Harrison, Brad
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: /'l LLI,A j
Candidates Position:
Residential Address: /f Z/1 4~ef: ~
City: State: TN Zip: ~57VI
I hereby state that I meet the above qualifications for exemption and am
therefore exempt from filing financial disclosure statements.
Candidates Signature Da e
c
q\n ) 2 g 1 `A
LNiitness'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.
Cr U: a
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6
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CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
Tor Single-Candidate Committees
1. DATE OF REPORT 2.8. NAME OF CANDIDATE OR COMMITTEE
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
16- s. .t j V
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
S `/I tj 9, Al-c-CC~_ T..i 3770) a-5-ASS) -//St
Ili 4.b. CANDIDATE'S HOME ADDRESS (if different than Co.)
Street or Rural Route City State Zip Code Phone
S ca.. rv` y,
5. OFFICE SOUGHT (include district number, if applicable) y.. 6. NAME OF POLITICAL TREASURER (may be candidate)
~ ~ 11.nf .5.~ ~~Q.: ~r~~~r~~a~r~. \ ► c-~L~~L
7. CATEGORY ORREPORT (Chedcone)
FIRST SECOND T~ ROA RTH PRE- PRE- MI YEAR WX~R
QUARTER QU 1 QLWTI'ER QUARTER MAR GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERI00
9. (Check one)
a. ❑ This campaign is exempt from detailed disdosure because contributions (including "nd) 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. Vwe 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 a signature of political treasurer date
11. WITNESS SIGNATURE
.1P JI&
signature of witness date signature of witness da e
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $
b. TOTALRECEIPTS THIS PERIOD 30101)
..M.........................$
C W
C. TOTAL.DISBl1RSEMENT'STHIS PERIOD .............................................a...................................$
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.0.) $
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $
Ask SS 1109 (Rev. 2106) Pape 1 or RDA 1159
SUMMARY PAGE CANDIDATE
13. NAME OF CANDIDATE OR COMMITTEE (In Full)
r- G._ c 3 14. REPORT COVERING THE PERIOD
RECEIPTS FROM: TO:
15. CONTRIBUTIONS (other than loans and interest)
B. Unitemized Contributions ($100 less from each source this period)
b. Itemized Contributions (over $100 from each source this period)
C. TOTAL CONTRIBUTIONS (other than bans 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.) ~ c>'7
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)
$
S
$
$
$
i
Total of Expenditures ($100 or less each payee)
b. Itemized Expenditures (Over $100 each payee this period) $
c. TOTAL EXPENDITURES (other than ban 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
I
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 Obligations Outstanding ($100 or less each)
b. Itemized Obligations Outstanding (Over $100 each) _
a TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.)
ADL of
SS-1133 (Rev. 4/02) Page
I mi
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
F, C--nQ- 01c- Ic- \ S FROM:
n
3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 If first ftetnized pne)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION corrinbutions lotaling more than $100 from an contributor
First Name Ws"e Name Contritx" Received For. Amount of Contribution
C~-
Last Name0vw,1zx5wNamK Primary Election ❑ General Election
Address S [3 Runoff (Local Elections Only) 3 O C
~L b 7* Co& Date of Contribution Aggregate Ttds Election
OoaQation
ER*W
IN Name Mid*Name Contribution Received For. Amount of Contribution
Last Nameop izatim Name ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City Sfax Zip Code Date of Contrbulion
Aggregate This Election
Occupation
Fast Name Name Conh!Wfion Received For. Amount of Contibuton
❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Onhj)
Gty State Zip Code Date of Contnbution
Aggregate This Hellion
Ocwpation
First Name 1~ddle Nam o
Last NamdO~Nration Darns. ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City State 4 Code Date of Contribution Aggregate This Election
Ocaipation
Eniploter
5. TOTAL ITEMIZED CONTRIBUTIONS
(Cant brwa d b hem 3. of next papa K addwol pages of ttib forth are used.)
