Bernstein, Davin-CTA 2018-02-16APPOINTMENT OF A CAMPAIGN TREASURER FORM CTA
BY A CANDIDATE PG
See CTA Instruction Guide for detailed instructions.
1 Total pages filed:
2 CANDIDATE
Ms MRS M FIRST MI
OFFICE USE ONLY
NAME
�AV
Filer ID #
)IV
. . .
NICKNA. ME . . . . . . . . . . LAS . T . . . . . . . . . . . . . . . . . .SUFFIX . . . .
Date Received
2N S T-ZF N
FEB 16 2018
3 CANDIDATE
ADDRESS / PO BOX; APT / SUITE #; CITY; STATE, ZIP CODE
MAILING
ADDRESS
•� Q ���� UO De
G_ CJ
t J
Date n - e ed or Po tmark
4 CANDIDATE
AREA CODE PHONE NUMBER EXTENSION
Receipt#
Amo nt$
PHONE
/---���777
Q N) / 7 _ �S /
/
Date Processed
5 OFFICE
HELD
Date Imaged
(if any)
6 OFFICE
SOUGHT
(if known)
7 CAMPAIGN
MS/MR/LR FIRST MI NICKNAME LAST SUFFIX
TREASURER
NAME
8 CAMPAIGN
STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
TREASURER
STREET
Q
9/0'VI I`� L (- N��ADDRESS
(residence or business)
' (l
9 CAMPAIGN
AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
`-)1W 796 "/O 9
10 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.
nature of Candidate Date Signed
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 12/7/2017
CANDIDATE MODIFIED FORM CTA
REPORTING DECLARATION PG 2
11 CANDIDATE
NAME
12 MODIFIED
REPORTING
COMPLETE THIS SECTION ONLY IF YOU ARE
DECLARATION
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 option is valid for one election cycle only. ••
(An election cycle includes a primary election, a general election, and any related runoffs.)
•• Candidates for the office of state chair of a political party
may NOT choose modified reporting. --
I 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.
TEC Filers may send this form to the TEC electronically at treasappo i nte-eth ics. state. tx. us or
Fax this form to (51.2) 463-8808 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:
https://www.ethics.state.tx. us/whatsnew/NewFilersGettingStarted. html
Forms provided by Texas Ethics Commission www. ethics.state.tx.us Revised 12/7/2017