Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) FORM CORRECTION AFFIDAVIT FOR CANDIDATE/OFFICEHOLDER SPECIAL PRE-ELECTION REPORT 1 ACCOUNT # 2 3 CANDIDATE / OFFICEHOLDER NAME Total pages filed: COR-COH-T OFFICE USE ONLY Date Received ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ LAST ○ ○ ○ ○ ○ ○ ○ NICKNAME MI ○ FIRST ○ MS / MRS / MR SUFFIX Date Hand-delivered or Date Postmarked 4 DATE ORIGINAL REPORT FILED Month Day Year Amount Legal 5 Receipt # Totals Date Processed EXPLANATION OF CORRECTION Date Imaged 6 AFFIDAVIT I swear, or affirm, under penalty of perjury, that this corrected report is true and correct. Signature of Candidate or Officeholder AFFIX NOTARY STA M P / SEAL ABOVE 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 Printed name of officer administering oath Title of officer administering oath Remember To Attach Any Part Of The Campaign Finance Report Form Needed To Report And Explain Corrections www.ethics.state.tx.us Revised 09/01/2007 American LegalNet, Inc. www.FormsWorkFlow.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) CORRECTION AFFIDAVIT FOR CANDIDATE/OFFICEHOLDER SPECIAL PRE-ELECTION REPORT All Reports: A filer who files a corrected report must submit a correction affidavit. The affidavit must identify the information that has changed. Reports filed with Texas Ethics Commission: A corrected special pre-election report filed with the Ethics Commission after its due date is considered late for purposes of late-filing penalties. A filer wishing to ask the Ethics Commission to consider waiving or reducing a late-filing penalty may do so by providing a basis of the request in the correction affidavit. Attach additional pages as necessary. INSTRUCTIONS FOR COMPLETING THIS FORM The following numbers correspond to the numbered boxes on the other side. 1. Account #. You should have received from the Ethics Commission a letter acknowledging receipt of your campaign treasurer appointment 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. Candidate/Officeholder Name. Put your full name here. Enter your name in the same way as on the report you are correcting. 4. Date Original Report Filed. Enter the date the report you are correcting was filed. The year is important because filers sometimes correct reports years after filing the original. 5. Explanation of Correction. Attach any part of the campaign finance report form 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 09/01/2007 American LegalNet, Inc. www.FormsWorkFlow.com