HomeMy WebLinkAboutSPAC, NRH4U Campaign Treasurer Appointment 2026 s
APPOINTMENT OFA CAMPAIGN TREASURER FORM STAo
BY A SPECIFIC-PURPOSE COMMITTEE PG
See STA Instruction Guide for detailed instructions. 1 Total pages filed:
If you are Involved in a School District Bond Election.you must file Form STA with the local filing authority 3
BEFORE sending a file-stamped copy to the Texas Ethics Commission.
2 COMMITTEE NRH4U OFFICE USE ONLY
NAME
Res'IDM
3 COMMITTEE ADDRESS IPOBOX, APT/SUITCU; CITY; STAT ZIPCOOE
ADDRESS 7113 Stephanie Ct North Richland .,z—dC E R�VI n .
Hills, TX 76182
-4Q ,I
4 CAMPAIGN MSIMRSIMR FIRST MI ffik
4)SEP Al 2026
TREASURER NAME Mrs Sara CITY SECRETARY
NICKNAME LAST SUFFIX
Date HanGCerivered or Postmarked
Jackson
Reccipitl I Amounts
5 CAMPAIGN STREET ADDRESS: APT/SUITE et CITY; STATE ZIP CODE
TREASURER 711.3 Stephanie Ct North Date Processed
STREET
ADDRESS(residence or business)
6 MAILING
Richland Hills, TX 76182
Date Imaged
OG/o�1202to
ADDRESS IPOBOx APT/SUITE S CITY; SPATE ZIP CODE
ADDRESS
0 same above
7 CAMPAIGN AREA CODE PHONE NUMBER EXTENSION
TREASURER
PHONE ( ) (817)915-8682
/ 8 PERSON FIRST MI LAST SUFFIX
APPOINTING TREASURER Joe D. Tolbert
9 SIGNATURE I understand that I have been appointed as the campaign treasurer for this specific-purpose
committee and that I am responsible for filing all required reports and that I may be subject to
fines for failure to do so. I am aware of the restrictions in title 15 oft - - action Code on contributions
from corporations and labor organizations.
a. C/�---
_ Signat = . CampaignTreasurer
10 ASSISTANT FIRST MI LAST SUFFIX
CAMPAIGN
TREASURER
(sue instructions)
11 ASSISTANT ADDRESS I PO BOX:. APTJSUITEtT: CITY: STA ZIP CODE
CAMPAIGN
TREASURER
ADDRESS
12 ASSISTANT AREA.coos PHONE NUMBER EXTETlSiON
CAMPAIGN
TREASURER ( )
'= : „ . PHONE
f CONTINUE ON PAGE2
ii', s , f`i '
�4`
SPECIFIC—PURPOSE COMMITTEE: FORM STA
0 PURPOSE AND MODIFIED REPORTING DECLARATION PG 2
13 COMMITTEE NAME
N H4 L
14 COMMITTEE- cANarATE,OFf1GFHGlnERNAIVE
PURPOSE
SUPPORT CANDIDATE
OPPOSE cm/o/c:ATE O''TICE SOUGh?(elute)/OrmICEHELD(caked&7)
• ASSIST OFFICEHOLDER
BALLOT IDENTIFICATION OFMEASURE I it D ELECDOUDATE
SUPPORT MEASURE a � 3 i OSt C n S "" 11~ / 0 31 /2 Z(
rOPPOSE MEASURE D£SCRIFrioN
t� too 2 GU of 3;&t,(-ce -st Mack"" City &I'v►c>✓s G0MPie-V
1.14=tr'/
15 MODIFIED
REPORTING COMPLETE THIS SECTION ONLY IF YOU ARE CHOOSING
REPO
DECLARATION MODIFIED REPORTING.
"This declaration must be filed no later than the 30th day
before the first election to which the declaration applies, --
0 --The modified reporting declaration is valid for one election cycle only. --
(An election cycle includes a primary electron,a general election,and any related tuna's)
The committee does not intend to accept more than $1,140 in political
contributions or make more than.$1,140 in political expenditures(excluding filing
fees)in connection with any future election within the election cycle.The
committee understands that if either one of those limits is exceeded,the
committee's campaign treasurer will be required to file pre-election reports and,
if necessary, a runoff report.
Year of election(s)or election cycle to Signature of Campaign Treasurer
which declaration applies
C
ATTACH ADDITIONAL COPIES OF THIS FORM AS NEEDED
TEC Filers may send this form to the TEC electronically at treasappointethics.state.txus
or mail to
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.11www.ethics.state.tx.uslfllinginfolQulckFileAReport.php
b.. ,
� This appointment Is effective on the date it is filed with the appropriate filing authority.
_. ;
tea._. • .. r•� �__�'
SPECIFIC-PURPOSE COMMITTEE: FORM ST
0 STATEMENT AUTHORIZING DIRECT CAMPAIGN EXPENDITURES PG 3
FROM CORPORATION OR LABOR ORGANIZATION POLITICAL
CONTRIBUTIONS UNDER SECTION 252.0031, ELECTION CODE
16 COMMITTEE
NAME.
17 Al-Fit-MATION t swear or affirm. under ponalty of perjury that the following statement is In all things true
(If applicable) and correct
The political committee named above is not established or controlled by a candidate or an
/ officeholder. and wilt not use any political contribution from a corporation or a labor
Y organization to matte a political contribution to (1) a candidate for elective office or
tch�Fk'° an officeholder. or (2) a political committee that has not included in Its campaign treasurer
Ain "orici
appointment a Statement Authorizing Direct Campaign Expenditures from Corporation or Labor
Organization Political Contributions declaring the same.
PLEASE COMPLETE EITHER OPTION (1) OR(2)BELOW:
(1) Affidavit Jurat:
eZ.t c a�-
JACOB HEFFERN
4�' Natty Public,State ofTexas Si ature of c nmlttee Representative
�". My Comm.Exp.07-30-2027
ID No.13210930 5
,{
Sworn to and subscribed before me by SW-A )edit r this the Z$=rh day of J'�t7f�tht�"'
20�, to certify which,witness my hand and seat of office. v
_ _ !' Josob ( r, Potts/ PubJ:t.
S enature of officer administering oath Printed Name of officer administering oath Title of officer adminisfer.ng oath
rtlf it
2) Unsworn Declaration Jurat:
. NI} narre is , and my date of birth is •
I'Vy Address is
(street) (city) (state) (zip code) (country)
Executed in County. State of , on the day of , 20 -
} Signature of Committee Representative(Declarant)
r, , ,,rnay send this form Co the TEC electronically at Non-TEC Filers must file this form
tfeasapaoint Tjethics.state.tx.us or by mail to: with the local filing authority