HomeMy WebLinkAboutCampaign Treasurer-01.05.2017-Gonzalez,TommyTexas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989)
AMENDMENT: APPOINTMENT OFA
FORM ALTA
CAMPAIGN TREASURER BYA CANDIDATE
PG E
1 CANDIDATE
NAME --1 /-
2 ACCOUNT#
3 Total pages filed:
I C1 MA\
cs-a/IZ,S. Z
See ACTA Instruction Guide for detailed instructions.
Use this form
for changes to existing information only. Do not provide information previously disclosed.
4 CANDIDATE
NAME
NEW MS/MRS/MR FIRST MMI
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M2
OFFICE
OF�USE ONLY
Date ,QQQyy'��e
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- -NICKNAME . • •LAST • • . . . . . . . . . .
SUFFIX
`CEIVED
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!AN 0 5 2017
5 CANDIDATE
NEW ADDRESS/PO BOX; APT SUITE 41; CITY; STATE; ZJPCODE
MAILING``
ADDRESS
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Date Hen Eelweredor Postmarked
Date Processed
6 CANDIDATE
NEW AREA CODE PHONE NUMBER EXTENSION
Date Imaged
PHONE
� _ ^�
7 OFFICE HELD
(f any)
8 OFFICE
N�^r
SOUGHT
(8known)
9 CAMPAIGN
TREASURER
NEW MS/MRSIMR FIRST MI NICKNAME
J /'
LAST SUFFIX
NAME
M`�% . j k(� lam- 6 O'1ZQ eZ,
10 CAMPAIGN
NEW STREETADDRESS (NO PO BOX PLEASE); APT/SUITE#; CITY; STATE;
ZIP CODE
TREASURER
STREET
-
ADDRESS
(residence or business)
r.,.-�
v L !`c,.rJ
CODE
11 CAMPAIGN
NEW AREA 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 resections in title 15 of the Election Code
on contributions
from orporation dl�abororganizations.
SlUnature of Candidate
Dae Signed
GO TO PAGE 2
www.ethics.state.tx.us Revised 0 711 412 01 0
Texas Ethics Commission P.O. Box 12070 Austin. Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989)
AMENDMENT: FORMACTA
CANDIDATE MODIFIED REPORTING DECLARATION PG 2
13 CANDIDATE
NAME
14 MODIFIED
N
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. ••
(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.eth les. state. lx. us Revised 07/14/2010