Caylor, [Bill] Mike
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
g For Single-Candidate Committees
1. 4AEj {EP~O :Lot $ I2.~FPAeDIDATE V O1; M~E~"~ / C W
CANDIDATE 3.CTITTE2o '5
2.b. KEJ~~EEfAME
0- L
4.a. CAMPIIAIGN ADDRESS AND PHONE
reet or Ruj4 Route_ stye p~d P~~ ~~-5
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.
Street or Rural Route City State Zip Code Phone
OFF 41 S~OG,HT nclude 'strict n~ uqber, applica6. E OF POLI fIAL T EASUR ma be candidate)
wf~WI V ,`1~~`V ~ r~
7. CATEGORY OR REPO (Check one)
FIRST SECOND THIRD FOURTH PRE- PRE- MIDD❑YEAR YEAR❑-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
~TE O EPORTING PERIOD
S.a. BFGINN~G D( OF REPORTING PERIOD 8.b. XDIN
9. (Check one)
a. ❑ This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi-
t s total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.)
b. This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000
and/or expenditures total more than $1,000 for this reporting period.
10. I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an
accurate accounting of campaign contributions and expenditures required to be reported by the candidate committee by the Campaign
Financial Disclosure Act. Additionally, [/we swear or affirm that no campaign contributions have been expended for the personal financial
b2h fi of th ndi to or for any other nonpolitical purpose as defined by the federa internal revenue code.
4-21-16 /it
signature of ca idate date si natur political tr r r d to
11. WITNESS SIGNATURE
signature of witness date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $
b. TOTAL RECEIPTSTHIS PERIOD ! 10
c. TOTAL DISBURSEMENTS THIS PERIOD 2A 43
.75
P~..1...2...
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $
Q, S
e. TOTAL LOANS OUTSTANDING ..........................................................,r~........... $
ED m
f. TOTAL OBLIGATIONS OUTSTANDING ...........................................0........... $
SS-1109 (Rev. 2/06) k9 ~CTO'' Page 1 of RDA 1159
s~~ztWd ~a
SUMMARY PAGE - CANDIDATE
13. NAT EfICANDATE dR JEMMITTEE (In Full) 11. R PORT COVERING THE PER OD
RECEIPTS
15. CONTRIBUTIONS (other than loans and interest)
a. Unitemized Contributions ($100 or less from each source this period) $
b. Itemized Contributions (over $100 from each source this period) $ ff''')
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ l l 1 W
16. LOANS RECEIVED THIS REPORTING PERIOD
17. INTEREST RECEIVED THIS REPORTING PERIOD
18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ lo
DISBURSEMENTS
19. EXPENDITURES (other than loan payments)
a. E enditures ($100 or less each payee this period) (must be listed by category - g., printing, postage, gasoline)
$
~N~e ~O 5 $ 2.?)
$
$
$
$
$
$
Total of Expenditures $100 or less each payee) $
b. Itemized Expenditures (Over $100 each payee this period) $ V +7 y
c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ IB24
20. LOAN REPAYMENTS MADE THIS PERIOD $ Q-JO - do
82
21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $
22.IN-KIND CONTRIBUTIONS
a. Unitemized in-kind contributions ($100 or less from each source this period) $
b. Itemized in-kind contributions (over $100 from each source this period) $
c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $
23. OBLIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $
b. Itemized Obligations Outstanding (Over $100 each) $
c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $
SS-1133 (Rev. 4102) Page of
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. N ANDIDIjrFS OR C M TEE 2. REPORT COVERING THE PERIOD
lea IR41w- 1% TO?[ 14Y
Amount
3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than $100 from an contributor
First Name Middle Name Contribution Received For: Amount of Contribution
Las~rr~lOrg i tick Nam~~ ~ 9050ro"Mary Election ❑ General Election (~O
Addr ~ 0
~4 P~k XA V, ❑ Runoff (Local Elections Only)
City 1 , Date of Contribution Aggregate This Election
Occupation 1
Employer
First Name Middle Name Contribu Received For: Amount of Contribution
L a e/O nation a Primary Election ❑ General Election
~ s ❑ Runoff (Local Elections Only) VO
Ad` S1,346
-
Cit V,r _ ~j/_, Date of Contribution Aggregate This Election
Occupation {v
Employer
First Name iddle Name Contribution Received For: Amount of Contribution
Last Name /Organization Name ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
Occupation
Employer
First Name Middle Name Contribution Received For: Amount o Contribution
Last Name/Organization Name ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
Occupation
Employer
5. TOTAL ITEMIZED CONTRIBUTIONS
(Carry forward to item 3. of next page if additional pages of this form are used.)
