A guide to the Ethics in government Act for filing officers [1994]

FILING OFFICER DEFINED

A filing officer is that official who is designated to receive Campaign Contribution Disclosure Reports and Financial Disclosure Statements and is identified as follows:

a. State Level Election

Secretary of State

b. County Level Election

Election Superintendent/Probate Judge

(In any county in which the county board of elections does not maintain an office open to the public during normal business hours for five days a week, the reports required by this Code Section shall be filed in the office of the judge of the probate court of that county.)

c. Municipal Level Election Municipal Clerk or Chief Executive Officer

DUTIES OF THE FILING OFFICER
1. DISTRIBUTE DISCLOSURE REPORT FORMS.
The filing officer shall forward copies of the reporting forms required by the Code to each candidate or public officer holding elective office within a reasonable time prior to each filing.
2. INSPECT REPORTS AND NOTIFY THE PERSONS OF TECHNICAL VIOLATIONS. The filing officer shall inspect each report filed by public officers, candidates or campaign committees and notify persons immediately if the report: a. does not conform with the law b. is unsigned, or c. is in technical violation of filing requirements
3. NOTIFY THE COMMISSION THAT ALL PERSONS HAVE FILED OR OF THOSE PERSONS FAILING TO FILE.
A report to the State Ethics Commission is due within ten days after the reporting period for candidates or public officials
The information given by the filing officer on the STATEMENT OF FILING report should indicate that:
A. 1 ALL CANDIDATES, PUBLIC OFFICERS HAVE FILED DISCLOSURE REPORTS. B. 1 ALL CANDIDATES, PUBLIC OFFICERS HAVE NOT FILED DISCLOSURE
REPORTS. All persons who fail to timely file the required reports or statements should be listed on page 2 of the statement along with their mailing addresses. FORM USED: Statement #2 for Campaign Contribution Reports
Statement #5 for Financial Disclosure Statements
AUTOMATIC LATE FILING FEES
EACH CANDIDATE OR PUBLIC OFFICER WHO FILES A CAMPAIGN CONTRIBUTION DISCLOSURE REPORT NOT FILED OR POST MARKED AS OF THE REQUIRED FILING DATE SHALL PAY A LATE FILING FEE OF $25.00. AN ADDITIONAL LATE FILING FEE OF $50.00 SHALL BE IMPOSED ON THE FIFTEENTH (15) DAY AFTER THE DUE DATE IF THE REPORT HAS STILL NOT BEEN FILED. Checks should be made payable to the State Ethics Commission and forwarded to State Ethics Commission office.

4. NOTIFY THE COMMISSION OF CANDIDATES QUALIFYING FOR SPECIAL ELECTIONS. The filing officer shall notify the State Ethics Commission in writing of the names of all candidates and offices sought in a special election, when held at a time other than election dates scheduled by law or charter. This report is due within ten days of the close of the qualification period. FORM USED: Statement #1 for special elections
5. NOTIFY THE COMMISSION THAT ALL COMMITTEES HAVE FILED OR HAVE NOT
FILED REPORTS DUE FOR RECALL ELECTIONS OR IN OPPOSITION TO RECALL ELECTIONS. A. [ ] ALL CAMPAIGN COMMITTEES HAVE FILED DISCLOSURE REPORTS.
B. r ] ALL CAMPAIGN COMMITTEES HAVE NOT FILED DISCLOSURE REPORTS
FOR THE REPORTING PERIOD SHOWN. All persons who fail to timely file the required reports should be listed on page 2 of the statement. FORM USED: Statement #4 for reporting of recall committees.
6. NOTIFY THE COMMISSION THAT ALL COMMITTEES FORMED TO INFLUENCE VOTER APPROVAL OR REJECTION OF A PROPOSED CONSTITUTIONAL AMENDMENT, STATEWIDE REFERENDUM OR ANY PROPOSED QUESTION ON THE BALLOT IN ANY COUNTY OR MUNICIPAL ELECTION. HAVE OR H AVE NOT FILED. A. [ ] ALL CAMPAIGN COMMITTEES HAVE FILED DISCLOSURE REPORTS B. [ ] ALL CAMPAIGN COMMITTEES HAVE NOT FILED DISCLOSURE REPORTS. All persons who fail to timely file the required reports should be listed on page 2 of the statement. FORM USED: Statement #3 for reporting of amendments, referendums or ballot questions.
7. MAINTAIN REPORTS FOR PUBLIC INSPECTION All reports are to be made available for public inspection and copying during regular office hours. No identification is required by persons wishing to inspect the reports. a. A fee may be charged for copying of such reports. The fee must not exceed the actual cost of reproduction. b. The reports must be preserved for a period of five years from the date they are received.
8. FORWARD COMPLAINTS TO THE COMMISSION The filing officer shall immediately notify the State Ethics Commission upon receiving a sworn, written complaint against a public officer, candidate or campaign committee or other person and shall forward the complaint to the Commission and retain a copy of the complaint. In the event any complaint is against a county or municipal public officer, candidate or campaign committee, a copy of the reports filed by such persons shall be forwarded to the Commission along with the complaint.
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DECLARATION OF INTENTION TO ACCEPT CONTRIBUTIONS
Candidates who are not public officers are required to file a Declaration of Intention to Accept Campaign Contributions prior to accepting contributions. The Declaration of Intention to Accept Campaign Contributions registration requires the disclosure of names and addresses of campaign committee officers, if there is a campaign committee, as well as the name and address of the candidate.
a. Candidates for State office file with the Secretary of State. b. General Assembly candidates and county candidates file with the Superintendent of
Elections/Probate JUdges. c. Municipal candidates file with the City Clerk or designated filing officer of the city. NOTE: Candidates who are already public officers at the time of their candidacy do not
have to file a declaration of intention to accept campaign contributions. FORM USED: Form-DOl - Declaration of Intention To Accept Campaign Contributions
REGISTERING CAMPAIGN COMMITTEES
Candidates having a campaign committee must register the Committee with the Secretary of State before accepting funds. Registrations shall remain in effect for the candidate's term of office unless the registration is cancelled or changed.
FORM USED: Form R.C. - Registration for candidate's campaign committee Organizations, committees or persons who accept contributions for, make contributions to, or make expenditures on behalf of candidates will register with the Secretary of State.
FORM USED: Form R.O. - Registration form for a non-candidate committee

CAMPAIGN CONTRIBUTION DISCLOSURE REPORTS

1. WHO IS REQUIRED TO FILE

a. Candidates or campaign committees for the following offices:

STATE:

Office of Governor, Lieutenant Governor, Attorney General, Secretary of State, Commissioner of Insurance, Commissioner of Agriculture, State School Superintendent, Commissioner of Labor and Public Service Commissioners, District Attorney, Members of the Georgia House of Representatives and Georgia Senate and all Constitutional and Judicial Officers.

COUNTY: All elected county officials.

MUNICIPAL: All municipal elected officials.

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b. Any organization, committee or person which accepts contributions or makes expenditures designed to bring about the recall or oppose the recall of a public officer.
c. Any organization, committee or person which accepts contributions or makes expenditures designed to influence voter approval or rejection of a proposed constitutional amendment or a statewide referendum provided the organization, committee or person has received contributions which total more than $500.00 or if such organization, committee or person has made expenditures which total more than $500.00.
d. Any organization, committee or person which accepts contributions or makes expenditures designed to bring about the approval or rejection by the voters of any proposed question in any county or municipal election. Such reports shall be required, however, only if the organization, committee or person has received contributions which total more than $500.00 or if such organization, committee or person has made expenditures which total more than $500.00.
e. Any organization, committee or person which accepts contributions for, makes contributions to, or makes expenditures on behalf of two or more candidates and the aggregate exceeds $500.00.
f. Any corporation, association or partnership or other entity which makes contributions to more than one candidate and the aggregate exceeds $500.00.

2. WHEN REPORTS ARE FILED

a. GENERAL PRIMARY
Three reports are filed surrounding the primary (if there is no runoff)

FIRST REPORT Due:
Who files:

45 days before primary All candidates in the primary election

SECOND REPORT Due: 15 days before primary election
Who files: All candidates in primary election

THIRD REPORT Due: 10 days after primary election
Who files: All candidates regardless of whether they won or lost the election

IN CASE OF RUNOFF Due: 6 days prior to runoff election
Who files: All candidates in primary runoff election

b. GENERAL ELECTIONS AND SPECIAL ELECTIONS

(If there is no primary, reporting begins at this stage)

REPORT Due:
Who files:

15 days prior to general election
All candidates in the general election. All candidates in the special election

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IN CASE OF RUNOFF

Due: 6 days prior to runoff election

Who files:

All candidates in general runoff election. All candidates in special runoff election

c. FINAL END OF YEAR REPORT (WHEN AN ELECTION HAS BEEN HELD)

Due: No later than December 31 of election year

Who files:

All candidates in primary election, special election, general election and all runoff elections regardless of whether they won or lost

d. FINAL END OF YEAR SUPPLEMENTAL REPORT (WHEN THERE IS NO ELECTION) Due: No later than December 31 of each year that office is held
Who files: All elected public officials

NOTE: All candidates shall have a five day grace period in filing the required reports except the Final Year End/Supplemental Year End report which shall have a fifteen day grace period. Runoff elections are also an exception.
In run off elections candidates shall have a two day grace period in filing the reports and should the run off election be scheduled on a Wednesday then the grace period shall end the Friday preceding the election.

ADDITIONAL FILING REQUIREMENTS
Candidates for or members of the General Assembly file their original report with the filing officer in the county in which they reside and a copy with the Secretary of State.
Any person elected to a public office who is required to file campaign contribution disclosure reports will, upon leaving public office with excess contributions, file a supplemental campaign contribution disclosure report no later than December 31 of each year until all contributions are expended in a campaign for elective office or used as provided in the Act.
Any unsuccessful candidate in an election who is required to file campaign contribution disclosure reports and has excess contributions from the campaign, will file a supplemental campaign contribution disclosure report no later than December 31 of each year until such contributions are expended in a campaign for elective office or used as provided in the Act.
Any unsuccessful candidate in an election who was required to file campaign contribution disclosure reports and who received contributions following the election to retire debts incurred in the campaign, will file a supplemental campaign contribution disclosure report no later than December 31 of each year until such unpaid campaign debts are satisfied.

EXCEPTION TO FILING REQUIREMENTS
Any candidate covered by the provisions of this act who has no opposition in either the primary or general election and received no contributions of $101.00 or more shall only be required to make the initial and final reports as required under the provisions of this Act.

