Affidavit For Candidate Or Officeholder-Electronic Filing Exemption

Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) OFFICE USE ONLY AFFIDAVIT FOR CANDIDATE OR OFFICEHOLDER: ELECTRONIC FILING EXEMPTION An exemption affidavit must be submitted with each paper report. A candidate or officeholder who has accepted more than $20,000 in political contributions or made more than $20,000 in political expenditures in any calendar year must file all subsequent reports electronically. Filer name Account # Date Received Date Hand-delivered or Date Postmarked Date Processed Date Imaged 1. I swear or affirm that I have not accepted more than $20,000 in political contributions or made more than $20,000 in political expenditures in a calendar year. 2. I further swear or affirm that I do not use computer equipment to keep current records of political contributions, political expenditures, or persons making political contributions to me. 3. I further swear or affirm that no person acting as my agent or consultant, and no person with whom I contract, uses computer equipment to keep current records of political contributions, political expenditures, or persons making political contributions to me. 4. I further swear or affirm that I understand that I am required to file my campaign finance reports electronically if I, my agent or consultant, or a person with whom I contract exceeds $20,000 in political contributions or political expenditures in a calendar year, or uses computer equipment to keep current records of political contributions, political expenditures, or persons making political contributions to me. 5. I am filing this affidavit with the __________________ report due on _______________________. I understand that this affidavit is required to be filed with each campaign finance report for which I am claiming an exemption from electronic filing. Signature of Candidate or Officeholder 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 Print name of officer administering oath Title of officer administering oath FILERS WHO ARE EXEMPT FROM THE ELECTRONIC FILING REQUIREMENT ARE STILL REQUIRED TO FILE CAMPAIGN FINANCE REPORTS ON PAPER www.ethics.state.tx.us Revised 02/22/2007 American LegalNet, Inc. www.FormsWorkFlow.com