STATE OF GEORGIA
Georgia Government Transparency and Campaign Finance Commission
200 Piedmont Ave SE, Suite 1402-West Tower, Atlanta, GA 30334
AFFIDAVIT OF A CANDIDATE’S INTENT NOT TO EXCEED $2,500 IN
CONTRIBUTIONS AND/OR EXPENDITURES
Per O.C.G.A. §21-5-34(d)(d.1)(1),
_________________________________________ is a candidate for______________________
(Full Name of Candidate) (Office Sought)
in________________________________.
(City or County)
By completing this form, ____________________________________________ am swearing
(Full Name of Candidate/Chairman/Treasurer)
that ___________________________________________ qualified on ___________________________
(Full Name of Candidate) (Date Qualified)
for the above listed office in the above listed location and the election will be held on _______________.
(Date)
By submitting this form I am affirming that I, the above named candidate above do not intend to accept
during this calendar year a combined total of contributions exceeding $2,500.00 for the campaign nor
make a combined total of expenditures exceeding $2,500. If the above named candidate does not exceed
$2,500.00 in contributions or expenditures then the candidate SHALL not have to file a report under
O.C.G.A. §21-5-34 (c).
I understand that if I, the above named candidate, exceed the $2,500 limit for either accepting
contributions or making expenditures for such campaign during the calendar year of such qualifying, but
do not accept a combined total of contributions exceeding $5,000.00 or make expenditures exceeding
$5,000.00 then I, the above named candidate, SHALL be required to file only the June 30 and October 25
reports required by O.C.G.A. §21-5-34 (c) (2). The first of such reports shall include all contributions
received and expenditures made beginning January 1 of such calendar year.
Furthermore, I understand that if I, the above named candidate accept a combined total of contributions
exceeding $5,000.00 or make expenditures exceeding $5,000.00 during the calendar year of such
qualifying, then I, the above named candidate SHALL be subject to the reporting requirements of this
Code section the same as if the I had not submitted written notice on the date that I, the candidate for the
above office as if I, have not filed this affidavit on the date of qualifying.
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/Chairman/Treasurer filing Affidavit
My Commission expires on _________, _____________
Notary Seal
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