Many software packages let you edit PDFs directly without ever converting it out of PDF; uncompressed PDFs can even be edited as text (and if there's no encrypt

Many software packages let you edit PDFs directly without ever converting it out of PDF; uncompressed PDFs can even be edited as text (and if there's no encryption, decompressing a compressed PDF is a simple task). But usually if you want complete control, without weird artifacts here and there, the easiest way is to completely recreate the document from scratch (depending on length and complexity of the original). The people you're sending the doctored version to, by definition don't have access to the original (or they would spot the fake), and usually can't compare the doctored version to a similar original document, and even if they could, probably won't. They want a document; you give them something that sort of looks like what they're expecting, and they're happy.