Loading...
Moon, Jerome F. M FINANCIAL DISCLOSURE STATEMENT EXEMPTION `p I Pursuant to TCA § 2-10-101(b) a candidate is exempt from filing financial disclosure statements: "If a candidate is seeking an office for which service is part-time, compensation is less than $1,000 a month, and the candidate does not spend more than $1,000 to get elected to office, the candidate does not have to file Campaign Financial Disclosure Reports." A-u G . CANDIDATE'S INFORMATION: Candidate's Name: Candidates Position: CP v,&W" t s S 1~ Residential Address. : City: [Jr State: TN Zip 3 I hereby state that I meet the above qualifications for exemption and am therefore exempt from filing financial disclosure statements. ; /-O/L Candidates Signature Date Wit s's Signature Date If my plans change and I realize I will spend more than $1,000 on my campaign, I will immediately make a financial disclosure report. FINANCIAL DISCLOSURE STATEMENT EXEMPTION Pursuant to TCA § 2-10-101(b) a candidate is exempt from filing financial disclosure statements: "If a candidate is seeking an office for which service is part-time, compensation is less than $1,000 a month, and the candidate does not spend more than $1,000 to get elected to office, the candidate does not have to file Campaign Financial Disclosure Reports." CANDIDATE'S INFORMATION: Candidate's Name: cJ~YO M O~/` , Candidates Position: C0u4Z Ca W n41 o Nt-~2 Residential Address:/ 8Z5 rvtt, T Y 1l~ City: State: TN Zip: -374*e9,,-F I hereby state that I meet the above qualifications for exemption and am therefore exempt from filing financial disclosure statements. Candidate's Signature Date ?-2(o-C Witness's Signature Date If my plans change and I realize I will spend more than $1,000 on my campaign, I will immediately make a financial disclosure report. "00~ mmn~ CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates "For Single-Candidate Committees 1. DAYEOO ~ T2.a.~JFR NAME OF CANDIDATE OR COMM(TT EE off' F 2.b. IF COMMITTEE, NAME OF CANDIDATE / 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE 2~~d Street or Rural Route City ,A 11119 . M A A vState / Zip CodeQ Phone 4.b. C IDATE'S HOME ADDR S (ff different than 4.a.) w Too ~~Q SUeet or Rural Route city state Zip Code Phone 5. OFFICE SOUGHT (include district number, If applicable) g• f NAME OF POLITICAL TREASURER (may be candidate) T ~i~t~6S:,oir~ Sp~ G v d71I 7. CATEGORY OR REPORT (Check one 13 Q ) FIRST SECOND THIRD FOURTH PR ~ PRE- PRE- MID-YEAR 8.a. BEGINNINGDATEOF,-%,"IINGPERIOD PRIMARY GENERAL UPPLEMENT ~ ND cT~L ZO 8.b. ENDING DATE OF REP )ftI1 PERIOD 51 9. (Check one) > a. This campaign Is exempt from detailed disclosure became contributions ncludi tures total $1,000 or less for this reporting ng 12f.) d) received total $1,000 or less AND e ~n9 period. (Complete items 12d., 12e. and 12L) xpendi- b• C3 This campaign is required to file a detailed financial and/or expenditures total more than $1,000 for this disclosure because contributions (including in-kind) received total more than $1,000 Porting period. 10. Uwe do solemnly swear or affirm that the Information contained in this cam accurate accounting of campaign contributions and expenditures required to pa bbeigrepoandb disclosure report is true and that this report is an Financial Disclosure Act. Additionally, l1we swear or affirm that no campaign contributions have bee Nate committee by the Campaign nded benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue ocode. for the personal financial .22 nature of candidate date gnature of political treasurer date 11. WITNESS SIGNATURE C1~~ signature of witness r/ signature of Air ss date 12. SUMMARY a. BALANCE ON HAND LAST REPORT b. TOTALRECEIPTSTHISPERIOD c. TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) O 15 e. TOTAL LOANS OUTSTANDING f. TOTAL OBLIGATIONS OUTSTANDING SS-1109 (Rev. 20) -JI Page 1 of RDA 1159 `qV ~~d( 56789 ~o VAI- ppointment of Political Treasurer v> y A For State and Local Candidates and Single-Candidate Committees INSTRUCTIONS X84 ~ c'1~~ The - ent 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 2-10-10 1, 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: 2. Name of Candidate or Committee: 3. Candidate e-mail address: 4. Campaign Address and Phone: City State Zip Code Phone S. 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 Affliation 8. Election Year 13/4iA~aNAW ~ G~ Mrns"7)L) St~9 TIC 9. Treasurer Name: 10. Treasurer e-mail address: ,j_c-r2t)j F 00t))t) 11. Treasurer Address and Phone: City State Zip Code Phone ~i% el) L{ >~P4~1 ryrW_5 M 12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature): Signature of Candidate Signature of Treasurer Signature of Witness Signature of Witness Registry of Election Finance SS-1120 (rev 10/2010) 0-oww", CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT / 2.a. NAME OF CAN IDATE OR COMMITTEE / ' Y 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 20/b 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route ~^~CI State Zip Code Phone 41. CANDIDATE'S HOME DR S ('d different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) 7. CATEGORY OR REPORT (Check one) Fl❑RST SECOND T ~ FOU11 RTH PIE- PR13 E- Mi YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.15. ENDING DATE OF REPORTING PERIOD /v407-- 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. 