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e. RECALL ELECTIONS
All committees formed to recall a public official or to oppose the recall of a public official must first register with the Secretary of State.
A separate committee must be registered for each person sought to be recalled, and a separate committee must be registered to oppose the recall of each person who is the object of a recall effort. Reports must be filed separately as well.

FORM USED: Form RO (To register a Committee)

WHERE TO FILE:

All reports are filed with the Secretary of State with a copy to the filing officer in the county or municipality where the recall is held.

FORM USED: 1a (To file Disclosure Reports)

Four reports are filed surrounding a Recall election

FIRST REPORT Due:
Who file:

Within 15 days after the date when the official recall petition forms were issued to the sponsors.
Committees formed to recall elected public official. Committees formed to oppose the recall of a public official

SECOND REPORT Due:
Who file:

45 days after filing of the first report All persons who registered

THIRD REPORT Due:
Who files:

20 days after the expiration date for acquiring signatures on the recall petition
All persons who registered

FOURTH REPORT Due:
Who files:

Final report filed prior to December 31 , of the year in which the recall election is held, if election is not held, prior to December 31 of any year contributions are accepted or expenditures made.
All persons who registered

f. ELECTION FOR PROPOSED CONSTITUTIONAL AMENDMENTS, STATEWIDE REFERENDUM OR ANY PROPOSED QUESTION APPEARING ON BALLOT IN ANY COUNTY OR MUNICIPAL ELECTION
All committees formed to promote or oppose any proposed constitutional amendments, Statewide referendum or any proposed question on ballot in any county or municipal election must register with the Secretary of State.
FORM USED: Form RO
WHERE TO FILE: Secretary of State

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Two reports are filed surrounding any constitutional amendments, statewide referendum or any ballot question.
FORM USED: Form 1d
WHERE TO FILE: Constitutional amendments, statewide referendums are filed with the Secretary of State.
County amendments, referendums or ballot questions are filed with the County Election SuperintendenVProbate Judge.
Municipal amendments, referendums or ballot questions are filed with the municipal clerk/chief executive.
REPORTS FILED Two reports are filed surrounding the amendments, referendum or ballot questions.

FIRST REPORT Due:
Who files:

15 days prior to date of election All organizations, committees or person whose contributions or expenditures exceed $500

SECOND REPORT Due:
Who files:

Final report due prior to December 31 of the year in which the election is held All organizations, committees or person whose contributions or expenditures exceed $500

FINANCIAL DISCLOSURE STATEMENT
The Financial Disclosure Statement is a form designed to disclose significant private interests of candidates and public officials which may influence the discharge of their public duties and responsibilities. It is the right of the general public to be aware of these interests. The Financial Disclosure Statement covers the preceding calendar year. There is no grace period for the filing of the Financial Disclosure Statement. The filing officer shall review each financial disclosure statement to determine that such statement is in compliance with the requirements of the law. Form Used: Financial Disclosure Statement (FD)
1. WHO IS REQUIRED TO FILE STATEMENT a. Every constitutional officer b. Every elected state official c. Executive heads of each state department or agency, whether elected or appointed d. Each member of the General Assembly e. Executive director of state boards or authorities and the members thereof f. Every elected county official, every elected county or area superintendent, and every elected member of a county or area board of education g. Every elected municipal official

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2. WHEN STATEMENTS ARE FILED CANDIDATES a. Candidates for statewide office No later than 7 days after qualifying as candidate b. Candidates for General Assembly No later than 15 days after qualifying as candidate c. Candidates for County and Municipal office No later than 15 days after qualifying as candidate d. Candidates in Special Elections File the same as candidates in regular elections
PUBLIC OFFICERS a. Public officers - statewide and general assembly
Not before the first day of January nor later than July 1 of each year in which the public officer holds office b. Public officers - County Not before the first day of January nor later than July 1 of each year in which the public officer holds office c. Public officers - Municipal Not before the first day of January nor later than July 1 of each year in which the public officer holds office
3. WHERE TO FILE STATEMENTS a. Each public officer and candidate listed below files with the Secretary of State. 1. Every constitutional officer 2. Every elected state official 3. Executive head of every state department or agency, whether elected or appointed 4. Each member of the General Assembly 5. Executive director of each state board or authority and the members thereof b. Each public officer and candidate listed below files with the Election Superintendent of the county of election. 1. Elected County Public Officials 2. Candidates for County Office c. Each public officer and candidate listed below files with the municipal clerk of the municipality of election. 1. Elected Municipal Public Officials 2. Candidates for Municipal Office NOTE: Exception to filing A public officer shall not be required to file a financial disclosure statement for the preceding calendar year in a year in which there occurs qualifying for election to succeed the public officer, if the public officer does not qualify for nomination for election for any public office. A public officer shall not be deemed to hold office in a year in which the public officer holds office for less than 15 days.
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REPORTING FORM USED BY FILING OFFICERS

There are five statements of filing that filing officers use to report the filing of disclosures or other election information.

These statements are printed in different colors to help distinguish them from each other. Tney are also numbered to give them a name but are not used in numerical order.

STATEMENT OF FILING #1 Used to report special elections COLOR: Yellow

STATEMENT OF FILING #2

Used to report the filing of disclosures for several reporting periods.

COLOR: Blue

Primary elections

General or special election

45 Days before primary 15 Days before primary 10 Days after primary 6 Days before primary runoff

15 Days before general or special election 6 Days before general or special election runoff

NOTE: Most cities have no primary elections. Therefore the first reporting period will be - 15 Days before the general or special election.

Final Year End

No later than December 31 of election year (Year in which elections occur)

Supplemental report due no later than December 31 of each non election year (Year in which no election occurs only public officers file)

STATEMENT OF FILING # 3
Used to report the filing of disclosure reports in connection with Proposed Constitutional Amendments, Statewide Referendums or any Proposed Question appearing on Ballot in any County or Municipal Election.
COLOR: Green

STATEMENT OF FILING # 4
Used to report the filing of disclosure reports in connection with the Recall of Public Officer and Opposition to Recall of Public Officer.
COLOR: Pink

STATEMENT OF FILING # 5 Used to report the filing of Financial Disclosure Statements COLOR: White

ON THE FOLLOWING PAGES ARE EXAMPLES OF THE STATEMENTS OF FILING LISTED ABOVE:

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STATEMENT OF FILING #1

The primary purpose of this statement is to make the State Ethics Commission aware of the fact that a Special Election is to be held and to list the names of the candidates in a special election.

Please fill out all sections and sign the statement.

S.E.C Form Sl 9/90

COLOR JS YELLOW
STATE ETHICS COMMISSION 2082 East Exchange Place Suite 235 Tucker, Georgia 30084 (404) 414-3450

SPECIAL ELECTIONS ONLY
Statement of Filing #1
This statement is, by Ga. law, to be filed by all filing officers and is due in the State Ethics Commission office within ten (10) days after qualification period in a SPECIAL ELECTION.

Date:

_ County:

_

FROM: (Check One) City:

Election Superintendent 0

Probate Judge

0

Zip Code:

_

Municipal Clerk

0

Secretary of State

0

Telephone:

SIGNATURE OF FILING OFFICER:

_

The following are CANDIDATES who have qualified for the SPECIAL Election.

To Be Held On: Close of Qualifying Period Was:

Dale of Special Election

NAME OF OFFICE QUALIFIED FOR:

NAME OF QUALIFYING CANDIDATE:

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STATEMENT OF FILING #2

Check the reporting period that the statement represents under "This statement is for"

Please fill out all sections and sign the statement.

Be sure to check either A (persons have filed) or B (All persons have not filed)

Page 2 is used to list only the names of those persons who have not filed.

SE.C Form S2 9190

COLOR IS BLUE
STATE ETHICS COMMISSION 2082 East Exchange Place Suite 235 Tucker, Georgia 30084 (404) 414-3450

Statement of Filing #2

This statement is to be filed by ALL FILING OFFICERS (Probate Judges, Election Superintendents, Municipal Clerks and the Secretary of State).

It is to be mailed to the State Ethics Commission office within TEN (10) DAYS after each disclosure report is due.

CAMPAIGN CONTRIBUTION REPORTS of the candidates are kept by the Wing officer in his/her office on public record.

Date:

_

County:

_

Date of Election:

_

City: FROM: (Check One)

Election Superintendent ::J

Zip Code:

_

Probate Judge

::J

Municipal Clerk

0

Secretary of State

0

Telephone:

SIGNATURE OF FILING OFFICER:

_

THIS STATEMENT IS FOR:

o 45 days before primary election o 15 days before primary election o 10 days after primary election o 6 days before primary runoff election

o 6 days before general runoff or special
runoff election
o no later than December 31 of election year o Supplemental report filed by office holder

::I 15 days before general or special election

December 31 of each off election year

A. u ALL CANDIDATES/PUBLIC OFFICERS HAVE FILED DISCLOSURE REPORTS.

* B. u ALL CANDIDATES/PUBLIC OFFICERS HAVE NOT FILED DISCLOSURE REPORTS FOR:

o primary election
:I general election
o special election

:I primary runoff election
o special runoff election o general runoff election

ELECTION TO BE HELD

------

'List only those candidates/public officers who have not filed on page 2.

o NO ELECTION WILL BE HELD FOR THIS

0 COUNTY THIS YEAR.
o CITY

11

STATEMENT OF FILING #2
Page 2 of Statement #2 To list only the names of those persons who have not filed.
COLOR IS BLUE

NAME OF OFFICE 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
I
I

STATEMENT OF FILING #2 (continued)
(Complete) CANDIDATES NAME AND ADDRESS
Name Address

Phone: (H)

(0)

Name

Address

Phone: (H)

(0)

Name

Address

Phone: (H)

(0)

Name

Address

Phone: (Hl

(Ol

Name

Address

Phone: (H)

(0)

Name

Address

Phone: (H)

(0)

Name

Address

Phone: (H)

(0)

Name

Address

Phone: (H)

(0)

Name

Address

Phone: IHI

(0)

Name

Address

Phone: (HI

10\

Check One OPPOSED UNOPPOSED

12

STATEMENT OF FILING #3

Please fill out all sections and sign this statement.

Check the reporting period that the statement represents under "This statement is for:"

Be sure to check either A (persons have filed) or B (All persons have not filed)

Page 2 is used to list only the names of those persons who have not filed.

