Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) FORM COR-C/OH CORRECTION AFFIDAVIT FOR CANDIDATE/OFFICEHOLDER 2 Total pages filed: 1 ACCOUNT # 3 CANDIDATE / OFFICEHOLDER NAME OFFICE USE ONLY Date Received ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ January 15 ○ ORIGINAL REPORT TYPE ○ 4 LAST ○ NICKNAME MI ○ FIRST ○ MS / MRS / MR SUFFIX Date Hand-delivered or Date Postmarked Runoff Other (specify) July 15 Exceeded $500 limit _______________________________ 30th day before election 15th day after treasurer appointment (officeholder only) 8th day before election Final report Receipt # Amount Legal Totals Date Processed 5 ORIGINAL PERIOD COVERED Month Day Month Year Day Year Date Imaged THROUGH 6 EXPLANATION OF CORRECTION 7 AFFIDAVIT I swear, or affirm, under penalty of perjury, that this corrected report is true and correct. 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 learned that the report as originally filed is inaccurate or incomplete. I swear, or affirm, that any error or omission in the report as originally filed was made in good faith. AFFIX NOTARY STA M P / SEAL ABOVE Signature of Candidate or Officeholder 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 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 report (other than a report due 8 days before an election or a special report near election) filed with the Ethics Commission after its due date is not considered late for purposes of late-filing penalties if: (1) any error or omission in the report as originally filed was made in good faith, and (2) the person filing the report files a corrected report and a good-faith affidavit not later than the 14th business day after the date the person learns that the report as originally filed is inaccurate or incomplete. Attach additional pages as necessary. INSTRUCTIONS FOR COMPLETING THIS FORM The following numbers correspond to the numbered boxes on the other side. 1. Account #. If you file with the Ethics Commission, you should have received a letter acknowledging receipt of your campaign treasurer appointment and assigning you an account number. Put that number in this box. If you do not file with the Ethics Commission, skip 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. Original Report Type. Mark the type of report you are correcting. 5. Original Period Covered. Enter the period covered by the report you are correcting. The year is important because filers sometimes correct reports years after filing the original. 6. 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. 7. 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