HomeMy WebLinkAboutUtzman, Michael CTA 2004 Texas Ethics CorT nission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 1-800-325-8506
APPOINTMENT OF A CAMPAIGN FORM CTA
TREASURER BY A CANDIDATE PG 1
Total pages filed:
See CTA Instruction Guide for detailed instructions. ,�
2 NIS/M /MR FIRST MI OFFICE USE ONLY
CANDIDATE n'1 Chore h .
NAME Acct #
NICKNAME LAST SUFFIX Date Received
Y`0.
3 ADDRESS/PO BOX, APT/SUITE#; CITY; STATE; ZIP CODE
CANDIDATE P
MAILING
ADDRESS
4 AREA CODE PHONE NUMBER EXTENSION HD/PM
CANDIDATE
PHONE
Dale Processed
5 [Date Imaged
OFFICE HELD
(if any)
6 n
OFFICE SOUGHT
(if known)
7 - MS/MRS/MR FIRST MI NICKNAME LAST SUFFIX
CAMPAIGN
TREASURER
NAME
8 STREET ADDRESS(NO PO BOX PLEASE); APT/SUITE#; CITY; STATE; ZIP CODE
CAMPAIGN S�
TREASURER
STREET
ADDRESS
or business) n
(Residence / 13 to 12 4., rx 74 j q J
8 AREA CODE PHONE NUMBER EXTENSION
CAMPAIGN l _ 0 I
TREASURER 5_
PHONE
10
CANDIDATE I am aware of the Nepotism Law, Chapter 573 of the Texas Government Code.
SIGNATURE
I am aware of my responsibility to file timely reports as required by title 15 of
the Election Code.
am aware of the restrictions in title 15 of the Election Code on contributions
from corporations and labor organizations.
Signatu e o Candidate Date Signed
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t Printed on recycled paper (Revised 09/01/2003)
Texas EthicsCommission P_O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 1-800-3258506
CANDIDATE MODIFIED FORM CTA
REPORTING DECLARATION PG 2
11
CANDIDATE NAME
12COMPLETE THIS SECTION ONLY IF YOU ARE CHOOSING MODIFIED
MODIFIED
REPORTING REPORTING.
DECLARATION
-• 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.)
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.
Ifle Printed on recycled paper (Revised 0910112007)