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CFC Form DOI Rev 09/2017 STATEWIDE/STATE LEVEL FILERS: File with Campaign Finance Commission COUNTY/MUNICIPAL: File with Local Filing Officer LOCAL FILING OFFICERS: eFax 1-[PHONE REDACTED] or eMail [EMAIL REDACTED] Georgia Government Transparency & Campaign Finance Commission 200 Piedmont Avenue S.E. I Suite 1416 - West Tower I Atlanta Georgia, 30334 DECLARATION OF INTENTION TO ACCEPT CAMPAIGN CONTRIBUTIONS (FORM DOI) INCOMPLETE FORMS WILL NOT BE PROCESSED • If form is handwritten, it must be legible. 1 Today’s Date: 2 Candidate (full name): Address: City, State, Zip: Telephone (optional): Email : 3 Select Office Type: Statewide State County Municipal Name of Office Sought or Held: (include district, post, or judicial circuit if applicable) 4 Next Election Year: Complete sections 5 and 6 ONLY if you have a campaign committee. This information does not register a campaign committee. (Please use Form RC to register.) 5 Campaign Committee Chairperson (full name): Address: City, State, Zip Email : 6 Treasurer (full name): Address: City, State, Zip Email : I CERTIFY THAT THIS STATEMENT IS COMPLETE, TRUE AND ACCURATE. Signature of Candidate Date Party Affiliation (optional): Democrat Non Partisan Republican Other SIGN