Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 CORRECTION AFFIDAVIT FOR POLITICAL COMMITTEE SPECIAL PRE-ELECTION REPORT FORM 1-800-325-8506 COR-PAC-T 2 Total pages filed: 1 ACCOUNT # OFFICEUSEONLY Date Received 3 COMMITTEE NAME 4 TREASURER NAME FIRST MI LAST Date Hand-delivered or Date Postmarked 5 DATE ORIGINAL REPORT FILED Day Receipt # Year Amount Legal Month Totals Date Processed 6 EXPLANATION OF CORRECTION Date Imaged 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. Signature of Campaign Treasurer AFFIX NOTARY STAMP / 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 Revised 09/23/2005 American LegalNet, Inc. www.USCourtForms.com Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1-800-325-8506 CORRECTION AFFIDAVIT FOR POLITICAL COMMITTEE 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 report filed with the Ethics Commission after its due date is considered late for purposes of late-filing penalties unless: (1) the report as originally filed substantially complies with the applicable law, (2) any error or omission in the report as originally filed was made in good faith, and (3) the person filing the report files a corrected report not later than the 14th business day after the date the person learns that the report as originally filed is inaccurate or incomplete. Also, 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 #. The committee’s campaign treasurer should have received a letter from the Ethics Commission acknowledging receipt of the campaign treasurer appointment and including the committee’s 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. Committee Name. Put the committee’s full name here. Enter the name in the same way as on the report you are correcting. 4. Treasurer Name. Put the treasurer’s full name here. 5. 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. 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. The committee treasurer should read the affidavit before signing. The committee treasurer 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. Revised 09/23/2005 American LegalNet, Inc. www.USCourtForms.com