HomeMy WebLinkAboutDesignations of Campaign Treasurer-Campaign Finance Reports & Filings-Chris Putnam-1/20/2017Texas Ethics Cammission P.O. Box 12070 Austin, Texas 78717-2070 (512) 463-5800 ('iDD 1-800-735-2989}
APPOINTMENT �F A CAMPAIGN TREASURER �oRnrt CTA
BY A CANDIDATE P� �
See GTA InsEr[action Guide for detailed instructPons.
1 Total pages flled:
2 CANDI�ATE MSlMRS! R FIRST �� OFF[CE EISE ONLY
NAM E ��'� i� v l�C�� �
aoot. #
NICKNAME . . . . . . . . LA�T . . . . . . . . . . . . . . . SUFFIX . .
De1 i e � n � �
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3 CANDI�ATE f1�DRES51PO6QX; APTISUITE#; CIFY; STATE; ZlPCO�E JAN 20 �D17
MAfLI[�tG
ADDFiESS �
� t►� ih��,��. ��. ���,'�'�.�v'� ���..� C11"YSECRETA�Y'S UFF1C
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4 CA�1D[QA"TE AREA CQDE PHONE Ni1MBER EX7ENSION �ateHandde[iveredorPo
PMONE
�ate Processed � �
5 OFFICE ����� `}� A Datelmaged P
HELD � r ,�VI1V�:.' �
(if any} � � � � � � (� � �
6 OFFICE � �
SOUGHT �� �I �t-L- � �
(ii known)
7 CAMPAIGN M R FIRST MI NICKNAME LAST SUFPIX
TREASURER
NAME �{ VL�I. �� �� 4�IL�/1'�
�
8 CAMPAIGlV STREETAODRESS (NOP4BOXPZEASE); AFTISUITE#; CITY; STA'fE; ZIPCOOE
TREASURER
S�fF2EET' %� j �� 1lu�.�� �. �� l�C.�.11'Vf i � L'C.: ��C � �t �� �
/aDDRESS T ` J
(residence or business}
9 CAMPAIGN AREA C01}E PWONE NUMBER EXf�N510N
TF2EASURER
PHONE �� � � 1 � G� � � /,� � � ��
tiJ
10 CAlV�IDATE
SlGNATURE I am aware of tfte Nepotism Law, Chapter 573 of the Texas Governmer�t Code.
I am aware of rr�y responsibility to fife tirrtely reporfis as req�ired by title 15 of
the Efection Code.
I am aware of the restrictions in #itle 15 of ihe Efection Code on con#ributions
frorn rporations n IaE�or organizations.
�� / �G
Signature of Candi[Eate ate Signe
G� TO PAGE 2
www,ethics.state.tx.us Re�ised Q711412a10
�
City of Colleyville Financial Disclosure and Business Conflict of Interest Forms
PERSONAL FINANCIAL STATEMENT
AFFIDAVIT
Financial Disclosure and Business Conflict of Interest Forms shall be provided by
candidates for Mayor and City Council and by applicants seeking appointments to the
Planning and Zoning Commission or the Zoning Board of Adjustment, and shall file such
forms within two (2) business days following the end of the candidate filing period, or if
for appointment, within (2) business day following the end of the application period
stated in the official City advertisement for application for the position.
The city manager and the city manager's senior staff members (including any staff
member who is appointed with City Council approval) shall also file the same within
thirty (30) days of hiring. All person(s), as outlined above, shall have a duty to file
supplemental disclosures annually and within five (5) business days of an occurrence of
any change in the information reflected in the forms previously filed by the individual.
Before me, th,,e undersigned authority, personally appeared:
�d�l�Y�'� who, after being duly sworn upon their
oath and deposed and stated as follows:
"My name is ��ii�'s b�u �n G.,-1 and I hereby submit
for filing the attached Financial Disclosure and Business Conflict of Interest forms. I
have personal knowledge of all information contained in said forms and all information
contained in the forms is true and correct."
"Further, all information contained in the forms is complete. There is no information
that has been withheld or not disc d which is re nsive to or required to be
disclosed by the forms." �`� ` J " v-�J
Affiant
to and subscribed before me, this the � day of �k , 20�_
Amy Shelley
Notary Public
State of Texas
My Comm. Exp.12/02/19
Public,
of Texas
INITIAL HERE: DATE:
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