OFFICE USE ONLY Date Received AFFIDAVIT FOR LOBBYIST: ELECTRONIC FILING EXEMPTION An exemption affidavit must be submitted with each paper report. Date Hand-delivered or Postmarked A registrant who during the calendar year becomes ineligible to file on paper based on the criteria listed below must file electronically. Receipt # Amount $ Date Processed Lobbyist Name Filer ID Date Imaged 1. I swear or affirm that I do not intend to be compensated or reimbursed for lobby activity in the calendar year covered by the registration; and I have not been compensated or reimbursed for lobby activity in either of the previous two calendar years. I further swear or affirm that I do not intend to make lobby expenditures during the calendar year covered by the registration; and I did not make lobby expenditures in either of the previous two calendar years. I further swear or affirm that I do not use a computer or mobile device, including a tablet or smartphone with access to the Internet. I further swear or affirm that no person acting as my agent or consultant, and no person with whom I contract, uses a computer or mobile device, including a tablet or smartphone with access to the Internet. I am filing this affidavit with the __________________report due on ________________. I understand that this affidavit is required to be filed with each lobby report for which I am claiming an exemption from electronic filing. 2. 3. 4. 5. Signature of Lobbyist NOTARY STAMP / SEAL Sworn to and subscribed before me by ________________________________________ this the ____________ day of _________________________, 20___________, to certify which, witness my hand and seal of office. Signature of officer administering oath Print name of officer administering oath Title of officer administering oath LOBBYISTS WHO ARE EXEMPT FROM THE ELECTRONIC FILING REQUIREMENT ARE STILL REQUIRED TO FILE LOBBY REPORTS ON PAPER. Form provided by Texas Ethics Commission www.ethics.state.tx.us American LegalNet, Inc. www.FormsWorkFlow.com Revised 12/24/2015