HomeMy WebLinkAboutTompkins, Jeremy CTA 2014 Texas 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 MS/MRS/MR FIRST MI
NAME
OFFICE USE ONLY
Acct #
NICKNAME . . . . . LAST . . . . . . . . . . . . . . SUFFIX
PallsqRecrW
3 CANDIDATE ADDRESS/PO BOX; APT!SUITE#; CITY; STATE; ZIP CODE
MAILING
ADDRESS JAN 3 1 M4
0? 5%��t°fi ve �a(ers TX 1G a c)
o a'n
4 CANDIDATE AREA CODE PHONE NUMBER EXTENSION
PHONE Jet /
(617 ) P 71 -8 62 6 Date Processed
5 OFFICE Date Imaged
HELD
(if any)
6 OFFICE
SOUGHT / Naee
(if known) �i14�eSS Ci-�r ��.n 0 1
7 CAMPAIGN MS/MRSIMR FIRST MI NICKNAME LAST SUFFIX
TREASURER /�j�
NAME 44S
8 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT/SUITE tt; CITY; STATE; ZIP CODE
TREASURER
STREET l
ADDRESS �667 ,5;�/I�°:` d/� oC
(residence or business)
9 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE \ Z 33
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 a are of the restrictions in title 15 of the Election Code on contributions
fro rporationns and labor organizations.
77 Z— r
Signature of Candidate ate Signed
GO TO PAGE 2
www.ethics.state.tx.us Revised 07/14/2010