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AFFIDAVIT OF AN INCUMBENT NOT SEEKING REELECTION Georgia Government Transparency & Campaign Finance Commission 200 Piedmont Ave S.E. - Suite 1402 West Tower - Atlanta, GA 30334 Effective as of (Date of this filing) Full name of Candidate: Mailing Address: Telephone: Email: I, am an incumbent to the office of (Your Full Name) (Office Held) (City or County or State) By completing this form, I am swearing that I will not be qualifying for the Primary Election / General Election to (Circle One) be held on for the above listed elected office. (Date of election) By submitting this form I understand that I place myself in a non election year status and I am only required to file disclosure reports in accordance with the non election year file schedule as provided in the Act. I further understand if I am leaving office with excess funds I will continue to file reports until such funds are expended as provided in the Act. No Personal Financial Disclosure Statement filing is required. Furthermore, if I qualify for the above office after submitting this affidavit to the Commission then I MUST: Notify the Commission in writing of my decision. File delinquent reports required of a candidate for elected office. Pay any late filing fees related to my failure to file by the correct schedule. State of Georgia County of I, the undersigned, being duly sworn, do swear or affirm, certify and say that this affidavit and the information hereinabove is true, complete and correct to the best of my knowledge and belief. Sworn to and subscribed before me on Signature of Notary Public Signature of Candidate My Commission Expires on Notary Seal