDRESS / PO BOX; APT / SU ITE CITY; STATE; ZIPCODE
ADDRESS
Date Received
(geb('aej';!IJik4) '17' 60
4 CAMPAIGN
FIRST MI
TREASURER
NAME
N16KNAME. . . . . . . . LAST* . . . . . . . SUFFIX
'gob
5rywf HD/PM
5 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #, CITY; STATE; ZIP CODE
TREASURER
Date Processed
STREET
ADDRESS
(residence or business)
geonje�o,wl',,Jj Te VA5 -�,5>696 Date Imaged
6 MAILING
ADDRESS IPO BOX; APT/SUrrE#,- CITY; STATE: ZIPCODE
ADDR
ameasabove
sse
7 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
)
8 PERSON
APPOINTING
FIRST MI LAST SUFFIX
/I
_r170
TREASURER
M,45 7)t 'IL r A LJ 'ro r
9 SIGNATURE
I understand that I have been appointed as the campaign treasurer for this specific -purpose
committee and that I am responsible for filing all r aired reports and that I may be subject
to fines for failure to do so. I am aware of t re r* tions in title o the Elegoon Code on
contributions from corporations and labor or, niz a S.
Signatutf camoigi—n Treasurer
10 ASSISTANT
FIRST MI LAST SUFFIX
CAMPAIGN
TREASURER
(see instructions)
11 ASSISTANT
ADDRESS PO BOX; APTISUITE#; CITY., STATE; ZIPCODE
CAMPAIGN
TREASURER
ADDRESS
12 ASSISTANT
AREA CODE PHONE NUMBER EXTENSION
CAMPAIGN
TREASURER
PHONE
CONTINUE ON PAGE 2
www.ethics.state.tx.us Revised 09/04/2014
SPECIFIC -PURPOSE COMMITTEE: FORM STA
PURPOSE AND
MODIFIED REPORTING DECLARATION PG 2
13 COMMITTEE NAME Ir -A
(geor8e'lewN ____ N5"/',4C
14 COMMITTEE
CANDIDATE/OFFICEHOLDER NAME
PURPOSE
SUPPORT CANDIDATE
F OPPOSE CANDIDATE
OFFICE SOUGHT (candidate) / OFFICE HELD (officeholder)
F__] ASSIST OFFICEHOLDER
PPIRT
La4U�SURE
BALLOT IDENTIFICATION OF MEASURE / # ELECTION DATE
(i'141 o -r 0el0ir4)o blIVII'l leXA5 Month / Day Year
0-6
fro 090A., 0,�Je_
F__] OPPOSE MEASURE
DESCRIPTION I
TA S05110 5f*,ree__[k; 'AAA
A Ct Ga r
15 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 declaration is valid for one election cycle only.
(An election cycle includes a primary election, a general election, and any related runoffs.)
The committee does 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.
The committee understands that if either one of those limits is exceeded,
the committee's campaign treasurer will be required to file pre-election
reports and, if necessary, a runoff report.
Year of election(s) or election cycle to Signature of Campaign Treasurer
Which declaration applies
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED
www.ethics.state.tx.us Revised 09/0412014