1/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, Vwe swear or affirm that no campaign contributions have been expended for the personal financial benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. signature of candidate date( signature of political treasurer date 11. WITNESS SIGNATURE / ZA , ~ AQ&]~? signature of witne date signature of witness ate 12. SUMMARY a. BALANCE ON HAND LAST REPORT - $ b. TOTAL RECEIPTS THIS PERIOD °j r c. TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) 41 • / e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ SS,4109 (Rev. 2106) Page 1 of 4- RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATIEMENT" '101! For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMM(TTE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE State Zip Code Phone Street or Rural Route city l L7 n `7rLL~I~ !l L ~!v y Ile 7 -3 ;7 4.b. CANDIDATE'S HOME ADDRESS differ eft than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number. If applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) 7. CATEGORY OR REPORT (Check one) FIRST SECOND T ~ F ~ ~ MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD g. (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. Uwe 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, Uwe swear or affirm that no campaign contributions have been expended for the personal financial benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. 71& 4 signature of candidate date r signature of political treasurer date 11. WJTNESS SIGNATURE /17 7 -W/ 3 , 2P13 id IL/Xr-, - signature of witness date signature of witne s date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTS THIS PERIOD $ c. TOTALDISBURSEMENTSTiIS PERIOD ...................................................................................3 d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) ................................................................................................e Zz,~ e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ SS-1109 (Rev. 2106) Page 1 of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates -For Single-Candidate Committees 1. DATE OF RE 2.a. NAME OF CANDIDATE OR COMMITTEE -7 2.b. IF CO I EE, NAME OF CANDIDATE 3. ELECTION DATE 2pl 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone l' I+ ~ ~ -Awt? - / ~ I & 11,11e, 78a~ ~Lff 4.b. CANDIDATE'S AOKRP- ADD SS (d different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE/ SOUGHT (include district number, If /applicable) 6. NAME OF POLITICAL TREASURER (may be ndidate) 7. CATE 1:1 1:1 0 1:3 1:3 GORY OR REPORT (Check one) MIX R SECOND THRD FOURTH PRE- PRE- MIDYEAR YEAR❑-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.15. ENDING DATE REPORTING PERIOD s. (Check one) This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- res 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. Uwe 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 AcL Additionally, Uwe swear or affirm that no campaign contributions have been expended for the personal financial benefit of the candidate or for any other nonpolitical purpose as defined by the federal Internal revenue code. 7 331~WZ- s atu e f cand' a date re of political treasurer date 11. WITNESS SIGNATURE 4 1, Aaa. zzuz-V signature of witnessf- da signature of kitness ate 12. SUMMARY a. BALANCE ON HAND LAST REPORT :17. ~ . ......~'Si................. $ ~l Q` W b. TOTAL RECEIPTS THIS PERIOD ................:..........~.~,......ti.._............ $ c. TOTAL DISBURSEMENTS THIS PERIOD A U y to $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) . u"'... .1 . . $ z ~4 e. TOTAL LOANS OUTSTANDING ~ 5 $ f. TOTAL OBLIGATIONS OUTSTANDING $ 22 p. S&IJ09 (Rev. 2106) RDA mires CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE _j-jj~j / S ze, / ~ 'i~`Tyl,1 L-~: / i 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE SFt,),.f tor Rural Route City State Zip Code Phone 4.b. CANDIDAT 'S HOME ADDRES (if differ nt than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) f GI o0 , C~!/r-fi :i~Gt7C SCE -T~- °JL'~ G i" 7. CATEGORY OR REPORT (Check one) 1:1 El El 1:3 FIRST SECOND THIRD FOURTH P❑RE- PRE- MID-YE AR YE4 K-D DARTER 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 pampaign 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, Uwe swear or affirm that no campaign contributions have been expended for the personal financial benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. signature of candidate date r's' ature of political treasurer date 11. WITNESS SIGNATURE 2- signature of witness dat signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ b. TOTALRECEIPTSTHISPERIOD x........................................$ c. TOTALDISBURSEMENTS THIS PERIOD d. BALANCE ON HAND 12.a. plus 12.b. minus 12.c. e / e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ - Aflk SS-1109 (Rev. 2106) Page 1 of RDA 1159 IMP, SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD FROM: TO: 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. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 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.) $ DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage, gasoline) $ $ $ Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD $ 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 121) $ SS-1133 (Rev. 4102) Page of ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: TO: 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more then E1go from any source during the period) Complete the Following for the Source of the Loan First Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Beginning of Period) Received Payments (End of Period) Last Name/Organization Name Address Loan Received For. Dale of Loan ❑ Primary Election ❑ General Election city Stala Zip Code ❑ Runoff (Local Elections Only) List All Endorsers or Guarantors forAbove Loan (If more space is needed please attach a page) First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organizatlon Name Address Address City State Zip Cade Gb State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last NamelOrganizabon Name Address Address Gb State Zip Code city State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City Stale Zip Code city State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address city State Zip Code City State Zip Code Amount Guaranteed Outstanding mount Guaranteed Outstanding 4. Totals for all Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans Loan Obtstanding Loan Balance (Total bans received should also be shown in item 16. on summary page.) (Beginning of Period Received Payments End of Period) (Total loan payments should also be shown in item 20. on summary page.) (Total outstanding loan balance should also be shown in item 12.e. on front page.) SS-1132 (Rev. 4/02) Page of RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: TO: oun 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 9 Am 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any oontnbutordudrp the period) First Name Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution Last NamelOrganization Name ❑ Primary Election ❑ General Election ❑ Runoff (Local Elections Only) Address Date of In4QW GonUrbution Aggregate thus Election City State Zip Code Description of In4Qnd Contribution Occupation Empbyer First Name Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last NamefOrganization Name ❑ Runoff (Local Elections Only) Address Dale ofin-bndConlnbution Aggregate this Becilm City State Zip Code Descr#on of In-Wrid Conhitwtion Occupation Empbyer First Name Meddle Name In-IGnd Contribution Received For. Value of In-Kind Contribution Primary Election [I General Election Last NaWOrganization Name ❑ Runoff (Local Elections Only) Address Daleof in-land Cantribulkin Aggregate this Election City State Zip Code Description of ]"nd Contrttwtion Occupation t-mplom First Name MIn-Kind Contribution Received For. Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last NamelOrganlzattonNome ❑ Runoff (Local Elections Only) Address Date ofin-WndConb'butioi Aggregate this Election City State Zip Cade Desaiptbnof lMGndContnbution Occupation Empbyer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contnbution Primary Election ❑ General Election LastName0ganization Name ❑ Runoff (Local Elections Only) Address Date dln-Kind Contribution Aggregate this Election City Slate Zip Code Description of "rid Contribution Occupation pioYfer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carry forward to hem 3. of next paged additional pages of this form are used.) Of this Is the last page of In-kind contributions, this amount must be shown in item 22b. of summary.) QD SS-1128 (Rev. 2106) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: tm'oun 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures Witting more than $100 to any payee during the period) First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness Name Address Gty State zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name6usiness 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 NameBusiness Name Address city state Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness Name Address Qy State Zip Code Fast Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address c3ty 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.) Anti, SS-1129 (Rev. 4102) Page of RDA 1159 CAMPAWN FINANCIAL Dam sm STATEMENT MEW mime LOOM Forsaom.C■ dNuft Cosa 1_ DATEOFREORT 2AL NIWEOFCANDDATEORCOMMITTEE 2b. IF COLG TTEE. NAM: OF CANDIDATE I P-- 3. ELECTION DATE S 2zs/ z~> 4.a CAMPADN ADDRESS MID PHONE Street or or Rural Rule Cdy State zv Code Phone i/li 5~ 5 rf~ d o !I ! s /moil / ,Xi 4.b. cAND"TFS HOME ADORM (O than 4.a.) Street or Rural Route CRY Stets Tip Code Phone OFfICE (ia#ide district number. If appicable) 6. NAME OF POLITICAL. TRH (mmyrbye tea) 5. Ake 7. CA OR( 0 ❑ ❑ ❑ ❑ ❑ ❑ FIRST SECOND THIRD FOU10H PRE` PRE- MD-YEAR: YEAR-EM &a. BELONNNGDATEOFREPORTMPEffiM Ob. ENDWGDATEOFREPORTMPEMM _ e~, 9. one) received tram $1 OW or less AND sVw d- Wdnd) a. ❑ This cernpaigrr Is q~ F I I >n n detailed disdosrae because ax* btdw s (ndudng i ~/'"n tolaf $1.000 or Im for Mb reporting period. (Compieb Hems 12d-, 12e. and 12f.) b. ® This =MOW is required to file a detaied financial di0*wm because om*&Jftm fndu~n9 i~-laan received tolat mope Vw $1.000 J ` andlbr folal mosey tlsan 11.000 for this repodirg Pettod 1& iNve do soiamnty mmm or afto 00 the irfarrrrer6on oorrtained in Ois cwrpalgn lirmndel diedow" report is tree and-OW Oft report is an aoarab aceotntiq of carapaigrr eorddbtdons and 1 1 rcihrres mgt drad to be reported by the canrxdete eornrnitae by the Campaign Rmidel Diedow" Ad AdMoneNy. IlWo smrw oraflim Omi no campaign eontritwl m have been eogrended fa Ore peraaml irmndal ban a M of the csrrdi & or for any other nonpoacd purpose as delbed by ft federal irlerrml reverie code nature of c trrtidale dais *P10" powcal beasim date 11. VNiN1ESS SUTURE Aell 1k, si ob" of wftm aigrmbae of wdrress date 12. SUMMARY ..............._._.._...._......