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TB ACTA Texas Ethics Commission P.O.Box 12070 Austin,Texas 78711-2070 (512)463-5800 (TDD 1-800-735-2989) AMENDMENT: APPOINTMENT OF A FORM ACTA CAMPAIGN TREASURER BYA CANDIDATE PG 1 1 CANDIDATE 2 ACCOUNT# 3 Total pag sfiled: NAME T H e m.1s g cit Lvws' See ACTA Instruction Guide for detailed instructions. Use this form for changes to existing information only. Do not provide information previously disclosed. 4 CANDIDATE NEW I MS/MRS/l FIRST RMI NAME 7 µ8//{•t Y� rite ' IC E l/ I I NICKNAME 1 /�� LAST SUFFIX Bu x.g.tws MAY 052014 5 CANDIDATE NEW I ADDRESS/PO BOX; APT/SUITE#; CITY; TATS; ZIP CODE City Secretary MAILING 132 (.J`) )0// P Pol ,� P K, City of Coppell ADDRESS o / )c / / Date Hand-delivered or Postmarked PE. ) "I Date Processed 6 CANDIDATE NEW I AREA CODE PHONE NUMBER EXTENSION PHONE Date Imaged ( 'f61) S 1 © i3 ) 7 OFFICE HELD NEW I (if any) 8 OFFICE NEW I SOUGHT .' 1 (if known) + 8414-c-6- 9 CAMPAIGN NEW &MRS/MR( FIRST MI NICKNAME LAST SUFFIX TREASURER fill /�^ -7 �j� NAME /Y`�' I�'�J F-t 5 10 CAMPAIGN NEW I STREET ADDRESS(NO PO BOX PLEASE); APT/SUITE#; CITY; STATE; ZIP CODE TREASURER � 3 % W N N Pio c—& D X STREET ADDRESS Al (residence or business) C U PP C /A_ ` � nk. 5f) 17 11 CAMPAIGN NEW I AREA CODE PHONE NUMBER EXTENSION TREASURER (1 f D i3 I PHONE \T4 1 12 CANDIDATE SIGNATURE l 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. 5-7140-1 J..a l (I., Signature of Candidate Dafi Tied GO TO PAGE 2 www.ethics.state.tx.us Revised 07/14/2010