(K ft is tM lut papa of oorkrb Aom ft am ur t must be shoo in hem 15b. of aiarxnary.) V C3 G~o
Ash
SS-l13l(Rev. 2106) Page of RDA 1159
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE
2. REPORT COVERING THE PERIOD
FROM: TO:
3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first Itemized page) n
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN40ND CONTRIBUTION (nadnd cw buboes totaling more tan $100 from any contnb for during tm Period)
Frst Name Middle Name
In I44 CormImbon Received For. Value of In4Qnd Contribution
Last NarOryarrization Name Q Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
Date orkr W C *bution
City Aggre9ap ft FJeetion
ZvCode Desatp6onofkrI ndCanbbution
00m" on Enp
First Name Middle New In-Kind Contribution Received For. Value of In4W Contribution
9x+lza6on Nine ❑ Primary Becton ❑ General Election
❑ Runoff (Local Elections Only)
Date ofIMGidCw*bAon
Aggregate Iris Election
Sleie zip Code Des0ip6m0fkwr4C0nkbu6on
First Name k1dde Name
nd CmIdbutiott -Remlmd For. Value of In I M Contribution
t ast NameAOrgarrzation flame ❑ Primary Election ❑ General Election
Addrou ❑ Runoff (Local Elections Only)
Date or nacnd cartbu6an
City Apgregale ft Election
State zip co* aos«ipti,nanlGneCa4nbu6en
Fku Name Middle Nzm
IrWind Cor Mejon Reoived For Value of In-K Contrbution
Last NamafOrparrrationName 1] Primary Election 13 General Election
❑ Runoff (Local Elections Only)
Address
Date of ln-IQW Cont>bAOn
A@OrogatetliaEiec6o
City n
sum Zip Code Desaip6onofkrlrWCormbuton
tkxupatian _
FkstName MiddaName
In-Kind Contribution Recelved For. Value of In4QW Contbution
Name Primary Section ❑ General Section
Addasa ❑ Runoff (Local Elections Only)
D* of kNCnd ConybAm
. Aggregate Iris Election
cay Sole Desaip6onorktlGid knkbulion
4 Code
5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS
(Cara romsro b item 3. of next page F&"borwl pages afl* form are used.)
(dit Is to test page of b4dnd oonbbutons. ft w4urt must bs h tem 22b. of summary.)
SS-1128 (Rev. 208)
Page of RDA 11159
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE - 2. REPORT COVERING THE PERIOD
c--Gk- c-- r FROM: TO:
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 If first itemized page) moon
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures l3tditp more ow $too to any payee during ft period)
First Name VAdle Name Purpose of Expen litre Amount of Expertdmxe
Last Namel9usiness Name
a . L~ m ~Q
Address
1,, r-/ ~ SZip
a 1-~ „0 cede -32
I t Name VAdle Name Purpose of Expenditure Amount of F_xpendiCxe
Last NMvIBusiness N
, S p ' ` 1O
Ad
City state 21P dress \ L ~ Jam-, _
First Name Middle Nana Purpose of Expenditure Amount of Expenditure
Last NamelBusiness Name
1-~.) \ -5 6
Address ( pp
Chy State Zip Code Qr C . \ V b C
G~ {vI
37.)
