Hinojosa-Smith, Brianna-ACTA 2021-04-06AMENDMENT: APPOINTMENTOFA FORMACTA
CAMPAIGN TREASURER BYA CANDIDATE PG 'I
1 CANDIDATE
2 FILER ID#
3 Total pages filed:
NAME Y nn \^ c
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 MS/MRS/MR FIRST MI
OFFICE USE ONLY
NAME
�/1/ �n n
0
,
Date Received
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
NICKNAME LAST SUFFIX
NEW
5 CANDIDATE
ADDRESS /POBOX; /SUITE#; CITY; STATE; ZIPCODE
7�7"
MAILING
ADDRESS
� ,�� � � ��'
Date Hand-delivered or Postmarked
I
v� ` _' 11 S-10
I
Receipt#
Amount$
Date Processed
/
6 CANDIDATE
NEW AREA CODE PHONE NUMBER EXTENSION
Date Imaged
PHONE
(
7 OFFICE HELD
NEw
(if any)
8 OFFICE
NEw /�
GO '1iJ
SOUGHT
1 ��1 �V� v�
(if known)
9 CAMPAIGN
NEW MS/MRS/MR FIRST MI NICKNAME LAST SUFFIX
TREASURER
NAME
M aV jZ :e C2-
10 CAMPAIGN
10
NEW STREET ADDRESS (NO PO BOX PLEASE); APT / SUITE #; CITY; STATE; ZIP CODE
TREASURER
STREET
ADDRESS
16S Ytcavk �V o 110V
(residence or business)
CSV T_)
11 CAMPAIGN
NEW AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE
12 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 corporation and labor orgalizations.
�2
Si tature-WCaMclatg D to §igneJ
GO TO PAGE 2
Forms provided by Texas Ethics Commission www. ethics. state. tx.us Revised 1/1/2021