Affidavit for Direct Campaign Expenditure Report: Electronic Filing Exemption - Entity Page: 1

                                
Texas Ethics Commission     P.O. Box 12070     Austin, Texas 78711-2070    (512) 463-5800   (TDD 1 -800-735-2989)

AFFIDAVIT FOR
DIRECT CAMPAIGN EXPENDITURE REPORT:
ELECTRONIC FILING EXEMPTION - ENTITY
An exemption affidavit must be submitted with each paper report.
A person not acting in concert with another person who makes one or more direct campaign
expenditures that exceed $100 in an election from the person's own property must file
campaign finance reports as if the person were the campaign treasurer of a general
purpose political committee. These reports are required to be filed electronically unless
the person is eligible to claim the statutory exemption.
An entity filing a direct campaign expenditure report that has made more than $20,000 in
direct campaign expenditures in any calendar year must file all subsequent reports
electronically.
Filer name                                    Account #

1. I swear or affirm that the entity for which I am reporting direct campaign expenditures has not made
more than $20,000 in direct campaign expenditures in a calendar year.
2. I further swear or affirm that the entity for which I am reporting direct campaign expenditures does not
use computer equipment to keep current records of direct campaign expenditures.
3. I further swear or affirm that no person acting as the entity's agent or consultant, and no person with
whom the entity contracts, uses computer equipment to keep current records of direct campaign
expenditures.
4. I further swear or affirm that I understand that the entity's campaign finance reports are required to be
filed electronically if the entity, the entity's agent or consultant, or a person with whom the entity
contracts exceeds $20,000 in direct campaign expenditures in a calendar year, or uses computer
equipment to keep current records of direct campaign expenditures.
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
entity is claiming an exemption from electronic filing.
Name of Entity
Signature of Individual with
Authority to Sign on Behalf of Entity
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

OFFICE USE ONLY
Date Received
Date Hand-delivered or Date Postmarked
Date Processed
Date Imaged

Texas Ethics Commission

P.O. Box 12070     Austin, Texas 78711-2070

(512) 463-5800  (TDD 1-800-735-2989)

www.ethics.state.tx.us

Revised 05/29/2012