Form 2201 - Statement of Officer (General Information) The attached form is designed to meet minimal constitutional filing requirements pursuant to the relevant provisions. This form and the information provided are not substitutes for the advice and services of an attorney. Execution and Delivery Instructions The Statement is considered filed once it has been received by this office. Mail: P.O. Box 12887, Austin, Texas 78711-2887. Overnight mail or hand deliveries: James Earl Rudder Officer Building, 1019 Brazos, Austin, Texas 78701. Fax: (512) 463-5569. Email: Scanned copies of the executed Statement may be sent to register@sos.state.tx.us. NOTE: The Statement of Officer form, commonly referred to as the "Anti-Bribery Statement," must be executed and filed with the Office of the Secretary of State before taking the Oath of Office (Form 2204). Commentary Article XVI, section 1 of the Texas Constitution requires all elected or appointed state and local officers to take the official oath of office found in section 1(a) and to subscribe to the anti-bribery statement found in section 1(b) before entering upon the duties of their offices. Local officers must retain the signed anti-bribery statement with the official records of the office. This form is designed for filing the anti-bribery statement by elected and appointed state-level officers. Elected and appointed state-level officers required to file the anti-bribery statement with the Office of the Secretary of State include members of the Legislature, the Secretary of State, and all other officers whose jurisdiction is coextensive with the boundaries of the state or who immediately belong to one of the three branches of state government. Op. Tex. Att'y Gen. No. JC-0575 (2002). Questions about whether a particular officer is a state-level officer may be resolved by consulting relevant statutes, constitutional provisions, judicial decisions, and attorney general opinions. Questions about this form should be directed to the Government Filings Section at (512) 463-6334 or register@sos.state.tx.us. Revised 01/2015 Form 2201 1 American LegalNet, Inc. www.FormsWorkFlow.com Form #2201 Rev. 01/2015 Submit to: SECRETARY OF STATE Government Filings Section P O Box 12887 Austin, TX 78711-2887 512-463-6334 512-463-5569 - Fax Filing Fee: None This space reserved for office use STATEMENT OF OFFICER Statement I, , do solemnly swear (or affirm) that I have not directly or indirectly paid, offered, promised to pay, contributed, or promised to contribute any money or thing of value, or promised any public office or employment for the giving or withholding of a vote at the election at which I was elected or as a reward to secure my appointment or confirmation, whichever the case may be, so help me God. Title of Position to Which Elected/Appointed: Execution Under penalties of perjury, I declare that I have read the foregoing statement and that the facts stated therein are true. Date: Signature of Officer Revised 01/2015 Form 2201 2 American LegalNet, Inc. www.FormsWorkFlow.com