COLOR IS GREEN

:'.E.L:.
FORM S3 1/88

ETHICS IN GOVERNMENT ACT

STATEMENT OF FILING NO.3

This statement is to be filed by FILING OFFICERS when reporting CAMPAIGN CONTRIBUTION DISCLOSURE REPORTS filed by campaign committees formed to influence voter approval or rejection of a PROPOSED CONSTITUTIONAL AMENDMENT, A STATEWIDE REFERENDUM OR ANY PROPOSED QUESTION on the ballot in any county or municipal election.
This statement is to be mailed to the State Ethics Commission, 2082 East Exchange Place, Suite 235, Tucker, Ga. 30084, within TEN (10) DAYS after each disclosure report is due.
CAMPAIGN CONTRIBUTION REPORTS OF THE CAMPAIGN COMMITTEES are kept by the appropriate filing officer in his/her office on public record.

Date:

_

FROM: (Check one)

Election Superintendent Probate Judge Municipal Clerk Secretary of State
SIGNATURE OF FILING OFFICER:

County:

_

City:

_

Zip Code:

_

Telephone:

_

___

IDENTIFY THE AMENDMENT, REFERENDUM OR QUESTION WHICH APPEARS ON THE BALLOT.

DATE OF ELECTION :

_

This statement is for: (Check appropriate box) Report due 15 days prior to date of election. Final report due prior to December 31 of year election is held.

!A.

ALL CAMPAIGN COMMITTEES HAVE FILED DISCLOSURE REPORTS

r'I *[

ALL CAMPAIGN COMMITTEES HAVE NOT FILED DISCLOSURE REPORTS

I

* List on page 2 all Campaign Committees who have not filed.

13

STATEMENT OF FILING #3
Page 2 of Statement #3 To list only the names of those persons who have not filed.
COLOR IS GREEN

,ORM S3

PAGE 2

STATEMENT OF FILING # 3 (Continued)

NAME OF COMMITTEE :

_

NAME OF CHAIRPERSON'

_

ADDRESS ,

_

TELEPHONE: (HOMEI

(OFFICE)

_

NAME OF COMMITTEE ,

_

NAME OF CHAIRPERSON'

_

ADDRESS'

_

TELEPHONE, (HOME)
NAME OF COMMITTEE: NAME OF CHAIRPERSON, ADDRESS ,

(OFFICE)

_

_ _ _

TELEPHONE: (HOMEI
NAME OF COMMITTEE , NAME OF CHAIRPERSON: ADDRESS ,

(OFFICE)

_

_ ___
_

TELEPHONE: (HOME)
NAME OF COMMITTEE' NAME OF CHAIRPERSON: ADDRESS:

(OFFICEI

_
_ _ ___

TELEPHONE, (HOME)
NAME OF COMMITTEE' NAME OF CHAIRPERSON , ADDRESS '

(OFFICE)

___ ___ _

TELEPHONE: (HOME)

(OFFICE)

_

14

STATEMENT OF FILING #4

Please fill out all sections and sign this statement.

Check the reporting period that the statement represents under "This statement is for"

Be sure to check either A (persons have filed) or B (All persons have not filed)

Page 2 is used to list only the names of those persons who have not filed.

COLOR IS PINK

S.E.C.
FORM S4 1/88

ETHICS IN GOVERNMENT ACT STATEMENT OF FILING NO.4

This statement is to be filed by FILING OFFICERS when reporting CAMPAIGN CONTRIBUTION DISCLOSURE REPORTS filed by campaign committees formed to bring about or oppose the RECALL OF A PUBLIC OFFICER.

This statement is to be mailed to the ~tate Ethics Commission, 2082 East Exchange Place, Suite 235, Tucker, Ga. 30084 within TEN (10) DAYS after each disclosure report is due.

CAMPAIGN CONTRIBUTION REPORTS OF THE CAMPAIGN COMMITTEES are kept by the appropriate filing officer in his/her office on public record.

=========================z=a=====.z=~===_=====================~==.==

Date:

_

County:

_

FROM: (Check One)

City:

_

Election Superintendent Probate Judge Municipal Clerk Secretary of State

Zip code:

__

Telephone:

_

SIGNATURE OF FILING OFFICER.:.:

_

Name of Public Officer ana Office held:

Name'

_

Office Held'

__

This statement is for: (Check appropriate box)
Initial report filed within 15 days of the date when the official recall petition forms were issued to the sponsors. Second report filed 45 days after the filing of the initial report. Third report filed within 15 days after the expiration date for acquiring signatures on the recall petition. Final report due prior to December 31 of year election is held, or if election is not held, prior to December 31 of any year contributions are accepted or expenditores made.

A.

ALL CAMPAIGN COMMITTEES HAVE FILED DISCLOSURE REPORTS.

B. * [ ALL CAMPAIGN COMMITTEES HAVE NOT FILED DISCLOSURE REPORTS
FOR THE REPORTING PERIOD SHOWN ABOVE.

L1.st on page a campa1.gn comm1.ttees w 0 ave no 1. e .

15

STATEMENT OF FILING #4

Page 2 of Statement #4

To list only the names of those persons who have not filed.

COLOR IS PINK

FOr-M S4

PAGE 2
STATEMENT OF FILING # 4 (Continued)

NAME OF COMMITTEE :

_

NAME OF CHAIRPERSON :

_

ADDRESS :

_

TELEPHONE: (HOME)
NAME OF COMMITTEE: NAME OF CHAIRPERSON: AODRESS:

(OFFICE)

_

_ _
_

TELEPHONE: (HOME)
NAME OF COMMITTEE: NAME OF CHAIRPERSON : ADDRESS :
TELEPHONE: (HOME)
NAME OF COMMITTEE : NAME OF CHAIRPERSON : ADDRESS :

(OFFICE)

_

_ _
_

(OFFICE)

_

_ _ _

TELEPHONE: (HOME)
NAME OF COMMITTEE: NAME OF CHAIRPERSON : ADDRESS:

(OFFICE)

_

_ _ _

TELEPHONE: (HOME)
NAME OF COMMITTEE : NAME OF CHAIRPERSON : ADDRESS:
TELEPHONE: (HOME)

(OFFICE)

_

-""''--

_

_

_

(OFFICE)

_

16

STATEMENT OF FILING #5
Please fill out all sections and sign this statement.
Check the reporting period that the statement represents under "This statement is for" Be sure to check either A (persons have filed) or B (All persons have not filed)
Page 2 is used to list only the names of those persons who have not filed.
COLOR IS WHITE
S.E.C. FORMS5 10192

ETIDCS IN GOVERNMENT ACT

STATEMENT OF RLING NO.5

This stalement is to be filed by FILING OFFICERS when reporting f1NANCIAL DISCLOSURE STATEMENTS filed by PUBLIC OFFICERS and CANDIDATES FOR PUBLIC OFFICE.
This stalement is to be mailed to the Stale Ethics Commission. 2082 East Exchange Place. Suite 235. Tucker. Ga 30084. within TI:N (10) DAYS after each f1NANCIAL DISCLOSURE STATEMENT is due.
f1NANOAL DISCLOSURE STATEMENTS are kepi by the appropriate filing officer in hislher office on public record.

Date:

_

FROM: (Oleck one)

Election Superintendent [l

Probate Judge

[1

Municipal Oerk

[1

Secretary of State

[1

SIGNATIJRE OF FILING OFFICER:

County:

_

City:

_

Zip code:

_

Telephone:

_

This statement is for. (Check appropriate box)
[l Public officers holding office [I Candidates for public office [J Candidates for public office qualifying after first day July

A. [] ALL PUBLIC OFFICERS/CANDIDATES FOR PUBLIC OFFICE HAVE fll.EP f1NANCIAL
DISCLOSURE STATEMENTS.
B.*[] ALL PUBLIC OFFICERS/CANDIDATES FOR PUBLIC OFFICE HAVE NOT FILED FINANCIAL
DISCLOSURE STATEMENTS FOR THE REPORTING PERIOD SHOWN ABOVE.
* List OIl page 2 all Public Officers!Candidates for Public office who have not filed.
17

STATEMENT OF FILING #5

Page 2 of Statement #5

To list only the names of those persons who have not filed.

COLOR IS WHITE

#5 PUBLIC OFHCERS/CANDIDATES FOR PUBLIC OFFlCE
(Furnish complete informauon requested below)

NAME & ADDRESS
~ame:
r--' Address:
Name: Address:
l-
Name:
I Address:

TELEPHONE NUMBER

I

I

Home:

(

l

Office

(

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Home:

(

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I Office

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Office

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OFFlCESOUGHT/HELD
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Home:
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18

INDEX OF REPORT FORMS
1. The Georgia Ethics in Government Act as it Applies to Candidates and Public Officers. (MC) This manual is for candidates, candidate's committees and pUblic officers.
2. The Georgia Ethics in Government Act as it Applies to Organizations, Committees or Persons Influencing Elections of Public Officers, the Recall of Public Officers, Proposed Constitutional Amendments, Statewide Referendums, or Local Ballot Questions. (MO) This manual is for Organizations and Non-Candidate Committees.
3. Declaration of Intention to Accept Campaign Contributions (DOl) Filed by candidates not in office to declare their candidacy for office before accepting contributions.
4. Registration Form for a campaign committee. (RC) Filed by candidates to register a campaign committee with the Secretary of State.
5. Registration Form for a Non-Candidate Campaign Committee. (RO) Filed by Organizations and Non-Candidate Committees.
6. PR-1 Campaign Contribution Disclosure Report. Long Form (more than 6 entries) mainly used by State and County Candidates, Public Officers, and Organizations or Non-Candidate Committees.
7. SF-Campaign Contribution Disclosure Report. Short Form (six entries or less) mainly used by municipal candidates and public officers.
8. FD-Financial Disclosure Statement Filed once a year by all candidates, elected pUblic officials and others designated by the Act.
9. 1a-Campaign Contribution Disclosure Report for Recall or Opposition to Recall Election. Filed by committees who wish to recall officials or who wish to oppose the recall of officials.
10. 1d-Campaign Contribution Disclosure Report for/against Proposed Constitutional Amendment, Statewide Referendum or any Proposed Ballot Question in any County or Municipal election. Filed by committees formed to influence the outcome of Constitutional Amendments, Statewide Referendums or any Ballot Questions.
11. Lobbyist Report Form. Lobbyists whose reports contain expenditures relating to county affairs will file with the County Filing Officer. Lobbyists whose reports contain expenditures relating to municipal affairs will file with the Muncipal Filing Officer.
12. Complaint Form. Against any person charging a violation or knowing failure to comply with provisions of the Ethics in Government Act.
THE FOLLOWING PAGES CONTAIN EXAMPLES OF REPORT FORMS USED BY: CANDIDATES, PUBLIC OFFICIALS, ORGANIZATIONS AND NON-CANDIDATE COMMITTEES
NOTE: These report forms are for the purpose of identification only and are subject to revisions as required by changes in the Ethics in Government Act.
19

