Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) CORRECTED FORM REG / AREG AND GOOD-FAITH AFFIDAVIT 1 ACCOUNT # 2 Total pages filed: OFFICE USE ONLY 3 REGISTRANT NAME TITLE; FIRST; MI NICKNAME; LAST; SUFFIX 4 ORIGINAL REPORT TYPE LOBBY REGISTRATION (FORM REG) DATE FILED: _____________________ LOBBY REGISTRATION AMENDMENT (FORM AREG) DATE FILED: _____________________ 5 EXPLANATION OF CORRECTION 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that this corrected report is true and correct. I further affirm that I have complied with Section 305.028, Government Code (Prohibited Conflicts of Interest). Check ONLY if applicable: I swear, or affirm, that I am filing this corrected report not later than the 14th business day after the date I became aware of the error or omission in the registration originally filed. I swear, or affirm, that any error or omission in the report as originally filed was made in good faith. Signature of Registrant AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said _________________________________ , this the __________ day of __________________ , 20 __________ , to certify which, witness my hand and seal of office. Signature of officer administering oath Printed name of officer administering oath Remember To Attach Any Part Of Form REG / AREG Needed To Report And Explain Corrections www.ethics.state.tx.us Revised 11/01/2007 American LegalNet, Inc. www.FormsWorkFlow.com HD / PM Receipt # Legal Date Processed Date Imaged Amount Title of officer administering oath Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) CORRECTED FORM REG / AREG LOBBY REGISTRATION AND LOBBY REGISTRATION AMENDMENT Under sections 305.033 and 571.0771 of the Government Code, a filer is subject to a $500 late-filing penalty in connection with a registration that is corrected after the deadline unless (1) any error or omission in the registration as originally filed was made in good faith and (2) the filer files a corrected registration not later than the 14th business day after the date the filer becomes aware of the error or ommission in the registration originally filed. A filer who files a corrected report after the filing deadline must submit a correction affidavit. The correction affidavit must identify the information that has changed. INSTRUCTIONS FOR COMPLETING THIS FORM The following numbers correspond to the numbered boxes on the other side. 1. Account #. When you registered with the Ethics Commission, you should have received a letter acknowledging receipt of your lobby registration and assigning you an account number. Put that number in this box. 2. Total Pages Filed. After completing this form and any attachments, count the number of pages. Enter that number in this box. Each side of a two-sided form counts as a page. In other words, this form is two pages. 3. Registrant Name. Put your full name here. Enter your name in the same way as on the report you are correcting. 4. Original Report Type. Mark the type of report you are correcting. 5. Explanation of Correction and Penalty Waiver/Reduction Request. Attach any parts of Form REG (Lobby Registration) or Form AREG (Lobby Registration Amendment) needed to report and explain corrections. Explain why there was an error on the original report. Also explain what information is being corrected and how the new information is different from the information on the original report. (Use additional pages if you need more space.) You may also use this area to request a waiver or reduction of a late-filing penalty and state the basis of your request. 6. Affidavit. Read the affidavit before signing. You must sign the affidavit in the presence of an individual authorized to take oaths. If signed before a notary public, the affidavit must include the notary's signature and seal. www.ethics.state.tx.us Revised 11/01/2007 American LegalNet, Inc. www.FormsWorkFlow.com