(If this is the last page of contributions, this amount must be shown in item 15b. of summary.)
SS-1131(Rev. 2/06) Page of RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1, N ANDLW"E 0 0 ITTEE R POR COVERING THE PERIO
li(j• T i
m nt
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period)
First Name Middle Name Purpose of Expenditure Amount of Expenditure
L t ame/Bye+n ss Nam i UID. Pos -~Lk
10 ON -t I o uL+ N.J First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address
City State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NamelBusiness Name
Address
City State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address
City State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address
City State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NamelBusiness Name
Address
City State Zip Code
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to item 3. of next page if additional pages of this form are used.)
(If this is the last page of expenditures, this amount must be shown in item 19b. of summary.)
0 SS-1129 (Rev. 4/02) Page of RDA 1159
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. ~ATEQF REPORT 12.a. ~„(V~MF !W0- Mt~~` l%`~~O t~~~ mi 113 2.b. IF COMMITTEE, NAME OF CANDIDATE '/V`` ~ 3. ECTIO DATE
~ 20 lS
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural R to Ci State Zip Coe Phone
12OD (%ACu C~r lqf' U~t Tel 3-7 5ID X3233143
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.)
Street or Rural Route ~Q City State Zip Code Phone
C,/i V
~OFFSOG 'T clude di_ strictgn= if applicable) 6. ME OF P `CjTREAR ay be candidate) V4
7. CATEGgRYORVREPO T((C/heecck~~one)
❑ ❑ ❑ ❑ ❑ ❑ ❑
FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE F REP TING PERIOD
cln, % 2F)t~
9. (Check one)
a. CJ T his campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi-
tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.)
b. ❑ This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000
and/or expenditures total more than $1,000 for this reporting period.
10. I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an
accurate accounting of campaign contributions and expenditures required to be reported by the candidate committee by the Campaign
Financial Disclosure Act. ditionally, I/we swear or affirm that no campaign contributions have been expended for the personal financial
Ve~t of a ca ate r f r any other nonpolitical purpose as defined by the feder internal revenue code.
'b
signature of candidate date si at of polit qa urer date
11. N S SIGNATURE
xvy
signature f tness date sig re of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $
b. TOTAL RECEIPTSTHIS PERIOD $
c. TOTAL DISBURSEMENTS THIS PERIOD ECEIVED....................................... $
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) APR i p ....2o $
e. TOTAL LOANS OUTSTANDING ..................................OM........................................................................... $
f. TOTAL OBLIGATIONS OUTSTANDING $
4) SS-1109 (Rev. 2/06) Page 1 of RDA 1159
A
RECEIVED
Appointment of Political Treasure'' ~ ` "
U NT COUNTY
For State and Local Candidates and Single-Candidate Committees ELECTION
INSTRUCTIONS
The Appointment of Political Treasurer statement must be used to appoint a political treasurer as required by
the Campaign Financial Disclosure Act (T.C.A. § 2-10-105) for state and local candidates and single- candidate
political campaign committees. A state candidate may not receive or expend funds for an election until a
political treasurer has been appointed for that election. A local candidate pursuant to T.C.A 2-10-101, may be
exempt from completing this form, please check with county election commission for more information. A
candidate may appoint himself or herself as political treasurer. A new form must be filed if the treasurer is changed.
Candidates for state public office must file their original Appointment of Political Treasurer statement ONLY with
the Registry of Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360.
Candidates for local public office must file their original Appointment of Political Treasurer statement ONLY with
their county election commission.
