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FEC FORM 2

STATEMENT OF CANDIDACY

FILING FEC-1031655

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1. Theodore Edward Rokita

5802 Oak Avenue
Indianapolis, IN 462197219

2. Identification Number: H0IN04170

3. Party: Republican Party

4. Office Sought: House of Representatives

5-6. State & District of Candidate: Indiana - 4

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DESIGNATION OF PRINCIPAL CAMPAIGN COMMITTEE

7. I hereby designate the following named political committee as my Principal Campaign Committee for the 2016 election(s).

    Hoosiers for Rokita, Inc.
    FEC ID #: C00476192

    5802 Oak Avenue
    Indianapolis, IN 462197219

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DESIGNATION OF OTHER AUTHORIZED COMMITTEES

8. I hereby designate the following named committee, which is NOT my principal campaign committee, to receive and expend funds on behalf of my candidacy.

    Hoosiers Victory Fund
    FEC ID #: C00590901

    824 S Milledge Ave
    Suite 101
    Athens, GA 306051332

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DECLARATION OF INTENT TO EXPEND PERSONAL FUNDS (House or Senate Only)

9. I intend to expend personal funds exceeding the threshold amount (see 11 C.F.R. 400.9) by

    9A. 0.00 for the primary election, and
    9B. 0.00 for the general election

Signed as: Theodore Edward Rokita
Signed by the candidate on: 11/03/2015

Filed: 11/03/2015

(End FEC FORM 2)

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