DB CTATexas Ethics Comm~ssion PO Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-7352989)
APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE PG I
1 Total pages filed: I-- See CTA Instruction Guide for detailed lnstmctions.
I
OFFICE USE ONLY 2 CANDIDATE
NAME
MSIMRSIMR FRST MI
M r.
NICKNAME
Davin
LAST
Bernstein
3 CANDIDATE I AWRESS I PO BOX; APT I SUITE #; MAILING
ADDRESS
228 Hollywood Dr Coppell, TX 75019
MAR 0 !3 2Ji2
CITY 3AEY
I I
, CODE PHONE NUMBER ~NSION D" Hwddeliveredor Posbnarked
I h ..
d
4 CANDIDATE
PHONE
AREA
5 OFFICE I Date lmeged
HELD
(a any)
( 972 ) 393-9309
6 OFFICE
SOUGHT
(if known)
3=J4/%
Date pmoassad
3-54-
City Council Place 4
MNRSMR FIRST MI NICKNAME LAST SUFFIX 7 CAMPAIGN
TREASURER
NAME Mr. Davin Bernstein
STREET ADDRESS (NO PO BOX PLEASE), APT I SUITE #, STATE, ZIP CODE 8 CAMPAIGN
TREASURER
STREET
ADDRESS
(residence or business) 228 Hollywood Dr.
AREA CODE PHONE NUMBER
( 972 ) 393-9309
EXTENSION 9 CAMPAIGN
TREASURER
PHONE
tO 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 corporations and labor organizations.
Signature of Candida Signed fl CAJ\ 5 2012
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www.eihii.state.b.us Revised 07/1412010