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
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:
EXPLANA TION OF CORRECTION
CANDIDA TE /
MS / MRS / MR FIRST MI
NICKNAME LAST SUFFIX
30th day before election
8th day before election
Exceeded $500 limit
15th day after treasurer
appointment (officeholder only)
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
Filer ID (Ethics Commission Filers)
Total pages filed:
Signature of Candidate or Officeholder
OFFICE USE ONL Y
Date Hand-delivered or Date Postmarked