Amendment-Appointment Of A Campaign Treasurer By A Specific-Purpose Committee {ASTA}

Revised //2017 Forms provided by Texas Ethics Commission www.ethics.state.tx.us 000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000 () GO TO PAGE 2FORM ASTAPG 1AMENDMENT: APPOINTMENT OF A CAMPAIGNTREASURER BY A SPECIFIC-PURPOSE COMMITTEE()ASSISTANTCAMPAIGNTREASURERPHONECAMPAIGNTREASURERPHONECOMMITTEEADDRESSADDRESS / PO BOX;APT / SUITE #;CITY;STATE;ZIP CODENICKNAMELASTSUFFIXSTREET ADDRESS (NO PO BOX PLEASE);APT / SUITE #;CITY;STATE;ZIP CODEADDRESS / PO BOX;APT / SUITE #;CITY;STATE;ZIP CODEAREA CODEPHONE NUMBEREXTENSIONFIRSTMILASTSUFFIXFIRSTMILASTSUFFIX ADDRESS / PO BOX;APT / SUITE #;CITY;STATE;ZIP CODEAREA CODEPHONE NUMBEREXTENSIONMS / MRS / MRFIRSTMISee ASTA Instruction Guide for detailed instructions.If you are involved in a School District Bond Election, you must file FormASTA with the local filing authority BEFORE sending a file-stampedcopy to the Texas Ethics Commission. Total pages filed:CAMPAIGNTREASURERSTREETADDRESS(residence or business)CAMPAIGNTREASURERNAMECOMMITTEENAMEASSISTANTCAMPAIGNTREASURERADDRESSASSISTANTCAMPAIGNTREASURER(see instructions)SIGNATUREPERSONAPPOINTINGTREASURER same as aboveCAMPAIGNTREASURERMAILINGADDRESS NEW NEW NEW NEW NEWNEW NEW NEW45678910111213141I understand that I have been appointed as the campaign treasurer for this specific-purposecommittee and that I am responsible for filing all required reports and that I may be subject tofines for failure to do so. I am aware of the restrictions in title 15 of the Election Code oncontributions from corporations and labor organizations. NEW Signature of Campaign TreasurerOFFICE USE ONLYDate Received Receipt #Date Hand-delivered or PostmarkedDate ProcessedAmount $ Date ImagedCOMMITTEE NAMEFILER ID #23 American LegalNet, Inc. www.FormsWorkFlow.com Revised //201 Forms provided by Texas Ethics Commission www.ethics.state.tx.usCOMMITTEEPURPOSE DESCRIPTIONELECTION DATEMonthDayYear CANDIDATE / OFFICEHOLDER NAMEOFFICE SOUGHT (candidate) / OFFICE HELD (officeholder)BALLOT IDENTIFICATION OF MEASURE / # COMPLETE THIS SECTION ONLY IF YOU ARE CHOOSINGMODIFIED REPORTING. SUPPORT CANDIDATE ASSIST OFFICEHOLDER OPPOSE CANDIDATE 225225This declaration must be filed no later than the 30th daybefore the first election to which the declaration applies. 225225225225The modified reporting declaration is valid for one election cycle only. 225225(An election cycle includes a primary election, a general election, and any related runoffs.)The committee does not intend to accept more than $500 in politicalcontributions or make more than $500 in political expenditures (exclud-ing filing fees) in connection with any future election within the electioncycle. The committee understands that if either one of those limits isexceeded, the committee's campaign treasurer will be required to filepre-election reports and, if necessary, a runoff report.Year of election(s) or election cycle towhich declaration applies AMENDMENT: SPECIFIC-PURPOSE COMMITTEEPURPOSE AND MODIFIED REPORTING DECLARATIONFORM ASTAPG 2COMMITTEE NAMEMODIFIEDREPORTINGDECLARATION This appointment is effective on the date it is filed with the appropriate filing authority. ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED151718 SUPPORT MEASURE OPPOSE MEASURE NEW ADD NEW ADD NEWFILER ID # 16Signature of Campaign Treasurer TEC Filers may send this form to the TEC electronically at treasappoint@ethics.state.tx.us or mail to Texas 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