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SIGNATURE I am aware of the Nepoilsrn Law, CI lapter 573 oft o Texas CT .-. - 44-0ou:;.
CA
I aill awe of Ill} ie .pt);:ii lii Lf Lis flit'- LN IIC..I} .Gi..=i..v ..,..-reCitri:..- •- .:tmcc:!tl3
the Election Code. a-
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11 oil,Cui pt.,:6:i•�ni A. --i i.-s , vi Gal llGcza.,:I:.
01/16 j«ta
S. nature of' -andidate Date Signr...d
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Forms pro:.-T: t y T r i' °-- Cs'.::-.::-.-.. :: thics :._.._ ...us Revs: 1:112022
CANDIDATEMODIFIED FORM CTA
REPORTING; DLCLARA iiCct PG 2
11 CA!`!D!D1 TE
NAME
12 e:,;^T REPORTING _E COMPLETE THIS SECTION ONLY !f YOU -:L
REPORTING
DECLARATION CHOOSING MODIFIED RFPO1 TIWCi:
•• This declaration must be filed no later than the 30th da,' bP.f re
the fire+ pinnt/or+ to sed.:nh th.• �.+r.lo nti� .-.�.�:n
(An election cydc includes a primary election,a genera!election,and ar:y relatxt runoffs.)
•• Candiciatet. for the off: :e of state chair of a political party
may NOT choose modified reporting. ••
I do not intend to accept more than $940 in political contributions
or make more than $940 in ,oliti_a! c-x;„c.n, i iirc- crc' icling
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 rcpc,rt.
•
2024 Election
Year of election(s)or election cycle to ignat C
which declaration applies
This appointment is ;,ffcstivc on the cafe it is filed with ins a:p:j cspriate f:17.:y suthwity.
TEC Filers may send this form to the ITC Or:T.tror.i 'ally at ti-r-n.-.-T:7nint:^•--11-irc ty
or mail to
Texas Ethis
/�
P.O.Bc,..'I /2 7 V
Au t ,T .71)7ii 207r.
Non-TEC Filers must file this form with the local filing authority
DO NOT SEND TO TEC
For more information about where to fil_o go to:
Forms pi vYiucu by Texas vrw...cthics.statc.tx.:s Revisor 11112022
nca EthicsCGttii3 ii5;ivy.