Manual of instruction to be used by candidates, candidate committees, and public officers. (Me)
Tim GEORGIA. Enncs IN Gol'ERNMEM' Acr
AS IT APPLIES TO CANDIDATES AND PuuUC OFFICERS
L~S'I1UTcnossos PREPARATIOS OF CA...~IPAIGS CO~"I1UDrnOSDISCWSIRE REPORTS FOR CA...''DIDATLfj SEEIiL~G STATE, COI~"IT OR MI~'1CIPAL
ELECl'ED OFFICE L~ GEORGIA A..''D
FL~~CL\L DISCWSlRE STAT&~IE.'TS FILED DY PrDue OFFICERS A...''D CA..''DIDATES SEEKL~G Pt'Bue OFFICE
"'"IIUSHED BY DIE "'TATE EDlU'S ro'L'IIS."IO~
20

Manual of instruction to be used by organizations, committees or persons influencing elections of public officers, recall of public officers, proposed constitutional amendments, statewide referendums, or local ballot questions. (MO)
THE GEORGIA ETHICS IN GOVERNMENT ACT AS IT APPLIES TO ORGANIZATIONS, COMMITTEES OR PERSONS
INFLUENCING ELECTIONS OF PUBLIC OFFICERS, THE RECALL OF PUBLIC OFFICERS, PROPOSED CONSTITUTIONAL
AMENDMENTS, STATEWIDE REFERENDUMS, OR LOCAL BALLOT QUESTIONS
INSTRUCTIONS ON PREPARATION OF CAMPAIGN CONTRIBUTION DISCLOSURE REPORTS REQUIRED TO BE FILED BY ORGANIZATIONS, COMMITTEES OR PERSONS
PUBLISHED BY THE STATE ETHICS COMMISSION
21

Declaration of Intention to Accept Campaign Contributions filed by persons not already in office to authorize them to legally accept campaign contributions to finance running for public office. (001)

SE.C Form 001

DECLARATION OF INTENTION TO ACCEPT CAMPAIGN CONTRIBUTIONS

Year of Election:
Date 01 thIS f,ling

CANDIDATE: (Full Name)

Campaign Commillee Chairperson: (Full Name)

Address:

Address:

Telephone Number(s): Area Code
Give Name of Office Sought 0 State (include distnct, post, or ludicial circUit)

n County

n Municipal

I For OnlCe Use Only

I

Telephone Number(s): Area Code Treasurer (Full Name) Address
Signature of C.ndidat&

FROM:

_

Place Stamp Here

22

Registration card for campaign committee (filed by candidate) (RC)

SEC Form RC 3 87

year of Election

REGISTRATION FORM FOR A CAMPAIGN COMMITTEE [ Date of thiS, '-,-

FOR USE BY CANDIDATE

__

registration

Committee (Full Name)

Candidate (Full Name)

Address

Address:

Telephone Number(s)' ~~ea Code
Chairperson (Full Name)
Address:

Telephone Numberls): Area Code
Treasurer (Full Name)
Address-

------------------------------

Give Name of Office Sought

o State (Include district. post. or JudICial CirCUIt) o County

o Municipal

-===============

[--~-~~-----~ For Office Use Only

_
_
Signature of Candidate registering committee

FROM

_

To: SECRETARY OF STATE 110 STATE CAPITOL ATLANTA. GEORGIA 30334

Place Stamp Here

23

Registration card for non-candidate committees (RO)

SEC
'onn""
8107

REGISTRATION FORM FOR A CAMPAIGN COMMmEE OTHER THAN CANDIDATE

TyQl of CpmmiUBB' (Check one)

o Recall Election Name Public OIlicBr

[] Organizafion or PRrson ofher

& OIlice Held

than Candidate's Campaign

Year of Election: Date ofthi. registration: CommitteB: (FUll Name)

Committee
o Const~utional Amendment

Address:

or Statewide Referendum
Chairperson: (Full Name) Addres.:

-_ .._.[] County or Municipal Ballot Question

TelephonB Number(s):
Area CodB Treasurer:
I(Full Name)
Address:

I] Onginal [] Amendment

~lilnaturB of Person RBgistering Campaign CciinmittBe

FOR OFFICE USE<:lNLY

FROM:

_
To: SECRETARY OF STATE 110 STATE CAPITOL ATLANTA, GEORGIA 30334

Place S"mp Here

24

PR-1 Campaign Contribution Disclosure Report.
Long Form (more than 6 entries) mainly used by State and County Candidates, Public Officers, and Organizations or Non-Candidate Committees.

SEC FORMPR-l Rev 5/93

STATE OF GEORGIA
ETHICS IN GOVERNMENT ACT
INSTRUCTIONS AND FOAMS FOR THE PUBLIC DISCLOSURE OF CAMPAIGN CONTRIBUTIONS AND EXPENDITURES REQUIRED OF PUBLIC OFFICERS, CANDIDATES OR THEIR CAMPAIGN COMMITTEES AND OTHER CAMPAIGN
COMMITTEES FORMED BY ORGANIZATIONS AND OTHER PERSONS sup-
PORTING CANDIDATES FOR ALL STATE. COUNTY AND MUNICIPAL OFFICES

I THE ETHICS IN GOVERNMENT ACT
The Act. as amended, requires all public officers. candidates. and campaign commitlees. to disclose contributions of $101 or more. and expenditures of $101 or more, and the total amount 01 all individual contributions received and expenditures made alless than $101 each
This packet contains one copy 01 Forms 1 through 3 which are reQuirt..>d to be filed under the Act. Campaign committee registration Forms RC and RO are not included
It additional forms Of continuatIOn sheets are needed. they may be obtained from the office of the Secretary of State, the office of the State Ethics Commission. probate judges. county election superintendents or municipal clerks

II FILING INFORMATION

A

WHO MUST FILE?

1 Public officers and Candidates or their campaign committee for the following offices

a State offices of Governor, Lieutenant Governor. Attorney General, Secretary 01 State, Commissioner of Insurance, Commissioner of Agriculture, State School Superintendent. Commissioner of Labor and Public Service Commissioners, District Attorneys. members of the Georgia House of Representatives and Georgia Senate and all Constitutional Judicial Officers

b County Offices c Municipal Offices

2 Organizations or Persons other than candidates or their campaign committee WHERE TO FILE?

1 Slale officers and candidates for STATE OFFICES, or their campaign committees, file this report with the Secretary of State, Elections
Division. Room 110. State Capitol, Atlanta, Georgia 30334 A candidate lor the General Assembly will file a copy also wifh the elecfion
superintendent in the counfy of the candidate's residence, In counties in whic~ the county board of elections does not maintain an office open 10 the public during normal business hours for five days a week, the report IS filed with the judge of probate court of the counfy oi residence

2 Counly officers and c,mdidiltes for COUNTY OFFICES. or their campaign commiHees, hie this report wilh the elecfion superintendent in the county of the eleclion In counties in which the county board 01 elections does not maintain an office open to the public during normal buSlne5S hours for five days a week, the report is filed with the judge of probate court in the county of the election

J MunICipal officers and candidates for MUNICIPAL OFFICES, or their campaign committees, file Ihis report with the municipal clerk in the city 01 the election or, if there is none, with the chief executive of the municipality

4 ORGANIZATIONS OR PERSONS file this report where the C(mdic1ate(sl they support files WHEN TO FILE?

NOTE

Candidates defeated in the primary must file all primary reports and the final r"port
Candidates withdrawing must file all primary reports ann the final report
Candidafes with no opposition (Primary or General) and who receive no contribuliol1s of $101 or more file only the initial and final report

Candidates In a primary runoff. general runoll or speCial runot! election must file a report

Organizations or Persons other than candidates campaign committee musf file their reports when the candidate whom they support files

1 Prior to Primary a When Due~Forty-five (45) days before primary and Fifteen (15) days before primary b. Who Files-AIl candidates in the primary

2 After the Primary a When Due-Ten {1O) days after the primary
b Who Files-AU candidates who were in the primary

3 Primary Runoff Election a When Due-Six (61 days before runoff election
b. Who Files-All candidates in runoff election

4 Prior 10 General or Special Election
a When Due-Fifteen (15) days befOfe general or special election b, Who Files-
i 1i All candidates in general election or special election

5 General Runoff or Special Runoff Election a When Due-Six (6) days before runoff election b, Who Files-All candidates in runoff election

6 End of the Year Final Report <'1. When Due-No later than December 31 of election year b. Who Files-All candidates, whether they won, lost or withdrew

7 Supplemental Report a When Due-No later than December 31 b INho Files-
( 1) Person elected to office in each year following the year in which the election occurs (2) Person leaVing office with excess contributions until such contributions are expended as provided in the Act (3) Unsuccessful candidate having excess contributions until such contributions are expended as provided in the Act
(4) Unsuccessful candidate, who receives contributions to retire debts incurred, until such unpaid expendifures are satisfied

III ANONYMOUS CONTRIBUTIONS

The making Of acceptance of anonymous contributions is PROHIBITED. Any anonymous cootribulions received should be fransmitted to Anonymous Campaign Contributions, OOAS, P. 0 Box 38198, Capitol Hill Stafion, Atlanta, Georgia 30334. The fact of an anonymous contribution and its transmiltalto the State must be reported to the State Ethics Commission.

IV JiAVE QUESTIONS?
Contact

STATE ETHICS COMMISSION 2082 East Exchange Place, Suite 235 Tucker, Georgia 30084 Phone - 404-414-3450

25

PR-1 Campaign Contribution Disclosure Report.
Long Form (more than 6 entries) mainly used by State and County Candidates, Public Officers, and Organizations or Non-Candidate Committees.
Page 2

S.EC FORM 1 5/93

For Office Use Only
ETHICS IN GOVERNMENT ACT

1. Date of this report

CAMPAIGN CONTRIBUTION DISCLOSURE REPORT Please type or print

o Original report o Report amendment
~

2. Check only one box and complete

D .

