Correction Affidavit for Candidate

Revised 04/27/2015
www.ethics.state.tx.usForms provided by Texas Ethics Commission
Remember To Attach Any Part Of The Campaign Finance Report Form
Needed To Report And Explain Corrections
Final report
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said ____________________________________, this the __________ day of __________________,
20________, to certify which, witness my hand and seal of office.
I swear , or affirm, under penalty of perjury , that this corrected
report is true and correct.
Check ONL Y if applicable:
7
AFFIDAVIT
5
ORIGINAL PERIOD
COVERED
6
EXPLANA TION OF CORRECTION
3
CANDIDA TE /
OFFICEHOLDER
NAME
MS / MRS / MR FIRST MI
NICKNAME LAST SUFFIX
ORIGINAL REPORT
TYPE
4
January 15
July 15
30th day before election
8th day before election
Other (specify)
_______________________________
Exceeded $500 limit
15th day after treasurer
appointment (officeholder only)
Runoff
THROUGH
Month Day Year Month Day Year
Other reports: 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.
Semiannual reports: I swear , or affirm, that the original report was
made in good faith and without an intent to mislead or to misrepre-
sent the information contained in the report.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
CORRECTION/AMENDMENT AFFIDAVIT
FOR CANDIDATE/OFFICEHOLDER
1
Filer ID (Ethics Commission Filers)
Total pages filed:
2
Signature of Candidate or Officeholder
OFFICE USE ONL Y
Date Received
Date Imaged
Receipt #
Amount $
Date Processed
Date Hand-delivered or Date Postmarked
FORM COR-C/OH
Page 1/2
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