Amendment Appointment Of A Campaign Treasurer By A Candidate {AJCTA}

Revised //201 Forms provided by Texas Ethics Commission www.ethics.state.tx.us FORM AJCTAPG 1 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 ()NEWNEW NEWNEW NEW 3 21JUDICIALCANDIDATENAMEFILER ID #Total pages filed:JUDICIALCANDIDATENAMEJUDICIALCANDIDATEMAILINGADDRESSOFFICE HELD(if any)OFFICE SOUGHT(if known)CAMPAIGNTREASURERNAMECAMPAIGNTREASURERSTREETADDRESS(Residence or business)CAMPAIGNTREASURERPHONEJUDICIALCANDIDATESIGNATUREAREA CODEPHONE NUMBEREXTENSIONMS\MRS\MRFIRSTMINICKNAMELASTSUFFIXMS\MRS\MRFIRSTMINICKNAMELASTSUFFIXADDRESS / PO BOX;APT / SUITE #;CITY;STATE;ZIP CODESTREET ADDRESS (NO PO BOX PLEASE);APT / SUITE #;CITY;STATEZIP CODE579101112 8 4See AJCTA Instruction Guide for detailed instructions.Use this form for changes to existing information only. Do not enter information that has not changed.AMENDMENT: APPOINTMENT OF ACAMPAIGN TREASURER BY A JUDICIAL CANDIDATENEWNEW ()NEWJUDICIALCANDIDATEPHONEAREA CODEPHONE NUMBEREXTENSION6 OFFICE USE ONLY Date Received Signature of CandidateI 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 ofthe Election Code.I am aware of the restrictions in title 15 of the Election Code on contributionsfrom corporations and labor organizations.Date Signed GO TO PAGE 2 Receipt #Date Hand-delivered or PostmarkedDate ProcessedAmount $ Date Imaged American LegalNet, Inc. www.FormsWorkFlow.com Revised //201 Forms provided by Texas Ethics Commission www.ethics.state.tx.usNEW This appointment is effective on the date it is filed with the appropriate filing authority. FORM AJCTAPG AMENDMENT:JUDICIAL CANDIDATE MODIFIED REPORTING DECLARATION15JUDICIALCANDIDATENAME Signature of CandidateMODIFIEDREPORTINGDECLARATION Year of election(s) or election cycle towhich declaration appliesI do not intend to accept more than $500 in political contributions ormake 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 berequired to file pre-election reports and, if necessary, a runoffreport.I understand that I am required to file semiannual reports, telegramreports, and special-session reports, if applicable, regardless of theamount of the contributions I accept or the expenditures I make.225225This declaration must be filed no later than the 30th day before thefirst election to which the declaration applies. 225225COMPLETE THIS SECTION ONLY IF YOU ARE CHOOSING MODIFIEDREPORTING. PLEASE READ THE EXPLANATION OF MODIFIEDREPORTING IN THE INSTRUCTIONS TO THIS FORM.225225The modified reporting option is valid for one election cycle only. 225225(An election cycle includes a primary election, a general election, and any related runoffs.) 16 TEC Filers may send this form to the TEC electronically at treasappoint@ethics.state.tx.usor mail toTexas Ethics CommissionP.O. Box 12070Austin, TX 78711-2070 Non-TEC Filers must file this form with the local filing authorityDO NOT SEND TO TECFor more information about where to file go to: American LegalNet, Inc. www.FormsWorkFlow.com