REPORT OF CANDIDATE OR CAMPAIGN COMMITTEE

Full name of Public Officer or candidate -"";;;",..-------;m;;;;'dd"'''O;---------;;;;,,,",

~

Mailing address """;:;.,,:..;;-----------;,,:;;;,y-----,,:Ooo"',,::-y-----,;""'"'e;:----~";c,,;c;;_:O;---

Telephone number: Office

Home

_

Check one and name the office sought/or held
o State (include district, post, or judicial circuit) o County o Municipal
Does the candidate or public officer have a campaign committee (one or more persons) to make campaign transactions, keep the financial records of the campaign, or file the reports? DYes oNo If yes, complete the following
Name of Committee
Full name of Chairperson or Treasurer

_ _
~
---,-_ _

Mailing address: street Telephone number: Office

city

county

state

Home

Zip cOde

o b. REPORT OF ORGANIZATION OR PERSON OTHER THAN CANDIDATE'S CAMPAIGN COMMITTEE.

Name of organization

_

Full name of Committee Chairperson or Treasurer

Mailing address ----;,:;;;"~;;;;,c;;oc;-;PC;.oo;bo;;;'----,;;;,,o-y---------;,"'oo"',,""y-----.c"";;;,,.-------;;zip;-,'"'_;;;;---

Telephone number: Office

Home

_

3. Type of report you are filing: (Check only one box)
o Report due 45th day before primary election
o Report due 15th day before primary election
o Report due 10th day after primary election.
o Report due 6th day before primary runoff election
o Report due 15th day before 0 general or 0 special election o Report due 6th day before 0 general runoff or 0 special runoff election o Final report due no later than December 31 of election year o &lpplemental report to be filed no later than December 31 by:
a. Person elected to office in each year following the year in which the election occurs. b. Person leaving office with excess contributions until such contributions are expended as provided in the Act c. Unsuccessful candidate having excess contributions until such contributions are expended as provided in the Act. d, Unsuccessful candidate, who receives contributions to retire debts incurred, until such unpaid expenditures are satisfied

VERIFICATION BY OATH OR AFFIRMATION

State 01

_

County of

_

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , being duly sworn (affirm),

depose and say that the information in this report form is complete, true and correct

Sworn to and subscribed before me on _ _ _ _ _ _ _ _ _ _ , 19__
Notary Public
My commission expires

Signature of liling person
PENALTIES: Any person ...no knowingly fails to comply with or who knowingly violates any of the provisions of the Ethics in Government Act shall be guilty ot a misdemeanor

26

PR-1 Campaign Contribution Disclosure Report.
Long Form (more than 6 entries) mainly used by State and County Candidates, Public Officers, and Organizations or Non-Candidate Committees.
Page 3

S.EC Fo<m2 5/93

CONTRIBUTIONS

1. Full name of (Check only one box and complete):
o Public officer or candidate: o Other person or organization required to file report:

I have: a. 0
o

No contributions to report. The following contributions, including Common Source, to report:

Cash Amount
3. Total contributions for this election reporting cycle which have been received and reported prior to this reporting period
4 CONTRIBUTIONS OF $101.00 OR MORE List names of each contributor (alphabetically-preferred) along with mailing address, amount of contribution, and contributor's business, occupation, or place of employment Slale corporate, labor union or other affiliation of political action committees

For Office Use Only _

In-Kind Contributions (Itemize)

General Description

Estimated Value

./ 5 Total amount of all individual contributions of less than
$101.00 received in this reporting period, if not shown above in section 4. "Common Source" contributions must be aggregated! 6. Total contributions reported this period (sum of all entries in Sections 4 and 5)
7. Total contributions to date (lines 3 + 6). Totals to be
carried forward to next due report.
I (use continuation sheet if needed)
Page _ _ 01_ _ Pages
27

PR-1 Campaign Contribution Disclosure Report.
Long Form (more than 6 entries) mainly used by State and County Candidates, Public Officers, and Organizations or Non-Candidate Committees.
Page 4

SEC Form 3
5/93

EXPENDITURES

1. Full name of (Check only one box and complete):
o Public officer or candidate: o Other person or organization required to file report:

2. I have: a. 0 No expenditures to report. b. 0 The following expenditures to report:

3. Total expenditures for this election reporting cycle which have been made and reported prior to this reporting period

EXPENDITURES OF $1OH)(} OR MORE
4. List names of each recipient (alphabeticallypreferred) for this reporting period. Give complete mailing address

If recipient is an individual, list occupation or place of employment

For Office Use Only _

Expenditures

General Purpose

Amount

5. Total amount of all individual expenditures of less than $101.00 made in this reporting period, if not shown above in section 4.
6. Total expenditures reported this period (sum of all entries in Sections 4 and 5).
7. Total expenditures to date (lines 3 + 6). Total to be carried forward to next due report.
(use continuation sheet if needed) Page __ 0'_ _ Pages
28

SF-Campaign Contribution Disclosure Report. Short Form (six entries or less) mainly used by municipal candidates and public officers.

CAMPAIGN CoNrRtIUTlON DtlcLOSURE REPORT
SHORT FORM
SIX OR FEWER EHTlllEi FOR USE ONLY BY PUBliC OFFtCERS AND CANDIDATES OR THEIR CAMPAIGN CQMMITIEES

ForCWloll.lMOnlr
ETHICS IN GOVERNMENT ACT

1. Date ofttlis report:

_

2. Full name of public officer orcandidate:

_

3 Mailing Address: -==------------,""=---------;::""""'=-------,_=-----;,."'e_=-

4. Telephone Numbers: Office

_ Home

_

5 Title 01 office sought, including district, post. circuit, if applicable. Local candidates should give name of county or city:

6. Does the candidate have a campaign committee to keep firl8ncial records of the campaign and file the reports? DYes oNo
If yes," please give the following: (1) Full nameotcommittee: (2) Mailing address:
(3) PhoneNumber:

7 Type of report you are filing: (Check only one boll) o Report due 45th day before primary election. U Report due 15th day before primary etion. o Report due 10th day after primary election. lJ Report due 6th day before primary runoff election. [J Report due 15th day before 0 general or 0 special election. [] Report due 6th day before 0 general runoff or 0 special runoff election. [J Final report due no later than December 31 of election year. [J Supplemental report to be filed no later than December 31 by: a. Person elected to office in each year following the year in which the election occurs.
b Person leaving office with excess contributioni until such contributions are expended u provided in the Act.
c. Unsuccessful candidate having excess contrlbutionl until such oontrlbutIonI are ~nded u provided in the Ad. d. Unsuccessful candidate, who receiveI contrlbutionI to retire debts incurred, until such unpaid debtlare satlafled.

8. I haye a. [l No contributions to report. b. [] The following contributions to report.

o No expenditures to report. o The loI1Qw;ng . _... to "PO'l.

_

...,....

_

_

In-kind ContrIbutlona (itemize)

10. CONTRIBUTlOHS OF '101.00 OR MORE List names of each contributof (alphabeticallyprefen"ed) along with mailing address, amount of contribution, and contributof'. business, occupation,
'" place of employment. State corporate, labor union, or other affiliation of political action committees.

'2. TOlOl_r-"<I .... _leumol .. _1n_'Oend").
'3. T _ OlO _ l_ttoo__dIu~e~-''2).T_IDbe CClNT-.Clll _ _
29

SF-Campaign Contribution Disclosure Report. Short Form (six entries or less) mainly used by municipal candidates and public officers. Page 2

EXPENDITURES

for 14. Total expenditures this election reporting cycle which have been reported prior 10 this reporting period.

EXPENDITURES OF $101.00 OR MORE 15. list names of each recipient (alphabetically-
preferred) for this reporting period. Give complete mailing address

If recipient is an individual, list occupation or place of employment.

General Purpose

Amount

1~. Total amount of all individual expenditures of less than $101.00 made in this reporting period, if not shown above in section 15 17. Total expenditures reported this period. (Sum of all entries in Sections 15 and 16) 18. Total expenditures to date (lines 14+ 17). Total to be carried forward to next due report

VERIFICATION BY OATH OR AFFIRMATION

State of Georgia

Countyof

_

I,

~

information in this report is complete, true, and correct

Sworn to and subscribed

beforemeon

~~

19

,being duly sworn (affirm), depose and say that the S<gnatll.e

NolaryP~ic

My commission expires

_

PENALTIES: Any person who knowingly fails to comply with or who knowingly violates any of the provisions of the Ethics in Government Act shall be guilty of a misdemeanor

Candidates for STATE OFFICES, or their campaign committees, lile this report with the Secretary of State, Room 110, State Capitol, Atlanta, Georgia 30334, A candidate for membership in the GENERAL ASSEMBLY, or hisJher campaign committee will file a copy of the report with the election superintendent in the county of the candidate's residence

Candidates: for COUNTY OFFICES, or their campaign committees, lile this report with the election superintendent in the county of the election

Candidates for MUNICIPAL OFFICES, or their campaign committees, file this report with the municipal clerk in the city of the election or, if there is none. with the chief executive of the municipality

NOTE:

In counties in which the county board of elections does not maintain an office open to the public during normal business hours lor five days a week, the report is filed with the judge of probate court in the county of the election

ANONYMOUS CONTRIBUTIONS

The making or acceptance of anonymous contributions is PROHIBITED, Any anonymous contributions received should be transmitted to: Anonymous Campaign Contributions, Fiscal Division of the Georgia Department of Administrative Services, P.O. Box 38198. Capitol Hill Station, Atlanta, Georgia 30334

THE FACT OF AN ANONYMOUS CONTRIBUTION AND ITS TRANSMlnAL TO THE STATE MUST BE REPORTED TO THE STATE ETHICS COMMISSION.

CAMPAIGN COMMITTEES

Candidates who have campaign committees must register their committee with the Secretary of State using FORM RC. If there are any questions about the law, please contact the State Ethics Commission at
Addrus: 2082 east Exchlinge ptace. SUite 235 Tucker, Georgia 30084

Tetephone: (404) 414-3450

30

FD-Financial Disclosure Statement.
Filed once a year by all candidates, elected public officials and others designated by the Act.

SEC FORM FD Rev, 1/93

STATE OF GEORGIA

L~-------:~------, For Official Use Only

FINANCIAL DISCLOSURE STATEMENT

Ethics In Government Act
Please Type or Print Using Pen

D Original Statement DAmendment

Date of this Statement

_

Name of Public Officer or Candidate --"'1"5"----------._---------"'ias"

_

Mailing Address

stleeto(po 50,

Telephone Number: Office

_

Home

_

Name of Public Office:

Check One"

Elected Public Officer

i-: Appointed Public Officer 1-' Candidate for Public Office

Member of State Authority or Board

WHO FILES FINANCIAL DISCLOSURE STATEMENT:

Each public officer holding office in Georgia. and each person who qualifies as a candidate for election as a public officer

for one of the offices listed below, and all others on the following list:

...

