Gormley, Robert
FINANCIAL DISCLOSURE STATEMENT EXEMPTION
Pursuant to TCA § 2-10-101(b) a candidate is exem t fro
disclosure statements: p m filing financial
"If a candidate is seeking an office for which service is
compensation is less than $1,000 a month, and the candidate does not sppend
more
than $1,000 to get elected to office, the candidate does not have to i1
Financial Disclosure Reports." f e Campaign
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~O RECEIVED
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CANDIDATE'S INFORMATION: Cn JU 2 2 loin w
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SLOW COUNTV
Candidate's Name: ~b `~E~aridN
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Candidate's Position: UiAU r--je 14xJ
,
Residential Address: &O-A T` 6304-_ L6
City: Z _0 L115 U".l/& State: TN Zip: 3 77 7 J
I hereby state that I meet the above qualifications for exemption and am
therefore exempt from filing financial disclosure statements.
Ll~ /
Candidate ignature Date
Witness's Sig ature 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.
MAN
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 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
theircountyelection commission.
1. Date: 2. Name of Candidate or Committee:
//b// 3. Candidate e-mail address:
4. Campaign Address and Phon : 0
j-
city State Zip Code Phone
Cl~SLICI/ 1qT . ' lso J1v c.
H if different than item 4 above): City tate Zip Code Phone 5 I r
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6. Office sought (include district number, if applicable) 7. Party Affliction g Elect Y
F. >
'is 01 LA 4A-)
9. Treasurer Name: 10. Treasurer e-mail address:
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11. Treasurer Address and Phone: City State Zip Code Phone
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
C
Signature of Candi a Signature of Trea er
ignature of Witness Signature of Witness
Registry of Election Finance
SS-1120 (rev 10/2010)