HomeMy WebLinkAboutCampaign Treasurer-07.11.2012-Gonzalez,TommyTexas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-8001-735-2989)
AMENDMENTs.
APP I T ENT ®F A
FORM ACTA
CAMPAIGN TREASURER E A CANDIDATE
PG
1 CANDIDATE
2 ACCOUNT #
3 Total pages filed:
NAME
4
See ACTA Instruction Guide for detailed instructions.
Use this form
for changes to existing information only. Do not provide information previously disclosed.
4 CANDIDATE
NEW MS / MRS J MR FIRST MI
IC
NAMEsem,
t a
Date Received
NICKNAME LAST SUFFIX
t
JUL 11
1.
NEW ADDRESS / PO BOX APT ( SUITE # CITY; STATE; ZIP CODE
ONE
laity Secretarl
5 CANDIDATE
MAILING
ADDRESS
Date Hand -delivered or Postmarked
NEW AREA CODE PHONE NUMBER EXTENSION
Date Processed
6 CANDIDATE
PHONE
Date Imaged
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7 OFFICE HELD
NEW
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8 OFFICE
NEvv
SOUGHT
(if known)
9 CAMPAIGN
NEN MS/MRS/MR FIRST MI NICKNAME
LAST SUFFIX
TREASURER
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NAME
i
6 @
10 CAMPAIGN
NEW STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE:
ZIP CODE
TREASURER
tla..,.6o°'µ,b�
(residence or business)
11 CAMPAIGN
NEW AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
(-, . _.
12 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 corporationsi"6nd labor organizations.
�
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33 pp
Signature of Candidate
Date Signed
G® TO PAGE 2
www. ethics. state. tx.us Revised 07/1412010
7
Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
FOR
CANDIDATE MODIFIED REPORTING DECLARATION PG
13 CANDIDATE
NAME
4 f
14 MODIFIED
NEIN
REPORTING
COMPLETE THIS SECTION ONLY IF YOU ARE
DECLARATION
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. ,o
(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.
Year of election(s) or election cycle to Signature of Candidate
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