(A) Every constitutional officer:

(B) Every elected state official;

(C) The executive head of every state department or agency, whether elected or appointed;

(D) Each member of the General Assembly;

(E) The executive director of each state board or authority and the members thereof;

(F) Every elected county official, every elected county or area school superintendent, and every elected member of

a county or area board of education; and

(G) Every elected municipal official.

WHEN TO FILE FINANCIAL DISCLOSURE STATEMENT:
Public Officer: Statement is filed not before January 1 and not later than July 1 of each year that a public officer holds office (except the year of election) covering the preceding calendar year
If the public officer chooses not to run for re-election or for another public office no financial disclosure statement need be filed in the year qualifying to succeed him takes place. A public officer shall not be deemed to hold office in a year in which the public officer holds office for less than 15 days
Candidate for Public Office: Statement for the period of the preceding calendar year shall be filed not later than July 11n the year in which the candidate qualifies. If due to a special election or otherwise, a person does qualify after the first of July, the person must file a financial disclosure statement for the preceding calendar year no later than the fifteenth (15) day following the date of qualifying as a candidate.
Special requirements for State Wide Candidates: Candidates for a public office elected state wide must file their financial disclosure statements not later than seven days after qualifying or filing a notice of candidacy. State wide candidates must disclose more information than other candidates for public office and forms for the additional disclosure sections required of state wide candidates may be obtained from the State Ethics Commission

WHERE TO FILE FINANCIAL DISCLOSURE STATEMENT: Every public officer and every candidate for election as a public officer defined above in categories (A) through (E) will file a statement with the Secretary of State, Elections Division, Room 110, State Capitol, Atlanta, GA 30334. Every public officer who is an elected county official and every candidate for election as a county public officer will file a statement with the election superintendent of the county of election. Every public officer who is an elected municipal officer and every candidate for election as a municipal public officer will file a statement with the municipal clerk or, if there is no clerk, with the chief executive officer of the municipality of election. If additional space IS needed, attach information on appropriately labeled continuation sheets.
SECTION I MONETARY FEES RECEIVED (This Section to be completed by Public Officers only) Identify each monetary fee of $101.00 or less accepted from speaking engagements, participation in seminars, discussion panels, or other activities which relate to the official duties of or the office of the public officer, with a statement identifying the fee or honorarium and the person from whom it was accepted I received: No monetary fee. Monetary fee(s) of $101.00 or less as shown on next page.

31

FD-Financial Disclosure Statement. Filed once a year by all candidates, elected public officials and others designated by the Act.
Page 2

Identify Fee and Amount Received

Name and Address of Person from Whom Received

SECTION II FIDUCIARY POSITIONS
Name all fiduciary positions held by the candidate for public office or the public officer. A fiduciary position is any position imposing a duty to act primarily for another's benefit as officer, director, manager, partner or other designations of general responsibility of a business entity. A business entity is any corporation, sale proprietorship, partnership, limited partnership, enterprise, franchise, association, trust, joint venture, or other entity, whether profit or nonprofit. I held:
o No fiduciary positions in any business entity.
o Fiduciary positions in the following business entity(ies).
IDENTIFY: 1. Title of each position. 2. Name and address of business entity. 3. PrIncipal activity in the following business entity(ies)
Business entity #1

Business entity #2

Business entity #3

SECTION III DIRECT OWNERSHIP INTERESTS IN BUSINESS ENTITY
Direct ownership Interest is the holding or possession of good legal or rightfUl title of property or the holding or enjoyment of real or beneficial use of the property by any person and includes any interest owned or held by a spouse of the person if such interest is held jointly or as tenants in common between the person and spouse. Identify the name, address and principal activity of any business entity and the office held by and the duties of the candidate for public office or public officer within a business entity as of December 31 of the covered year in which a direct ownership interest: (A) Is more than 10 percent of the total interest in the business; or (B) Has a net fair market value of more than $20,000. I held:
o No direct ownership interests in any business entity. o Direct ownership interests In the following business entity(ies)
IDENTIFY: 1. Name and address of business entity. 2. Principal activity of business entity. 3. The office held by the candidate or the public officer within the business entity. 4. The duties of the candidate or the public officer in which direct ownership is held.

32

FD-Financial Disclosure Statement.
Filed once a year by all candidates, elected public officials and others designated by the Act.
Page 3

Business entity #1

Ownership Interests Check One or Both If Applicable
o Ownership interest is more than 10% o Ownership interest has a net fair mar-
ket value of more than $20,000.00

Business entity #2

o Ownership Interast is more than 100/0 o Ownership interest has a net fair mar-
ket value of more than $20,000.00

Business entity #3

o Ownership interest is more than 10% o Ownership interest has a net fair mar
ket value of more than $20,000.00

SECTION IV DIRECT OWNERSHIP INTERESTS IN REAL PROPERTY Identify each tract of real property in which the candidate for public office or public officer has a direct ownership interest as of December 31 of the covered year when that interest has a net fair market value in excess of $20,000. ~Net fair market" value means fhe appraised value of the property for ad valorem tax purposes less any indebtedness thereon. The disclosure shall contain the county and state and general location where the property is located.
I had:
o No ownership interests with a net fair market value in excess of $20,000. o Ownership interests with a net fair market value in excess of $20,000.
identify Location of Real Property
Property #1

Property #2

Property #3 Property #4

33

FD-Financial Disclosure Statement. Filed once a year by all candidates, elected public officials and others designated by the Act. Page 4
SECTION V ANNUAL PAYMENTS RECEIVED BY THE PUBLIC OFFICER OR BUSINESS
ENTITY FROM THE STATE OF GEORGIA. (This section to be completed by Public Officers only) Identify all annual payments In excess of $20,000,00 received by the public officer or any business entity with whom the public officer is associated from the State, any agency, department, commission, or authority created by the State and authorized and exempted from disclosure under Gode Section 45-10-25. Also identify the agency, department, commission, or authority making the payments, and the general nature of the consideration rendered for the source of payments. I received:
o No annual payments in excess of $20,000,00 from any State entity.
CJ Annual payments in excess of $20,000.00 from the below named State entities.
IDENTIFY:
1. Name and address of State entity. 2. Amount of annual payment in excess of $20,000.00. 3. The general nature of the consideration rendered for the payment(s). State entity source #1
State entity source #2

State of Georgia County of,

VERIFICATION BY OATH OR AFFIRMATION
~

_ _ _ _ _ _ _ _~

~

depose and say that the information in this statement is complete, true and correct.

Sworn to and subscribed before me on _ _ _ _ _ _ _ _~, 19

Signature of filing person

beingdulysworn(aHirm),

Notary Public My commission expires

PENALTIES: Any person who knowingly tails to comply with or who knowingly violates any of the provisions of the Ethics in Government Act shall be guilty of a misdemeanor.

34

1a-Campaign Contribution Disclosure Report for Recall or Opposition to Recall Election.
Filed by committees who wish to recall officials or who wish to oppose the recall of officials.

S.E,C. FORMla
Rev. 5/93

STATE OF GEORGIA Ethics in Government Act Campaign Contribution Disclosure Report

For Office Use Only

INSTRUCTIONS AND FORMS FOR THE PUBLIC DISCLOSURE OF CAMPAIGN CONTRIBUTlOtJS AND EXPENDITURES REQUIRED OF CAMPAIGN COMMITTEES FORMED TO BRING ABOUT OR TO OPPOSE THE RECALL OF A PUBLIC OFFICER.

0 Original report 0 Report amendment

THE ETHICS IN GOVERNMENT ACT The Act, as amended, requires public disclosure by all campaign committees of contributions of $101.00 or more
and exPenditures of $101.00 or more, and the total amount of all individual contributions received and expenditures made of less than S101.00each.

II. FILING INFORMATION
This packet contains one copy of each of the forms which are required to be filed under the Act. Form RO is a registration form which becomes part of the record keeping system of the office of the Secretary of State. Forms la, 2 and 3 are for campaign financing information.
If addittonal forms or continuation sheets are needed, they may be obtained from the office of the Secretary of State. the office of the State Ethics Commission, probate judges, county e~ion superintendents or municipal clerks.

A. Who must file and where: Any recall election campaign committee will file reports with the Secretary of State, Elections Division, Room 110 State Capilol, Atlanta, Georgia, 30334.
In the case of state or county officials sought to be recalled, a copy of each report(s) will be filed with the etection superintendent in the county of residence of the official. In counties in which the county board of etections does not maintain an office open to the public during normal business hours for five days a week, the report is filed with the judge of probate court in the county of the election.
In the case of municipal officials sought to be recalled, a copy of the report will be filed with the munictpaJ clerk or executive officer in the muntcipality of residence of the official.

III. SECTION TO BE COMPLETED BY CAMPAIGN COMMITTEE (Please print or type)

A. Date of this report:

_

B. Report of Campaign Committee formed to: (Check only one box)
o Bring about the recall of a public officer holding public office. o Oppose the recall of a public officer holding public office.

C. Campaign Committee:

Full name of Committee: Mailing address:_---,----,-_---,-
street or p.o. box
Telephone number(s):~

---,city
~

---,county

--,-----,state

---,-_---,zip code
_

Commiffee Chairperson (Full Name):
Horne address:----;;st".".=.".';cP;;;.o;-;.tx<=----....."c,.y. -------;;coo"'n"lyC-----s"ta"....------,''''io-code=-

Telephone number(s): Name of Public Officer: Office held by such officer:

_ _ _

D. Type of report you are filing: (Check only one box)
o Initial report filed within 15 days of the date when the official recall petition forms were issued to the sponsors. o Second report filed 45 days after the filing of the initial report. o Third report filed within 15 days after the expiration date for acquiring signatures on the recall petition. o Final report due prior to December 31 of year etection is hekJ, or if election is not held, prior to December
31 of any year contributtons are accepted or expenditures made.

VERIRCATION BY OATH OR AFFIRMATION

State of

_

County of

_

FUlnamaoflilingperson
depose and say that the information in this report form is complete, true and corl'flC1.

