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SPACTexas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989) APPOINTMENT OF A CAMPAIGN TREASURER FORM STA BY A SPECIFIC -PURPOSE COMMITTEE PG 1 1 Total pages filed: See STA Instruction Guide for detailed instructions. 2 COMMITTEE NAME �; %Z,3W-5 FOR COPn`Ll, Ol ITI OFFICE USE ONLY / oF Gt A D t iu J 3 COMMITTEE ADDRESS ADDRESS/PO BOX; APT/SUITE CITY, STATE, ZIP CODE / ®t K i A `L� C/ 1)� GOPP� 7x. 75-019 OCT 232013 4 CAMPAIGN TREASURER MS / MRS / MR FIRST D� MI HJ/PM City of Coppell Clji2iSTI E NAME 1/5 Date Processed NICKNAME LAST SUFFIX Date Imaged STREET ADDRESS (NO PO BOX PLEASE); APT I SUITE #; CITY; STATE; ZIP CODE DTIFia)may,/\ I )p 5 CAMPAIGN TREASURER STREET t2�1 I 1 WC.c-a/ !ll---���F. `�� ADDRESS Cc Ony `r. 7] Z© lQ residence or business �1 ` r r G l- I� / J 1 I 6 MAILING ADDRESS /PO BOX; APT/SUITE#; CITY; STATE; 21P CODE ADDRESS .! _measabo 7 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION TREASURER PHONE '5C^iV._ -30/ , (17-;Z)l 7 /y- 8 PERSON FIRST MI LAST) SUFFIX APPOINTING �,Q p (� ED14 AD TREASURER 0 % 6, K) 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 organiMTigna�tureof'_a mpaign Treasurer a 10 ASSISTANT FIRST MI LAST SUFFIX CAMPAIGN ttJJ ►V /' f1 jV J QP,b TREASURER (see instructions) 11 ASSISTANT CAMPAIGN ADDRESS/PO BOX; APT/SUITE#) LCITY'STATE, ZIP CODE PA �1 ��• V4/ G �� TREASURER ADDRESS `r / 1 Ntf� coPDG i F . 7 / I Cr L�PHONE 12 ASSISTANT AREA CODE NUMBER EXTENSION CAMPAIGN TREASURER L7f, �0 j4� PHONE CONTINUE ON PAGE 2 This appointment is effective on the date it is filed with the commission. www.ethics.stateAX.us Revised 09/01/2003 Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) SPECIFIC -PURPOSE COMMITTEE: FORM STA PURPOSEAND MODIFIED REPORTING DECLARATION PG 2 13 COMMITTEE NAME C f TleW6 %zap 6nfPez& OtAIII I-V Qr- L%rc_ 14 COMMITTEE CANDIDATE/OFFICEHOLDER NAME PURPOSE SUPPORT CANDIDATE OPPOSE CANDIDATE OFFICE SOUGHT(candidate)/OFFICE HELD (officeholder) ASSIST OFFICEHOLDER BALLOT IDENTIFICATION OF MEASU l # /` ) P�L 5 VBG 1AL, EfW,�dV j / ELECTION DATE Month D Year SUPPORT MEASURE `h> J—r / / /3 OPPOSE MEASURE DESCRIPTION cgxjr Sfl1�5 7AY 15 MODIFIED REPORTING DECLARATION COMPLETE THIS SECTION ONLY IF YOU ARE 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 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 ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED www.ethics.state.tx.us Revised 09101/2003