The URL can be used to link to this page

Home My WebLink AboutEuless Families for a Fair Overtime Law APPOINTMENT OF A CAMPAIGN TREASURER FORM STA BY A SPECIFIC-PURPOSE COMMITTEE PG 1 See STA Instruction Guide for detailed instructions. 1 Total pages filed: If you are involved in a School District Bond Election, you must file Form STA with the local filing authority 3 BEFORE sending a file-stamped copy to the Texas Ethics Commission. 2 COMMITTEE OFFICE USE ONLY NAME Euless Families for a Fair Overtime Law Filer ID# 3 COMMITTEE ADDRESS/PO BOX, APT/SUITE#; CITY, STATE: ZIPCODE ADDRESS (� n IN � 211 S Main St, Euless, TX 76040 ILA`] IIJI � NUV D 4 CAMPAIGN MS/MRS/MR FIRST MI �I 2 7 2019 , I TREASURER rLESS NAME Mr. Michael J CITY OF E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NICKNAME LAST SUFFIX Date Hand-delivered or Postmarked Hachey Receipt# Amount$ 5 CAMPAIGN STREET ADDRESS (NO PO BOX PLEASE); APT/SUITE#; CITY. STATE; ZIP CODE TREASURER STREET Date Processed ADDRESS 1800 N Charles St, #500, Baltimore, MD 21201 (residence or business) Date Imaged 6 MAILING ADDRESS/PO BOX; APT/SUITE#, CITY, STATE; ZIPCODE ADDRESS Xsameasabove 7 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE ( 703 ) 344-4778 8 PERSON FIRST MI LAST SUFFIX APPOINTING Stephanie Rub TREASURER p y 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 required reports and that I may be subject to fines for failure to do so. I am aware of the restrictions in title 15 of the Election Code on contributions from corporations and labor organizations. p Signature o mpaign rea rer 10 ASSISTANT FIRST MI LAST SUFFIX CAMPAIGN TREASURER (see instructions) 11 ASSISTANT ADDRESS/PO BOX; APT/SUITE#; CITY; STATE; ZIPCODE CAMPAIGN TREASURER ADDRESS 12 ASSISTANT AREA CODE PHONE NUMBER EXTENSION CAMPAIGN TREASURER ( ) PHONE CONTINUE ON PAGE 2 Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 10/14/2019 SPECIFIC-PURPOSE COMMITTEE: FORM STA PURPOSEAND MODIFIED REPORTING DECLARATION PG 2 13 COMMITTEE NAME Euless Families for a Fair Overtime Law 14 COMMITTEE CANDIDATE/OFFICEHOLDER NAME PURPOSE SUPPORT CANDIDATE OPPOSE CANDIDATE OFFICE SOUGHT(candidate)/OFFICE HELD(officeholder) F7 ASSIST OFFICEHOLDER BALLOT IDENTIFICATION OF MEASURE / # ELECTION DATE Month Day Year ®SUPPORT MEASURE To be determined To bo/etermt�ed DESCRIPTION OPPOSE MEASURE A measure to enact requirements on certain large employers in Euless regarding overtime, scheduling, and other provisions. 15 MODIFIED COMPLETE THIS SECTION ONLY IF YOU ARE CHOOSING REPORTING MODIFIED 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 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 TEC Filers may send this form to the TEC electronically at treasappoint .ethics.state.tx.us or mail to Texas Ethics Commission P.O. Box 12070 Austin,TX 78711-2070 Non-TEC Filers must file this form with the local filing authority DO NOT SEND TO TEC For more information about where to file go to: hftps://ethics.state.tx.us/filinginfo/QuickFileAReport.php This appointment is effective on the date it is filed with the appropriate filing authority. CONTINUE ON PAGE 3 Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 10/14/2019 SPECIFIC-PURPOSE COMMITTEE: FORM STA STATEMENT AUTHORIZING DIRECT CAMPAIGN EXPENDITURES PG 3 FROM CORPORATION OR LABOR ORGANIZATION POLITICAL CONTRIBUTIONS UNDER SECTION 252.0031, ELECTION CODE 16 COMMITTEE NAME Euless Families for a Fair Overtime Law 17 AFFIRMATION I swear, or affirm, under penalty of perjury that the following statement is in all things true (If applicable) and correct: The political committee named above is not established or controlled by a candidate or an officeholder, and will not use any political contribution from a corporation or a labor organization to make a political contribution to: (1) a candidate for elective office or (Check if an officeholder, or (2) a political committee that has not included in its campaign treasurer applicable) appointment a Statement Authorizing Direct Campaign Expenditures from Corporation or Labor Organization Political Contributions declaring the same. PLEASE COMPLETE EITHER OPTION (1) OR (2) BELOW: (1) AffidavitJurat: Signature of Committee Representative Notary Stamp/Seal Sworn to and subscribed before me by this the day of 20 , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed Name of officer administering oath Title of officer administering oath 2) Unsworn Declaration Jurat: My name is and my date of birth is My Address is (street) (city) (state) (zip code) (country) Executed in County, State of on the day of , 20 Signature of Committee Representative (Declarant) Filers may send this form to the TEC electronically at trea sappo i nt(cD-eth ics.state.tx.us or by mail to: Texas Non-TEC Filers must file this form Ethics Commission, P.O. Box 12070,Austin,TX 78711-2070 with the local filing authority Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 10/14/2019