Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) REQUEST FOR ELECTRONIC FILING PASSWORD (Texas Ethics Commission Filers Only) Please print or type everything other than your signature. See the back for additional information about completing this document. 2 NAME OF CANDIDATE/ OFFICEHOLDER REQUESTING PASSWORD (see instructions) MAILING ADDRESS Mr Mrs Ms FORM COH PASS 1 ACCOUNT # (Ethics Commission Filers) OFFICE USE ONLY Date Received 3 ADDRESS / PO BOX; APT / SUITE #; CITY; STATE; ZIP CODE 4 Date Hand-delivered or Postmarked FILER'S EMAIL ADDRESS (For Commission to send filing requirement notices) TELEPHONE AREA CODE PHONE NUMBER EXTENSION PASSWORD: 5 ( 6 OFFICE HELD (if any) ) 7 OFFICE SOUGHT (if known) 8 SECURITY QUESTION 9 ANSWER TO SECURITY QUESTION 10 CANDIDATE/ OFFICEHOLDER SIGNATURE I swear that I am the person required by Title 15, Election Code, to file campaign finance reports with the Texas Ethics Commission. This document is my official password request for the purpose of filing electronic campaign finance reports with the Texas Ethics Commission. Signature 11 IF APPLICABLE, CHECK HERE In addition to myself, I authorize the Texas Ethics Commission to release my password to: ______________________________________ Name ________________________ Phone # Revised 07/12/2013 American LegalNet, Inc. www.FormsWorkFlow.com www.ethics.state.tx.us Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) REQUEST FOR ELECTRONIC FILING PASSWORD Passwords are used to enable you to file Texas Ethics Commission campaign finance reports electronically regardless of what method of transfer you have selected. The Ethics Commission electronic filing software uses your unique password and the Ethics Commission filer account number to digitally encrypt and sign your electronic campaign finance reports. To receive a password, the person responsible for filing reports must complete this form and return it by mail to the Texas Ethics Commission, P.O. Box 12070, Austin, TX 78711-2070, by fax to 512-463-8808, or by handdelivery to 201 E. 14th St., Sam Houston Bldg., 10th Floor, Austin. It is your responsibility to protect your password. If you forget your password, contact the Ethics Commission at one of the numbers listed above. You will be given your password ONLY after you correctly answer the question you provided in Box #8. INSTRUCTIONS FOR COMPLETING THIS FORM The following numbers correspond to the numbered boxes on the other side. 1. Filer Account #. Enter the filer account number assigned to you by the Texas Ethics Commission. Please note that the filer account number is NOT the same as the official password to file electronically. 2. Name of Candidate/Officeholder Requesting Password. Person who requests password must be the candidate/ officeholder. 3. Mailing Address. Enter the complete address of the filer requesting the password. The Ethics Commission will mail the official password to the address provided. 4. Email Address. Enter the email address of the candidate/officeholder requesting the password. 5. Telephone Number. Enter the telephone number of the filer requesting the password, including the area code and, if applicable, the extension number. 6. Office Held. If you are an officeholder, enter the office you currently hold. 7. Office Sought. If you are a candidate, enter the office you seek, if known. 8. Security Question. Enter a question. Choose a question to which only you know the answer. If you forget your password, this is the question you will be required to correctly answer before the Ethics Commission gives you your password. 9. Answer to Security Question. Enter the answer to the question you entered in Box #8. For your security and convenience, make sure the answer is something that only you know and that is extremely difficult for others to guess, even if they are asked your question. If you forget your password, this is the answer you will be required to give to the question in Box #8 before the Ethics Commission gives you your password. 10. Filer Signature. Sign after reading the statement. 11. If Applicable, Check Here. If you will not be available to obtain your password from the Ethics Commission, you may authorize the release of your password to the person you name. (The password will be released to the person you name when the security question you provided in Box #8 is answered.) www.ethics.state.tx.us Revised 07/12/2013 American LegalNet, Inc. www.FormsWorkFlow.com