1. Date: =;Candidate rst and Last Name: 3. Candidate e-mail address:
Z~'0- 8 . CG o 12. bmca~l or~ma~ V;~~-~~►. o
4. Campaign Address and Phone: City State Zip Code Phone
3
IZEO ~r~ 0 0L C ~ ~cCV2 ~v- t(q"k4- To 378o4 Bros3233 114
5. Home Address and Phone (if different than item 4 above): City State Zip Code Phone
6. Office Sought (include district number, if applicable) 7. Party Affiliation 8. Election Year
~~o~~- Conniu~s~co►~ p~s~v ~s1-5~'3
9. Treasurer Name:
10. Treasurer e-mail address:
I
Asp) - Cc)&&
11. Treasurer Address and Phone: City State Zip Code Phone
sa6\ e, R GS 3 t1c) S2 6 b
12. Candidate a d Treasurer Sign ture (both signatures must be witnessed. T asurer can not witness can idate's signature):
L (J
Signature of Candidate ignatur r urer
Signature of Witness Signature of Wit
Registry of Election Finance
SS-1120 (rev 12/2013)
IAL DISCLOSURE STATEMENT
CAMppIGN FINANCIAL
For State and Local Candidates
For Single-Candidate committees ~O
`-a
2.a~^MEOFCANDID TEORCOf~tM{IT tkeG~ n ^
1. ATE OF REPORT I l (J~ l
-2-q - ` 3. EI,E,CTION DACE
2.b. IF C IA~ NA F CANDIDATE AA ~L
a 1M~-JiJ~. Phone
4.a. CAMPAIGN ADDRESS AND PHONE 1`~1
ty 1 M ate 0~{ 32
`,r~t`O~` R`U~ r^ n S, c 3
l.~C~ Phone
State Zip Code
4.b. CANDIDATE'S HOME ADDRESS (if different tC iy 4.a.)
Street or Rural Route A ~r
licable) B. ME OF POUT C L T ASURER (y~1Y be ca~ate)
G
OFFICE SOUGHT (include ^~ber{ P Nt4k \
❑ ❑ MID-YEAR YEAR END
7. CATEGORY OR REPORT (Check one
❑
❑ FOURTH GENERAL SUPPLEMENTAL SUPPLEMENT
FIRST SECOND THIRD R - PRE
QUARTER QUARTER QUARTER QUARTER PRIMARY
8. . ENDI`DATE gREP T IP E
8.a. BEGINNING DATE IFJRCP_ORTINGIlP,ER`IOD 2
T 22
9.(Chec one)
lemstions (includin in-k) d) received total $1,000 or less AND expendi-
a. This campaign is exempt from detailed disclosure bC contribu
tures total $1,000 or less for this reporting period. ( Ple
b. This campaign is required to file a detailed financial disclosure bc use contributions (including in-kind) received total more than $1,000
and/or expenditures total more than $1,000 for this reporting period.
report is an
ereport is true itte and that this financial
campa for I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure e
ded the personal
10. accurate accounting of t. Addi contributions a expenditures required to be reported by the candidate
internal have been
I/we swear affirm that no campaign as defined by the contributions
code. /
Disclosure Act. for ai nally,
net ft e candi q C1/a..0/L
l l date ,
natu e of politics surer
date
si t of candida
11. WITNESS SIGNATURE
date
date signature of witness
signature of witness
12. SUMMARY $ C
a. BALANCE ON HAND LAST REPORT
9.34
$
~ 0 f.<.
b. TOTAL RECEIPTS THIS PERIOD APW•
$
C. TOTAL DISBURSEMENTS THIS PERIOD
:
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.
e. TOTAL LOANS OUTSTANDING
f. TOTAL OBLIGATIONS OUTSTANDING
Page 1 of RDA 1159
SS-1109 (Rev. 2106)
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT NAME QF DIDATE Ott COMNREE
3. ELECTION DATE
2.b. I CQM ITTEE, E OF Cf NDIDATE
4.a. CAMPAIGN ADDRESS AND HONE 4 N ip C Phone
Street or Rural Rout A
~
1 ~ &nt
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) State Zip Code Phone
Street or Rural Route ~KA Cif
OFFICE SOUGHT (include district number, if applicable) 6. NALAFE OF POLITIC~`~ASURER Imay be ndidate)
[r~Z~ ~~043
7. CA EGO OR REPORT (Check one) ❑ ❑ ❑
p❑RE- MIDYEAR YEAR-END
SECOND THIRD FOURTH PRE-
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
9. (Check one)
a. ❑ This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi-
tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.)
b. This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000
X and/or expenditures total more than $1,000 for this reporting period.
10. Ihve do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an
accurate accounting of cam aign contributions and expenditures required to be reported by the candidate committee by the Campaign
Financial Disclosure Act. A ditionally, I/we swear or affirm that no campaign contributions have been expended for the personal financial
ben it of the Ca ida or f r any other nonpolitical purpose as defined by the fede I internal revenue code.
