05 - Appointment of a Campaign Treasurer by a CandidateFORM CTA
PG 1
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APPOINTMENT OF A CAMPAIGN TREASURER
BY A CANDIDATE
See CTA Instruction Guide for detailed instructions.1 Total pages filed:
2 CANDIDATE
NAME
MS / MRS / MR FIRST MI OFFICE USE ONLY
NICKNAME LAST SUFFIX
3 CANDIDATE
MAILING
ADDRESS
ADDRESS / PO BOX;APT / SUITE #;CITY;STATE;ZIP CODE
Date Processed
Filer ID #
Date Imaged
4 CANDIDATE
PHONE
AREA CODE PHONE NUMBER EXTENSION
()
Receipt #
Date Received
Date Hand-delivered or Postmarked
Amount $
5 OFFICE
HELD
(if any)
6 OFFICE
SOUGHT
(if known)
7 CAMPAIGN
TREASURER
NAME
MS/MRS/MR FIRST MI NICKNAME LAST SUFFIX
8 CAMPAIGN
TREASURER
STREET
ADDRESS
(residence or business)
STREET ADDRESS;APT / SUITE #;CITY;STATE;ZIP CODE
9 CAMPAIGN
TREASURER
PHONE
AREA CODE PHONE NUMBER EXTENSION
()
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.
Signature of Candidate Date Signed
GO TO PAGE 2
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2023
www.ethics.state.tx.us
FORM CTA
PG 2
CANDIDATE MODIFIED
REPORTING DECLARATION
11 CANDIDATE
NAME
12 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 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 $1,010 in political contributions
or make more than $1,010 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
which declaration applies
Signature of Candidate
Forms provided by Texas Ethics Commission
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 treasappoint@ethics.state.tx.us
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/filinginfo/QuickFileAReport.php
Revised 1/1/2023