,belng duly sworn (affirm),

Sworn to and subscribed before me on _ _ _ _ _ _ _ _ _ _ _ _ , 19 _ _

SignMunt aI Iiling peI'IOn

PENN..TES:""'pereonwhokrlowirlgty . . Io~Vtlithorwho~

vil:lIIIdlls~ at the pIUlIIiIionI oIhElhk:ain Gowrnment kJ.lhIIlbe~

oIa ~ on the .... otfeNe ..t l4XJI'I corMction .......... be

~_lora~endlClQnlNMCOndor~on...

"'be~oI. teIony.and\CXlflCOlWidion

t ......... by

~lornol. . . 1Nn(:IMnormore

tNt~orby.hnol

Io..-ed S6.OOO. or boCh.

35

1a-Campaign Contribution Disclosure Report for Recall or Opposition to Recall Election.
Filed by committees who wish to recall officials or who wish to oppose the recall of officials.
Page 2

CONTRIBUTIONS

1. Full name of (Check only one box and complete)
o Public officer or candidate: o Other person or organization required to file report

2. I have
o o

No contributions to report The following contributions, including Common Source. to report

Cash Amount
3 Total contributions for this election reporting cycle which have been received and reported prior to this reporting period
4 CONTRIBUTIONS OF $10100 OR MORE List names of each contributor (alphabetically-preferred) along with mailing address, amount of contribution, and contributor's business, occupation, or place of employment State corporate. labor union. or other affiliation of political action committees

[
For Office Use Only
_

In-Kind Contributions (Itemize)

General Description

Estimated Value

5. Total amount of atl individual contributions of less than $101.00 received in this reporting period, if not shown above in section 4 "Common Source" contributions must be aggregated I
6. Total contributions reported this period (sum of all entries in Sections 4 and 5).
7. Total contributions to date (lines 3 + 6). Totals to be carried forward to next due report. (use continuation sheet if needed)
Page _ _ 01_ _ Pages
36

1a-Campaign Contribution Disclosure Report for Recall or Opposition to Recall Election. Filed by committees who wish to recall officials or who wish to oppose the recall of officials.
Page 3

SEC Form 3

EXPENDITURES

""

1. Full name of (Check only one box and complete):
o Public officer or candidale: o Other person or organization required to file report:

2. I have:
a. 0 No expenditures to report.
b. 0 The following expenditures to report

~
3. TotaJ expenditures for this etection reporting cycle which halt'e been made and reported prior to this reporting period.

EXPENDITURES OF 5101.00 OR MORE 4. List names of each nldpienl (alphabetically-
preferred) tor this reporting period. Give COfl'lP'ete mailing address.

" reciptent is an indivUJal, list ~lion or place of employment.

For Office Use Only _

Expenditures

General Purpose

Amount

5. Total amount of all-.a& ""llO"diIu1llO of _ than 5101.00"- in thlo reporting period. Wnot _ . - in aeclion 4.
. . 5. Total _ _ _ reponed thlo period laum of all_In Secliono 4 and 5). .

7. TotaI _ _ 1o _ 1 _ 3 + 5). Tolal to be carried _ 1_ <:onIInuaIIon _ w_ )

to next duo f8IXri.

Plogo _ oI_ _ Pogeo

37

1d-Campaign Contribution Disclosure Report for/against Proposed Constitutional Amendment, Statewide Referendum or any Proposed Ballot Question in any County or Municipal election.
Filed by committees formed to influence the outcome of Constitutional Amendments, Statewide Referendums or any Ballot Questions.

SEC FORM ld Rev. 5193

STATE OF GEORGIA
Ethics in Government Act Campaign Contribution Disclosure Report

For Office Use Only

INSTRUCTIONS AND FORMS FOR THE PUBLIC DISCLOSURE OF CAMPAIGN CONTRIBUTIONS AND EXPENDITURES REOUIRED OF CAMPAIGN COMMITTEES FORMED TO INFLUENCE VOTER APPROVAL OR REJECTION OF A PROPOSED SONSTITUTIONAL AMENDMENT, A STATEWIDE REFERENDUM OR ANY PROPOSED QUESTION ON THE BALLOT IN ANY COUNTY OR MUNICIPAL ELECTION.

0 Original report 0 Report amendment

THE ETHICS IN GOVERNMENT ACT
The Act, as amended, requires public disclosure by all campaign committees of contributions of $101.00 or more and expenditures of $101.00 or more, and the total amount of all individual contributions received and expenditures made of less than $101.00 each

FILING INFORMATION
This packet contains one copy of each of the forms which are required to be filed under the Act. Form RO is a registration form which becomes part of the record keeping system of the office of the Secretary of State Forms 1d, 2 and 3 are for campaign financing information
If additional forms or continuation sheets are needed, they may be obtained from the office of the Secretary of State, the office of the State Ethics Commission, probate judges, county election superintendents or municipal clerks
A. Who must file and where: Any campaign committee which accepts contributions or makes expenditures designed to bring about the approval Or
rejection by the voters of a proposed constitutional amendment or a statewide referendum will file reports with the Secretary of State, Elections Division, Room 110 State Capitol, Atlanta, Georgia, 30334.
Any campaign committee which accepts contributions or makes expenditures designed to bring about the approval or rejection by voters of any proposed Question which 1& to appear on the ballot in any county or municipal election will file reports, provided the campaign committee has received contributions which total more than $500.00 or has made expenditures which total more that $500.00. All advertising pertaining to the referendum must identify the principal officer of the campaign committee by listing or stating the name and title of the principal officer. The report will be filed with the election superintendent of the county in the case of a county election or with the municipal clerk in the case of a municipal elections. In counties in which the county board of election does not maintain an office open to the pubhc during normal business hours for five days a week, the report is filed with the judge of probate court of that county

III. SECTION TO BE COMPLETED BY CAMPAIGN COMMITTEE (please print or type)

A. Date of this report:

.

'

._ _ --

. ---_

B. Report of Campaign Committee formed to: (Check only one box)
o Influence voter approval or rejection of a proposed constitutional amendment or a statewide referendum o Influence voter approval or rejection of any proposed question appearing on the ballot in any county or municipal
election
C Campaign Committee

Full name of Committee:

._ _.

street or po box

~_ city

Mailing address:

------- --.-.-

county

state

liP code

Telephone number(s)

_

Committee Chairperson (Full Name):___

Home address

street or po, box

Telephone number(s)'

_

_ city

county

state

Zip code

Name of proposed Constitutional Amendment, Statewide Referendum, or Question in any County or Municipal Election
------

D. Type of report you are filing: (Check only one box)
o Report due 15 days prior to date of election.
o Final report due prior to December 31 of year election is held.

VERIFICATION BY OATH OR AFFIRMATION

State at

_

County of

_

Full name of filing person
depose and say that the information in this report form is complete, true and correct.

, being duly sworn (affirm),

Sworn to and subscribed before me on _ _ _ _ _ _ _ _ _ _ _ _ _ _ , 19 _ _
Notary PublIC
My commission expires

Stgnature of tilIng person
PENALTIES Any person who knoWIngly lalls to comply w'th or who knowlr>gly VIolates any of the proviSIOns of the EthICS in Government Act shall be guilty of a m;sdemeal'lOf on the first offense, and upon convK:lIOn thereof. Shall be punished as for a misdemeanor: and upon the second or subsequenl offense Shall be guilty of a felony. and upon convIctIon thereof, shall be puniShed by Impr;sonment lor not less than one nor more than five years or by a tme not 10 exceed $5.000, or both

38

1d-Campaign Contribution Disclosure Report for/against Proposed Constitutional Amendment, Statewide Referendum or any Proposed Ballot Question in any County or Municipal election.
Filed by committees formed to influence the outcome of Constitutional Amendments, Statewide Referendums or any Ballot Questions.
Page 2

CONTRIBUTIONS
1 Full name of (Check only one box and complete):
o Public officer or candidate: o Other person or organization required to file report:

c~_ For Office Use Only _

2. I have: a. 0 b. 0

No contributions to report The following contributions, including Common Source. to report:

Cash Amount
3. Total contributions for this election reporting cycle which have been received and reported prior to this reporting period
4. CONTRIBUTIONS OF $101,00 OR MORE List names of each contributor (alphabetically-preferred) along with mailing address, amount of contribution, and contributor's business, occupation, or place of employment. State corporate, labor union, or other affiliation of political action committees

In-Kind Contributions (Itemize)

General Description

Estimated Value

5. Total amount of all individual contributions of less than $101.00 received in this reporting period. if not shown above in section 4. "Common Source" contributions must be aooreaated!
I.e. Total contributions reported this period (sum of all
entries in Sections 4 and 5).
7. Total contributions to date (lines 3 + 6). Totals to be carried forward to next due report. (use continuation sheet if needed)
Page _ _ 01_ _ Pages
39

