HomeMy WebLinkAboutRegistration Form For A Compaign Committee For Use By CandidateSEC
Forth RC REGISTRATION FORM FOR A CAMPAIGN COMMITTEE
Year of Election:
Original
Rev 4/06 FOR USE BY CANDIDATE
Date of this Registration:
Amendment
Committee (Full Name): i'k� e4' &1 40"'4—
Candidate (Full Name): { 7 Se� IP , t c,, f U
Committee Address: 13405- &4m, Co
Candidate Address:
Telephone Number(s): ( f(y�� 5r ✓ f
Telephone Number(s):
j
Chairperson Name): `C';
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(Full t l%
Treasurer (Full Name):
Chairperson Address: ��+5 FxAti ey
Treasurer Address:
Give Name of Office Sought: (include district, post, or judicial circuit)
❑ State ❑County 10 Municipal
Party Affiliation (Optional):
❑Democrat ❑Republican E] Other or None
i
Name of Incumbent: � Y t � "'�
CA /
For Office Use
SIGNATURE OF CANbIDATE REGISTERING COMMITTEE
MAIL TO:
STATE ETHICS COMMISSION
205 JESSE HILL JR DR, SE
STE 478 - EAST TOWER
ATLANTA, GEORGIA 30334
CPTY CLERK
My OF I411I,TON