Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 1-800-325-8506 OFFICE USE ONLY TEXAS ETHICS COMMISSION AFFIDAVIT OF TIMELY REPORT Date Received Complete this affidavit only if you contend that a fully completed and properly executed report was filed in a timely manner as required. HD / PM Filer Name Account # Date Processed Date Imaged I, _______________________________________, filed a _____________________________ with the (description of report) (name of filer) Texas Ethics Commission on or before _______________________________ by the following method: (date of deadline) (indicate one) by first-class United States Mail, properly addressed with all postage charges prepaid. by common or contract carrier, properly addressed with all delivery and handling charges prepaid. Name of carrier:______________________________________________ by personally delivering it to the offices of the Texas Ethics Commission at 201 East 14th Street, Sam Houston Building, 10th Floor, Austin, Texas. by electronic transfer using a modem or over the internet. Ethics Commission electronic filing confirmation #: TX - _______________________ or TXL - _______________________ I swear, or affirm, under penalty of perjury that the foregoing statements are in all things true and correct. Signature of Filer NOTARY STAMP / SEAL 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 Revised 05/12/2008 American LegalNet, Inc. www.FormsWorkflow.com