1d-Campaign Contribution Disclosure Report for/against Proposed Constitutional Amendment, Statewide Referendum or any Proposed Ballot Question in any County or Municipal election.
Filed by committees formed to influence the outcome of Constitutional Amendments, Statewide Referendums or any Ballot Questions.
Page 3

~~~3

EXPENDITURES

""

1. Full name of (Check only one box and complete): o Public officer or candidate:
o Other person or organization required to file report

2. I have: a. 0 No expenditures to report
o The following expenditures to report

3. Total expenditures for this election reporting cycle which have been made and reported prior to this reporting period

EXPENDITURES OF $101.00 OR MORE
4. List names of each recipient (alphabeticallypreferred) for this reporting period. Give complete mailing address

It recipient is an individual, list occupation or place of employment

For Office Use Only _

Expenditures

General Purpose

Amount

5. Total amount of all individual expenditures of less than $101.00 made in this reporting period, if not shown above in section 4
6. Total expenditures reported this period (sum of all entries in Sections 4 and 5) 7. Total expenditures to date (lines 3 + 6). Total to be carried forward to next due rep~rt
(use continuation sheet if needed) Page _ _ 01_ _ Pages
40

Lobbyist Report Form.
Lobbyists whose reports contain expenditures relating to county affairs will file with the County Filing Officer. Lobbyists whose reports contain expenditures relating to municipal affairs will file with Municipal Filing officer.

LOBBYIST REPORT FORM
STATE OF GEORGIA STATE ETHICS COMMISSION
2082 East Exchange P1al:e, Suite 235 Tucker, Georgia 30084
Lobbyist Line (404) 414-3452
JIOa OPPJCE USE ONLY
~
REPORTING PERIOD

.&...-..D

PLEASE CHECK THE APPROPRIATE BLOCK UNDER [A) 10 _ _ for which reportiDg
period you ~ filing. ReporIs wv1bo time poriod IiIled uoder IB]. ReporIs ~ due for Ihat period 00 Ibo dale lill&ed UDder [C]. Monthly Rcpgrts Ire dye the firth cia! of ttc fQIIOWhw month (or IO! month or portion or
month tNt the GmcraJ. Awmbly k in scssjop including mmal mom Two otbQ" rmorts OR due August
Sth and Januan 5th

[A) IB] PERIOD [C) DUE DATE

IllDuuy 1-31 February 5th

February 1-28 March 5th

March 1-31

April 5th

[A)

IB] PERIOD

[C) DUE DATE

April I -luly 31

August 5th

August I - Dec:ember 31 Special _00: (dales of special _00)

<_....) IllDuuy 5th 5th

NAME

UoI

... IDENTIFICATION

Idi....

MAn.lNG ADDRESS

-

(SoU)

Cloy

.....

Zip

TELEPHONE NUMBER

LOBBYING ON BEHALF OF: (ONE GROUP PER PORN)

EXPENDITURES
PLEASE CHECK ONE EXPENDITURES MADE ON BEHALF OF TIlE INDICATED GROUP: [S..
the manuallaformation Concemigg lpbbyjst Registration gd Reporting for cicfinitiOD of expeaditure].
I bave mode NO expcuditures doriag Ibis reportiDg period.
I bave mode EXPENDITURES duriDg Ibis reportiDg poriod. My eq>mdituns are Iist<d OD page 2.
Thi5 is aD AMENDMENT to add or delete eotries 00 p~ious report.

VERIFICATION BY OAm OR AFFIRMATION

SlaIe of LOBBYlSI': I.

Couoty of ..,....,:--:-:-_--:=
beiog duly IWOfIl (affirm) depose lIDd .y

IbaI Ibo iofOfDlllioo in Ihi, report is COlIIpI.... true. lIDd conec:L

SIGNATURE OF LOBBYIST:

NOTARY PUBLIC (print &. lip uame):.

_

My c:ommissioo upirel:

ThiI cIocumr.at was IwonI to or affumcd ud IUbecribed before me 011

PENALTIES: Auy penon wbo koowiogly &iIa 10 COlIIply with or wbo koowiogly vio_lIDY of Ibo proviIiODl of Ibo Elhia; 10 0 0 _ A<1 obaIl be guilty of. misdemeooor.
FILING FEFS
PLEASE CHECK ONE: I tegiIrend lhiI poup as Je8UIar poup aod bave llIIcl.-I tbe SIO.OO fiJing fee. I resi-.d lhiI poup as 501)(3) or )(4) (DOD-profit) poup aod. lhefore. do DOl pay filing r.... I resi-.d Ihi, poup as JOY""""'" a>lity lIDd. lhefore. do DOl pay filing f....
IF YOU MADE EXPENDITURES. COMPLETE PAGE 2.

41

Lobbyist Report Form.
Lobbyists whose reports contain expenditures relating to county affairs will file with the County Filing Officer. Lobbyists whose reports contain expenditures relating to municipal affairs will file with Municipal Filing officer.
Page 2
, I- - - - - - - - - - - - - - - - - - - - - - - - - - - - - ,

LOBBYIST REPORT FORM

PAGE 2

USE THIS PAGE ONLY IF YOU MADE EXPENDITURES If using an attachment to this fonn, please clearly label the attachment with your name and the name of the group on behalf of which the expenditures were made.

FOR OFFICE USE om.Y

o

LOBBYIST NAME: LOBBYING ON BEHALF OF (.... fonD)

PUBLIC OFJi1CERI IDENTIFIABLE GROUP Lise Name and Title of
Officer or Description of Group

EXPENDITURES

AMOUNT DATE

DESCRIPTION OF EXPENSE

NUMBER OF
Bll.L RESOLUI"ION REGULATION

USE OF PUBLIC OFFICERS' FAMILY SERVICES

NAME: List IIllIIIO of my member of, public officer', immocliaIe family employed by or whooe profoosioaal oeM,"" __ poid for by
Ihe lobbyill during the noporting period.

PUBUC OFFICER TO WHOM RELATED

RELATIONSHIP

42

Complaint Form.
Against any person charging a violation or knowing failure to comply with provisions of the Ethics in Government Act.

$.E.C Forme 3/87

STATE ETHICS COMMISSION 2082 East Exchanga Place Suita 235 Tucker, Georgia 30084

COMPLAINT
AGAINST ANY PERSON CHARGING A VIOLATION OR KNOWING FAILURE TO COMPLY WITH PROVISIONS OF THE ETHICS IN GOVERNMENT ACT.

I. PERSON BRINGING COMPLAINT

Name:

_

Address:

_

City:

~

County:

Zip Code:

_

Telephone Number:

Area Code:

_

II, PERSON AGAINST WHOM COMPLAINT IS BROUGHT:

Name:

Address:

_

City:

County:

Zip Cod~:

_

Telephone Number:

Area Code:

_

Title of office held or sought:

_

III. STATEMENT OF FACTS:

State in your own words the detailed facts and the actions of the candidate or organization named in Paragraph II which prompted you to make this complaint. The brief space provided below is not intended to limit your statement offaets. Use the back of this form or additional sheets if necessary. Include relevant dates and times and the names and addresses of other persons whom you believe have knowledge of the facts and any documentary evidence that supports the facts alleged in the complaint.

(If continued on other side or on additional sheets, please check here _ _.)

STATE OF COUNTY OF

1,

..

.

VERIFICATION BY OATH OR AFFIRMATION _ _

.

~, being duly sworn, depose (affirm) and say that the

information in this Complaint is true, and correct to the best of my knowledge and belief.

Sworn to and subscribed before me on
Notary Public My commission expires

19 _. . 19_ .

Signature of person bringing complaint
PENAL TIES: F. . . . . . .'ing A person to whom a lawful oath o. affirmation has been administered or who execules a document knowing that il purports to be an acknowledgment of a lawful oath or affirmation commits false swtNlr ing when, in any matter or thing other than a judicial proceeding. he knowingly and willfully makes a false statement. A person convicted of false swearing shall be punished by a fil'le of not more than $1,000 or by imprisonment for not less than one nor more than five vean. or both.

43

ORDERING INFORMATION
Supplies must be requested. This order form lists all available materials. You can make copies of the order form from the Filing Officer's Guide when needed. Due to changes in the law, these forms may be revised but the identification found in the top left hand corner will remain the same with only the revision date changing.

FILING OFFICER'S ORDER FORM FOR SUPPLIES

MAIL THE FOLLOWING TO:

NAME:

_

COUNTY:

_

ADDRESS:

_

PHONE:

_

DATE:

_

QUANTITY

FORMS USED BY CANDIDATES, ORGANIZATIONS, POLITICAL ACTION COMMITTEES AND COMMITTEES.

FORM NAME

FORM ID

Manual of Instructions for Candidates and Public Officers. . . . . . . . . . . .. MC

Manual of Instructions for Organizations, Committees or Persons

Influencing Elections of Public Officers, the Recall of Public Officers,

Proposed Constitutional Amendments, Statewide Referendums, or

Local Ballot Questions

MO

Declaration of Intention to Accept Campaign Contributions Card. . . . . . .. DOl

Registration Card for Candidates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. RC 3/87

Registration Card for Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. RO 3/87

Campaign Contribution Disc;losure Report . . . . . . . . . . . . . . . . . . . . . . .. PR-1 4/94

Campaign Contribution Disclosure Report (Six entries or less) Short Form

SF 4/94

Financial Disclosure Statement

FD 4/94

Campaign Contribution Disclosure Report for Constitutional

Amendments, Referendum or Ballot Question Pink Form

1d

5/93

Campaign Contribution Disclosure Report for Recall or Opposition to Recall Election Green Form ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1a
5/93

Ethics in Government Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. /94

44

ORDERING INFORMATION
Supplies must be requested. This order form lists all available materials. You can make copies of the order form from the Filing Officer's Guide when needed. Due to changes in the law, these forms may be revised but the identification found in the top left hand corner will remain the same with only the revision date changing.
FILING OFFICER'S ORDER FORM FOR SUPPLIES

MAIL THE FOLLOWING TO: NAME: ADDRESS:

_

COUNTY:

_

PHONE:

DATE:

_ _
_

FORMS USED BY FILING OFFICERS WHEN REPORTING TO STATE ETHICS COMMISSION

QUANTITY

FORM NAME

FORM ID

Statement #1 (used for reporting special elections only) Yellow Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S1
9/90

Statement #2 (used for reporting the filing of campaign disclosure for primary,

general, runoff, and special elections and for final end of year reports)

Blue Form

S2

9/90

Statement #3 (used for reporting filings in connection with constitutional amendments, statewide referendums or any proposed question on the ballot in county or municipal elections) Pink Form

S3 1/88

Statement #4 (used for reporting filings in connection with Recall or Opposition to Recall elections) Green Form. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S4
1/88

Statement #5 (used for reporting the filing of . Financial Disclosure Statements)
White Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S5 10/92

Manual of Instructions for Filing Officers. . . . . . . . . . . . . . . . . . . . . . . . .. FOG 11/93

45

LOBBYING DUTIES

State, County and Municipal lobbyist are required to register with the State Ethics Commission and file reports on their lobbying activities.

There are three categories of lobbyists:

A. Individual who lobbys for compensation

B. Individual who expends more than $250.00 annually lobbying

C. Executive or Judicial Branch of State or Local Government Employees

All Lobbyists will register and file reports with the State Ethics Commission.

All County and Municipal lobbyists will be required to file the following reports:

Report
May September January

Due Date
On or before the 5th of May On or before the 5th of September On or before the 5th of January

Lobbyists who file reports that contain expenditures relating to county affairs will file a copy of such report with the County Filing Officer. Lobbyists who file reports that contain expenditures relating to municipal affairs will file a copy of such report with the Municipal Filing Officer.

All reports are to be made available for public inspection and copying during regular office hours.

NOTE: A copy of the lobbyist reporting form has been included in the index of forms.

46

ADDITIONAL INFORMATION OR HELP
Please call the State Ethics Commission office using the following numbers. STATE ETHICS COMMISSION 2082 EAST EXCHANGE PLACE SUITE 235 TUCKER, GEORGIA 30084 Executive Secretary C. Theodore Lee (404) 414-3450
STATE/COUNTY ELECTION FILINGS ARE HANDLED BY: Hariette W. Bell (404) 414-3453
MUNICIPAL ELECTION FILINGS ARE HANDLED BY: Peggy S. Dowell (404) 414-3455
47