Affidavit For Committee-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 Date Received AFFIDAVIT FOR COMMITTEE: ELECTRONIC FILING EXEMPTION An exemption affidavit must be submitted with each paper report. A campaign treasurer of a political committee that 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 Hand-delivered or Date Postmarked Date Processed Date Imaged 1. I swear or affirm that the political committee of which I am the campaign treasurer has 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 the political committee of which I am the campaign treasurer does not use computer equipment to keep current records of political contributions, political expenditures, or persons making political contributions to the committee. 3. I further swear or affirm that no person acting as the committee's agent or consultant, and no person with whom the committee contracts, uses computer equipment to keep current records of political contributions, political expenditures, or persons making political contributions to the committee. 4. I further swear or affirm that I understand that I am required to file the committee's campaign finance reports electronically if the committee, the committee's agent or consultant, or a person with whom the committee contracts 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 the committee. 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 the committee is claiming an exemption from electronic filing. Signature of Campaign Treasurer 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