_._.»...............»........_.»».....».......i a BALJ,NICEONHANDI.ASTREPORT b. TO1ALRECEIPTSlHISPER1OD _ ...i c. TOTAL THISPEMM i d. BALANCE ON HAND (12.a. plus 12.b. mhn 12~m) O l' . e TOTALL OANSOUTSTANUING i ' r co c" _ C TOTALOBL IGATIONSOl1TSTANDWG_.»._.... _ -.,WI1I ~i . Q » M» i 00 IS ELECTION o SS-1109 (Rev. 20) en > ` N- Pape 1 of ~ RBA 1159 Wb Wet Tl~ SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) d 14. REPORT COVERING THE PERIOD FROM: T0:, / 3 0 ~i 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. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 16. LOANS RECEIVED THIS REPORTING PERIOD 17. INTEREST RECEIVED THIS REPORTING PERIOD V d r 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage, gasoline) $ $ $ Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ l~©d~ c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD $ 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) 22AWKIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ r 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) $ G c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $ V ■ SS-1133 (Rev. 4102) Page G= ' of -7- ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: l TO: /i mount 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) - i) - 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 Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Dale of Contribution Aggregate This Election Occupation Employer First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organization Name ❑Primary Election ❑ General Election Address ❑Runoff (Local Elections Only) City state JT~~da Date of Contribution Aggregate This Election Occupation Employer First Name iddle Name Contribution Received For: Amount of Contribution as 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: Amounf 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 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.) 0 SS-1131(Rev. 2106) Page . of _~7 RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE -/7 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FRO TO: m0un 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any contributor during the period) First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Data of In-Kind Contribution Aggregate this Election City state Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election city state Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation LMP10yer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) (If this is the last page of in-kind contributions, this amount must be shown in item 22b. of summary.) SS-1128 (Rev. 2106) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD , ~~%'!~►f FROM: i TO: ~Q Grp 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) Amount 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 Last Name/Business Nam Gl~T~ Address Se~ city / v ` )47L 1/, 11 Stns7V Zip. e First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Busines s Name VP OA/6- Address I J 3 3 City Y~ ~ State Zip Cod Q , Ile- 77ty/ 3 O First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City j_ state Zip Code l~ E 7-W I First Name Middle Name Purpose of Expenditure Amount of Expenditure Las~Name/Businpss Name Address City State Zip Code / / Zp 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 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.) 7 ■ SS-1129 (Rev. 4/02) Page 5- of / RDA 1159 ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more than $100 from any source during the period) Complete the Following for the Source of the Loan First Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Beginning of Period) Received Payments (End of Period) Last Name/Organization Name Address Loan Received For: Date of Loan ❑ Primary Election I❑ General Election city State Zip Coda ❑ Runoff (Local Elections Only) List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page) First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address city state Zip Code City -F;te7 Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding 4. Totals for all Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Total loans received should also be shown in item 16. on summary page.) B innin of Period Received Payments End of Period (Total loan payments should also be shown in item 20. on summary page.) (Total outstanding loan balance should also be shown in item 12.e. on front page.) ■ SS-1132 (Rev. 4/02) Page of _Z RDA 1159 ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD J !i , FROM' TO: - /l 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Incurred Payments Outstanding Balance OBLIGATION (obligations totaling more than $100 owed to any (Beginning of Period) This Period This Period (End of Period) person/vendor at the end of the reporting period) First Name Middle Name Last Name/Business Name Address City State Zip Code Description o Obligation First Name Middle Name Last Name /Business Name Address City State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation First Name Middle Name Last NamelBusiness Name Address City State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation 4. TOTALS f~ (Total from Outstanding Balance - (End of Period) column must also be shown - 4 in item 23b. on summary page.) l ■ SS-1127 (Rev. 4/02) Page-- of --L' RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATEOFREPORT 2.a. NAME OF CANDIDATE OR COMMITTEE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE St et or Rural Route City State Zip Code Phone 4.b. CANDIDAT ts HOME ADDRES (if differ nt than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) 7. CATEGORY OR REPORT (Check one) FIRST SECOND THIRD FOURTH PRE PRE MID YEAR YE4 -END DARTER 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- ures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. ❑ This pampaign 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. Uwe 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, I/we swear or affirm that no campaign contributions have been expended for the personal financial benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. IZI, signature of candidate date sJe ature of political treasurer date 11. WITNESS SIGNATURE signature of witness dat signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ b. TOTALRECEIPTSTHISPERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND 12.a. plus 12.b. minus 12.c. 0 / . Q e. TOTAL LOANS OUTSTANDING $ f. TOTALOBLIGATIONS OUTSTANDING $ - SS-1109 (Rev. 2/06) Page 1 of J_ RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD FROM: 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. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 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.) $ DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage, gasoline) $ $ Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ - c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD 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.) $ 23.013LIGATIONS a. Unitemized Obli afions 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 121) $ 4D SS-1133 (Rev. 4/02) Page of 0n ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: TO: 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (bans totaling more than $100 from any source during the period) Complete the Following for the Source of the Loan nrst Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Beginning of Period) Received Payments (End of Period) Last NamelOrganizalion Name Address Loan Received For: Date of Loan ❑ Primary Election ❑ General Election City state T p Code ❑ Runoff (Local Elections Only) List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page) First Name Middle Name First Name Middle Name Last NamelOrganiza0on Name Last Name/Organization Name Address Address city State Zip Code city 4MWiddle Zip Code Amount Guaranteed Outstanding mount Guaranteed Outstanding nrst Name Middle Name First Name Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address city State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last n Name Address Address city State Zip Code City State Zip Code Amount Guaranteed Outstanding mount Guaranteed Outstanding 4. Totals for all Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans Loan outstanding Loan Balance (Total bans received should also be shown in item 16. on summary page.) Be inni of Period Received -Payments End of Pert (Total loan payments should also be shown in item 20. on summary page.) (Total outstanding loan balance should also be shown in item 12.e. on frontpage.) AML SS-1132 (Rev. 4/02) Page of RDA 1159 `QW ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: T0: Amount 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any contnbutor during the period) First Name Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last NamefOrganization Name ❑ Runoff (Local Elections Only) Address Date ofln4GWConlrbu6on Aggregate this Election GU' Slate Zp Code Description of InAnd Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address DateoflM(indConfnbutim Aggregate this aection City state Zip Code Description of inland Contribution O=patbn Employer Fast Name Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Namelgrgankatlon Name ❑ Runoff (Local Elections Only) Address DateaflnM Contribution Aggregate this Election City state zip code Description of In-land Contribution Occupation Employer In-Kind Contribution Received For. Value of In-Kind Contribution Fast Name 7:rm ❑ Primary Election ❑ General Election Last NamelOrganization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election city State Zip Code Description of in-IGnd Contnbution Occupation Employer Rrst Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-land Contribution P 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carry forward to item 3. of next page N additional pages of this form are used.) (If this Is the last page of in-kind contributions, this amount must be shown in item 22b. of summary.) SS-1128 (Rev. 2106) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: TO: mount 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 Last Narne/Business Name Address city State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NarrieBusiness Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Lost NameBusiness Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address city State Tip 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 CRY State Zip Code 5. TOTAL ITEMIZED EXPENDITURES (Carty forward to item 3. of next page K additional pages of this form are used.) (If this Is the test page of expenditures, this amount must be shown in item 19b. of summary.) Aflhk SS-1129 (Rev. 4/02) Page of RDA 1159