Fast Name Uddle Name Purpose of Emptxtditure Amount of Expenditure
Last NaTogusiness Name
Address
CM stare zip Code
First Nana w"a Nana Purpose of Expenditure Amount of Expenditum
Last Nww%siness Name
Address
city Stab Zip Code
First Nara Wddle Name Purpose of Expenditure Amount of ExperK%jre
Let NamelBusiness Name
Address
City Stab Zip code
5. TOTAL ITEMIZED EXPENDITURES l/
(Cary forward b Nem 3. of next page it additional pages of Cws Corm are used.) 3f3 / cf~
(If r>ts is the het page of axpeMitures, ft woo must be shown in Nam I9b. of armnay.) ~
Agm
SS-1129 (Rev. 4102) Page of RDA 1159
ITEMIZED STATEMENT OF LOANS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: T0:
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN Ibms iotervg more I= slop from any source during ft period)
A~lmllmll
Complete the FoUW*V for the Source of the Loan
First Name (fiddle Name Outstanding Loan Balarxe Loans Loan Outstanding Loan balance
(Begimkg of Period) Received Payments (End of Period)
Last Name/oromiW" Name
Address Loan Received For. Date or Lean
State ❑ Rirrwy Election ❑ Genersi Electio
c4ty n
ZP Code
a Runoff (teal Bectiau Only)
Ust All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page)
Fist Name addle Name First Na" Neill
Middle Name
Last Name/Org&*sdm Name Last NamalOrganaatim Name
Address
Address
C* Stale Zrp Code Cdy Slate Zrp Code
Arnoutd Cwaranbed 0ulstandpg Guaranteed Outstandag
MXKW Firs( Name htiddb Name Fist Name Middle Name
Last NarrieOgm4gon Nam last Name0ganiz" Name
Address Address
J Stab Zip Code Gly Stake Zip Code
MV M Guarantied Outstxidig Qwsnieed Ordataod"
Fist Name (fiddle tdame Fist Name I fiddle Name
Last NamoAOrgwjution Name Last Nxn 0ganirabon Name
Address Address
st* ZD Code CRY State zip Code
Amount Guaranteed Outsstandinp Guarantied Outstandig
Fiat Name kmddlo Name First Name 6iddle Name
Lest N-n*O jW-bm Num Lmst Name/0(garks6on Name
Address
Address
CRY State Zip Code CUy State Zip code
Ampmt Guarantied Outst"Wirg M4W Guarantied Outstanding
4. Tot* ford LOana (cotnple6e on fast papa of kemt md)Oa(fs) Outstanding Loan Batarxe Loarx Loan outstanding Lean ltatarxe
(Total bars roceived should also be shown in item 16. on sumnory papa.) ftinfarg of ParioM Received paworts mm of PiA
(W ban payments should also be shown in item 20. on sumrwy page.)
(Total outshndig ban baiarxe should also be slaws b Nam 12a. on f+oM page.)
® SS-1132 (Rev. 4102) Page of RDA 1159
ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: TO:
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)
Me Hama Middle Name
L ut NamalBusinm Name
Address
CRY Stale Zip code
nmt Name Middle Name
Lftt was= NWW
Address
City stab Zip Code
oes«pranaobrgaGOa
FkV NNW Midde Name
Last Nwdffiuskass Name
Address
CRy Stabe Zip Code
Deavow of Ob6pa6on
Flat Name VA& Name
List Namal&aMm Name
A&%u
City stale Zip Code
Desa"-0(0b6*-
Flat Name Middle Name
Last NamesAin sa Name
Address
CRy stale Zip Code
Dwe*w of ObNaGon
4.TOTALS
(total from OutstarxfrG Balancee - (End of Period) column must also be shown
in item 23b. on summary page.)
of RDA 1159
AwkL SS4127 (Rev. 4102) Page
24
Print Form
Appointment of Political Treasurer
For State and Local Candidates and Single-Candidate Committees
INSTRUCTIONS
FtheCampaign pointment of Political Treasurer statement must be used to appoint a political treasurer as required by
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, 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 Committee:
3. Candidate e-mail address:
n 3 l a"4 11wI'/'
4. Campaign Address and Phone: City State Zip Code Phone
1-5,111 A~cr~~. ~J
5. Home A=andh ifferent t han item 4 above): City State Zip Code Phone
6 .Office Sought (include district number, if applicable) 7. Party Affiliation 8. Election Year
A/W VII 70 zaH
z 6-0 - 9. Treasurer )Name: TO. Treasurer e-mail address:
14~JNrTG~cK ~✓r'JITLuc~CPA •Cor✓~
11. Treasurer Address and Phone: City State Zip Code Phone
12. Candidate and Treasurer Signature (both signatures must be witnessed J. Treasurer can not witness candidate' signature):
Signature of Candidate Signature of Treasurer
h.
e~ Signature of Witness Signature of Witness
N
Giz Registry of Election Finance " W
SS-1120 (rev 10/2010) W
N
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