Correction Affidavit for Political Committee
Revised 04/27/2015
Forms provided by Texas Ethics Commission
www.ethics.state.tx.us
Remember To Attach Any Part Of The Campaign Finance Report Form
Needed To Report And Explain Corrections
Check ONLY if applicable:
Signature of officer administering oath Printed name of officer administering Title of officer administering oath
AFFIX NOT ARY ST AMP / 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.
Semiannual report s: I swear, or af firm, that the original report was
made in good faith and without an intent to mislead or to
misrepresent the information contained in the report.
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.
Signature of Campaign Treasurer
8
AFFIDAVIT
2
CORRECTION/AMENDMENT AFFIDAVIT
FOR POLITICAL COMMITTEE
FORM
COR-PAC
OFFICE USE ONL Y
Date Processed
Receipt #
Date Hand-delivered or Date Postmarked
Amount $
Date Imaged
3
COMMITTEE NAME
TREASURER NAME
4
1
Filer ID (Ethics Commission Filers)
Total pages filed:
ORIGINAL REPORT
TYPE
5
January 15
Dissolution Report
Runoff
10th day after campaign treasurer
termination
Other (specify _________________________
July 15
30th day before election
8th day before election
THROUGH
Month Day Year Month Day Year
6
ORIGINAL PERIOD
COVERED
7
EXPLANA TION OF CORRECTION
Date Received
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