1 _l ' '~f 1
date si atur politica er date
signature of candidate
11. WIT ESS SI NATURE
1 3 _j Ll-
date U nature of witness date
signature of witness
ff MMARY
BALANCE ON HAND LAST REPORT $ TT ~zo $
1-710
. TOTAL RECEIPTS THIS PERIOD ry i ry
c. TOTAL DISBURSEMENTS THIS PERIOD . : $
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.)
e. TOTAL LOANS OUTSTANDING $
$
f. TOTAL OBLIGATIONS OUTSTANDING
Page 1 of RDA 1159
Aft
SS-1109 (Rev. 2106)
f<
~r'
SUMMARY PAGE - CANDIDATE
13. M rANM*TE O C MITTEE (In Full) 14. REPORT COVERING THE PERIOD
\ FR T0:
RECEIPTS
15. CONTRIBUTIONS (other than loans and interest)
a. Unitemized Contributions ($100 or less from each source this period) $
b. Itemized Contributions (over $100 from each source this period) $ c? `may
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ -7
16. LOANS RECEIVED THIS REPORTING PERIOD _61-
17. INTEREST RECEIVED THIS REPORTING PERIOD 'Ie~"
18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ DISBURSEMENTS
19. EXPENDITURES (other than loan payments)
a. E ndi`ures $100 or less each payee this period) (must be listed by category e. printing, postage, gasoline)
40
$
$
Total of Expenditures ($100 or less each payee) $
b. Itemized Expenditures (Over $100 each payee this period) $ I 4
c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ V~~ y~ l `
20. LOAN REPAYMENTS MADE THIS PERIOD XJ
21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ tQ l Iq
22.IN-KIND CONTRIBUTIONS
a. Unitemized in-kind contributions ($100 or less from each source this period) $
b. Itemized in-kind contributions- (over $100 from each source this period) $
c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $
23. OBLIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $
b. Itemized Obligations Outstanding (Over $100 each) $
c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $
Afflhk
SS-1133 (Rev. 4/02) Page of
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NA A ID:::Z
` 2. REPORT COVERING THE PERIOD
FR ..S ( TO: 3 -1
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) mount
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period)
First Name Middle Name
Purpose of Expenditure Amount of Expenditure
t aRr ~u ness e l p
Add
F)o !~;vV - s v
Gty
First Name Middle Name Purpose of Expenditure
Amount of Expenditure
t N gsi `CD~ LP
C 02, Add
n ~
r-F--Z- ~
G " ~~CJ
L
First Name Middle Name Purpose of Expenditure
Amount of Expenditure
m u ine
Ad SeNm ~IkA ~ aj l 250
`'~vv S aJ
Ci
First Name Middle Name
Purpose of Expenditure Amount of Expenditure
Last ame u s jp cj~ caccL 6 O
Addret ♦ ~ n 1 I ~ 1 ~ , °
city `3~-- Zi Code
First Name Middle Name Purpose of Expenditure
Amount of Expenditure
Last Name/Business Name
Address
city Slate Zip Cade
First Name Middle Name Purpose of Expenditure
Amount of Expenditure
Last Name/Business Name
Address
City State Zip Code
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to item 3, of next page if additional pages of this form are used.)
(If this is the last page of expenditures, this amount must be shown in item 19b. of summary.)
A3h
SS-1129 (Rev. 4/02) Page of RDA 1169
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAMAOf C AfN, DATE ORICOMM1I' E 2. REPORT COVERING THE PERIOD
V~ FRO T0:
3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) Amount
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than $100 from an contributor
FW&M Middle Name Contribution Received For
at\ h1 Amount of Contribution
Last ryarJOrgantzatioA,N me I
t rimary Election ❑ General Election J[,O
~TG1r V_ ~
Address . 0- rU I ❑ Runoff (Local Elections Only)
City r Date of Contribution
cm, Aggregate This Election
Occupatbn, ~(C u l Co I V-}- 3 -2-g - 1 q .
Employer v 1
First Nam Middle Name Contribution Received For. Amount of Contribution
Last N A~rga ' 'n Name Primary Election ❑ General Election
SDC~
Address.-5 L ❑Runoff (Local Elections Only)
Date of Contribution
~ Aggregate This Election
Occupation
Employer o~ W
tt ~l
l~
First Nam iddleName Contribution Received For: Amount of Contribution
La7
a as name rimary
Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
Crly b~,() ` Zip Code Date of Contribution
vp~ ~ Aggregate This Election
Occupation
t:mp ye
First Name Middle Name Contribution eceive or. Amount o ntn upon
Last Name/Organization Name
❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City State ZrpCode Date of Contribution Aggregate This Election
Occupation
Employer
5. TOTAL ITEMIZED CONTRIBUTIONS
(Carry forward to item 3. of next page if additional pages of this form are used.)
