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CFC Form RC Rev 1/14 Filer ID: MAIL TO: Georgia Government Transparency and Campaign Finance Commission I 200 Piedmont Avenue S.E. I Suite 1402 - West Tower I Atlanta Georgia, 30334 Georgia Government Transparency & Campaign Finance Commission REGISTRATION FORM FOR A CANDIDATES CAMPAIGN COMMITTEE Any substantive changes to the registration information of a committee must be updated within 7 business days FORM RC INCOMPLETE FORMS WILL NOT BE PROCESSED • If form is handwritten, it must be legible. 1 Today’s Date: Select Form Type: Original Amended 2 Committee (Full Name): Address: City, State, Zip: Telephone Number (optional): Email: 3 Campaign Committee Chairperson (full name): Address: City, State, Zip: Email : 4 Treasurer (full name): Address: City, State, Zip: Email : 5 Candidate (full name): Address: City, State, Zip: Email : 6 Select Office Type: State County Municipal Name of Office Sought or Held: (include district, post, or judicial circuit if applicable) 7 Incumbent: Next Election Year: I CERTIFY THAT THIS STATEMENT IS COMPLETE, TRUE AND ACCURATE. Signature of Person Registering Committee Date Party Affiliation (optional): Democrat Non Partisan Republican Other