Affidavit To Cease Dual Reporting Obligations

Texas Ethics Commission P.O. Box 12070 Austin, Texas 78711-2070 (512) 463-5800 (TDD 1-800-735-2989) Affidavit to Cease Dual Reporting Obligations Pursuant to Ethics Advisory Opinion No. 465 (2005) OFFICE USE ONLY Date Received (To be used ONLY by a non-judicial officeholder or former non-judicial candidate who is CURRENTLY a judicial candidate.) Name of Filer (First, MI, Last) Account # (TEC filers) Date Hand-delivered or Postmarked Date Processed Date Imaged This is notice that I will not be required to file a campaign finance report in connection with non-judicial activity because: (1) I do not maintain unexpended political contributions raised as a non-judicial candidate or officeholder. (2) I do not maintain unexpended interest or income earned from political contributions raised as a nonjudicial candidate or officeholder. (3) I do not retain assets purchased with political contributions raised as a non-judicial candidate or officeholder. (4) I do not retain assets purchased with interest or other income from political contributions raised as a non-judical candidate or officeholder. AFFIDAVIT I swear, or affirm, under penalty of perjury, that this statement is true and correct. Signature of Filer AFFIX NOTARY STAMP / SEAL ABOVE 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 Printed name of officer administering oath Title of officer administering oath www.ethics.state.tx.us Revised 02/22/2007 American LegalNet, Inc. www.FormsWorkFlow.com