(If this Is the last page of contributions, this amount must be shown In item 15b. of summary.)
SS-1131(Rev. 2/06) Page of RDA 1159
Appointment of Political Treasurer
For State and Local Candidates and Single-Candidate Committees
INSTRUCTIONS
The Appointment of Political Treasurer statement must be used to appoint a political treasurer as required by
the Campaign Financial Disclosure Act (T.C.A. § 2-10-105) for state and local candidates and single- candidate
political campaign committees. A state candidate may not receive orexpend funds for an election until a
political treasurer has been appointed for that election. A local candidate pursuant to T.C.A 2-10-101, maybe
exempt from completing this form, please check with county election commission for more information. A
candidate may appoint himself or herself as political treasurer. A new form must be filed if the treasurer is changed.
Candidates for state public office must file their original Appointment of Political Treasurer statement ONLY with
the Registry of Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360.
Candidates for local public office must file their original Appointment of Political Treasurer statement ONLY with
their county election commission.
1. Date: 2. Name of
Candidate or corn ittee: 3. Candidate e-mail address:
/ Ca~~o
ri - t q I A t~.E F, 16MCatA Jha v'1~¢
-+Ii. %d✓
4. Campaign Address and Phone: City State Zip Code Phone
~-oo ~e4ja., e tiro M.g4k, -W 319oli4 3'2Z St43
5. Home Address and Phone (if different than item 4 above): City State Zip Code Phone
6. Office XSoght (i9~lude dis`rid n mbggr, if applkable) 7. Party Affliation 8. Election Year
C O~l `C:~/1AMC50~OIJ t2) -2 kq
113, GeCA
9. Treasurer Name: 10. Treasurer e-mail address:
C4044-' "~J-CWA
I LW-
11. Treasurer Address and Phone: City State Zip Code Phone
~20o I~~r~~a. C~rG~ Mb{c/►'~I~ `C'rJ 3`l 3~0--52eir
12. Candidat nd Treasurer at re (both signatures must be witnessed. Treasurer cannot witness candidate's signature):
C
AA.
Signature of Candi to Sig ture of Tres re
w
Signature of Wit es Signature of Witnes
Registry of Election Finance
SS-1120 (rev 10=10)
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Com Ittees
1. ATEt~FREPOt (0 to 12.a. ~ DIDATE MMI E R
2.b. IF COMMI EE, NAME OF CANDIDATE 3. CTIOAT
4.a. CAMPAIGN ADDRESS AND PHONE O'
Street or Rural Ro e , city
0' liar CV_ ~3~
4.b. CANDIDATE'S HOME ADDRESS (if different th4-D
Street or Rural Route City State Zip Code Phone
5. OFF S f HT Mde tricf\um er, r ppl ble) 6. NAME OF POLITICAL SUR R (may be candidate)
7. CATEGORY OR REPORT( eckone) "
FIRST SECON0 1:1 D THIRD FOURTH PRE- ❑ PRE- 1:1 ❑
MID-YEAR YEAR-END
UARTER UARTER QUARTER UARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. E ING ^ ^-^^RTING PERIOD
.-A uve C)
9. (Check one
a. This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi-
tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.)
b. ❑ This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000
and/or expenditures total more than $1,000 for this reporting period.
10. l/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an
accurate accounting of campaign contributions and expenditures required to be reported by the candidate committee by the Campaign
Financial Disclosure Act. Addit nally, I/we swear or affirm that no campaign contributions have been expended for the personal financial
efi
t o the candida r for ar~y other nonpolitical purpose as defined by the fed ral internal revenue code.
X-acs
signature of candidate date 'Vgnat of politi I asure date
11. WITNESS SIGNATURE
signature of witness date signature of witness aM pM / e
12. SUMMARY r
VED s`
~ RECEI
a. BALANCE ON HAND LAST REPORT
~ 4 101
A 1G 0
b. TOTAL RECEIPTS THIS PERIOD $ BLOUNT COUNTY
~,►,ECTt~
o
c. TOTAL DISBURSEMENTS THIS PERIOD $
W
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2106) Page 1 of RDA 1159