LETTER OF INTENT (AS 15



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CANDIDATE REGISTRATION

Before undertaking certain campaign activities, you must report the information requested below. You must file a Registration within 15 days (for state office) or 7 days (for municipal office) after filing a declaration of candidacy of a nominating petition.

To sitting legislators:

The Select Committee on Legislative Ethics has interpreted AS 24.60.030(a)(5) and AS 24.60.030(b) to prohibit the use of the Legislator’s legislative office phone number or legislative email on campaign related materials. If you are a sitting legislator, please avoid using your legislative phone number or legislative email on materials submitted to the Alaska Public Offices Commission. The Public Offices Commission only needs a contact number for you. This number could be a campaign number or other number or email in which you can be contacted.  If you have questions about the application of the Legislative Ethics rules, please contact the Select Committee on Legislative Ethics at 269-0150.

ALL filings submitted to the Alaska Public Offices Commission are public records and available to the public as submitted. Do NOT include any of the following personal information: social security numbers, account numbers, credit card numbers, copies of checks, financial records with account numbers or access codes, or any document with personal identification numbers.

CANDIDATE INFORMATION

Name:

Campaign Committee Name:

Campaign Mailing Address:

Contact Phone: Contact Fax: Email:

CAMPAIGN OFFICERS:

Chairperson(s)

Name(s):

Chair’s Address:

Contact Phone: Contact Fax: Email Address:

Treasurer

Name:

NOTE: You must disclose this information before a treasurer may accept campaign contributions on behalf of the candidate’s campaign committee.

Treasurer’s Address:

Contact Phone: Contact Fax: Email Address:

Deputy Treasurers

Only persons authorized by the campaign as deputy treasurers may accept campaign contributions for the campaign.

List by name and address. Please attach additional sheets if necessary.

CAMPAIGN ACCOUNT

If you intend to raise or spend more than $5,000 during a state or municipal election, designate below which regulated banking institution will serve as the campaign account depository:

Name of Depository: Location:

CERTIFICATION: I certify that the information contained in this registration statement is true, complete and correct.

Signature of Candidate: Date:

PLEASE NOTE: To reimburse yourself after the election for a personal contribution/loan to the campaign, you must notify the Commission within five (5) days of the date of the contribution/loan. (AS 15.13.078(b)(2)). The reimbursement may not occur until after the date of the election, in accordance with AS 15.13.116.

Alaska Public Offices Commission

2221 East Northern Lights, Rm. 128 Anchorage, Alaska 99508

Ph. (907) 276-4176 Fax: (907) 276-7018 Toll Free (800) 478-4176

03/2010 doa.apoc

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