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Blount County Political Action Committee CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For Multicandidate Committees (PACs) MENT 1• jAT OFRE RT 2. NAMEOFCOMMITTEE C J S r 1 ~S 2•A• ORT N ME OF COMMITTEE IF APPLICABLE) / a~f E 3. ADDRESS AND PHONE Street or Rural Route City State Zip Code Q Phone 4. TYPE E. CANDIDATES SUPPORTED C a < " 0s- yQ~ STATE PUBLIC OFFICE 0 LOCAL PUBLIC OFFICE BOTH 5.A. NA(utF F POLI ICAL TREASURER 5.6 DATE APPOINTED 6. ATEGORY REPORT (Check one) FIRnST SECOND THIRD FOURTH QUARTER UARTER PRE- PRE- MID YEAR YEAR-END 7.A.BEGINNING TEOFREPORTING PERIOD U TER RIMARY GENERAL SUPPLEMENTAL SU P EMENTAL 7.B.EN NGDA OFREPORTINGPERIOD 8. (Chec one) A. This committee is exempt from detailed disclosures because contributions (including in-kind) received total $1,000 or less AND expenditures total $1,000 or less for this reporting period. I do solemly swear or affirm that the information contained in this statement is true and that the committee has complied with all applicable provisions of the Campaign Financial Disclosure Act. (Items 10d., 10e. and 10f must also be completed.) B. This committee 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. I do solemly swear or affirm that the information contained in this statement is true and that the following page(s) are a complete and accurate accounting of all contributions and expenditures required to be reported by political campaign committees by the Campaign Financial Disclosure Act. fJ~l~ signature o political trea r date 9. WITNESS SIGNATURE 31~ tZ signature of witness date 10. SUMMARY a. BALANCE ON HAND LAST REPORT ...............................Vil?; 6..291.? I b. TOTAL RECEIPTS THIS PERIOD c. TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) It 4 Q, e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ SS-1122(Rev. 2/06) RDA Pending ' SUMMARY PAGE - PAC 11. NAME OF COMMITTEE (In Full) f p 12. REPORT COVERINGTHEPERIOD RECEIPTS f ( FROM To: 13. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ nn b. Itemized Contributions (over $100 from each source this period) $ 500, on c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 13.a. and 13.b.) . y. $ 14. LOANS RECEIVED THIS REPORTING PERIOD $ 15. INTEREST RECEIVED THIS REPORTING PERIOD $ 16. TOTAL RECEIPTS (add 13.c., 14., and 15.) (must be shown in item 10.b.) $ d ,O DISBURSEMENTS 17. EXPENDITURES (other than loan payments) a. Unitemized 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. Independent Expenditures d. TOTAL EXPENDITURES (other than loan repayments)(add 17.a., 17.b. and 17.c.) 18. LOAN REPAYMENTS MADE THIS PERIOD 19. TOTAL DISBURSEMENTS (add 17.d. and 18.) (must be shown in item 10.c.) 20.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 20.a. and 20.b.) 21. LOANS LOANS OUTSTANDING (must be shown in item 10.e.) ' 22. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) b. Itemized Obligations Outstanding (Over $100 each) c. TOTAL OBLIGATIONS OUTSTANDING (add 22.a. and 22.b.) (must be shown i item 10.f.) $ SS-1136 (Rev. 11/04) Page of NAME OF COMMITTEE ITEMIZED STATEMENT OF CONTRIBUTIONS - PAC 1. 10~ CUh bl ~c 5 f, 2. REPORT COVERING THE PERIOD FROM: TO: 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) Amou 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION FastName M.I contributions totalin more than $100 from an contributordurin the rind . Last Name/Orga Ization ame Q Ci>^ , ArraimtafGonUbution ClIty Sfa/t~e ~ Zip Code? 11 `r ( 7 0 3 Da Date of Contribution Empoyer Fast Name M.I. Last Name/Organization Name dress AmountorCantribifion city state Zip Code Date ofContribution Occupation Employer FhstName M.I. Last Nw"anization Name Tess Amountofico*h Son Slate Zip Code Occupation Dale ofContrbution Empoyer First Name M.I. Last Nameturganization Name Tess MaintdC 6ihutlm City P Code DateofContdbution Occupation Employer First Name M.1. Last Narmoganization Name Address AmountdCori"Xion Gty State Zip Code Occupation DatedContdbution Empbyer FRStName M.I. Last NarraJCkganization Name Address AmountorC thfion city state Zlp Cade Occupation Date of Contribution Employer 5-TOTAL ITEMIZED CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) j Soo. 0 (If this is the last page of contributions, this amount must be shown in item 13b, of summary.) SS-1119-C (Rev. 2/06) Page of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For Multicandidate Committees (PACs) 1. DATE FREP T 2. NAMEOFCOMMITTEE 3 1 / Lvv o /'OA e;~, r~ ~~tel 2.A. S 0RT NAME OF COMMITTEE (IF APPLICABLE) --P e- E 3. ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 4. TYPE OF CANDIDATES SUPPORTED STATE PUBLIC OFFICE LOCAL PUBLIC OFFICE BOTH 5.A. NAME OF POLITICAL TREASURER 5.13. DATE APPOINTED no 6. CATEGORY RR PT ( eck e ❑ ❑ ❑ 0 0 FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 7.A.BEGINNING DATE OF REPORTING PERIOD 7.B.ENDING DATE OF REPORTING PERIOD I I/ x©11 (0 30 .2~l~ 8. (Check e) A. IGt This committee is exempt from detailed disclosures because contributions (including in-kind) received total $1,000 or less AND l°~' expenditures total $1,000 or less for this reporting period. I do solemly swear or affirm that the information contained in this statement is true and that the committee has complied with all applicable provisions of the Campaign Financial Disclosure Act. (Items 10d., 10e. and 10f must also be completed.) B. This committee 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. I do solemly swear or affirm that the information contained in this statement is true and that the following page(s) are a complete and accurate accounting of all contributions and expenditures required to be reported by political campaign committees by the Campaign Financial Disclosure Act. 7LZ signature of political treawawo' date 1e 9. WITNESS SIG A RECEIVED h JUL 13 201' Lo ' oo signature of witness date 10. SUMMARY a. BALANCE ON H PORT..... $ b. TOTAL RECEIPTSTHIS PERIOD Soo , oo c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (10.a. plus 10.b. minus 1O.c.) $ 21 e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ SS-1122(Rev. 2/06) RDA Pending