Holley, Angie J. CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPOT-- t
2.a. NNAMEOF CANDIDATE ORCOMMITTEE
ii/d A/.1312- 1,1a I GJ Liz Li 3.ELECTION DATE
2.b. IF COMMITTEE,NAME OF CANDIDATE
'
4.a.CAMPAIGN ADDRESS AND PHONE State Zip Code Phone
Street or Rural Route City
4.b.CANDIDATE'S HOME ADDRESS(if different than 4.a.) Phone
Street or- .I Route City State Zip Code
f —et::, .. 1 • 1. O 1 S , = I !eV • C o 0
5. OFFICE SOUGHT(include district number,if applicable) 6. ME OF POLITICAL TREASURER(may be candidate)
M LD Egli ivki ME
6 3 wi-C
7. CATEGORY OR REPORT(Check one)
I
FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR El YEAR YEAR-END
•UARTER • ARTER •UARTER •UARTER PRI •-Y GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a.BEGINNING DATE OF REPO TINGPERIOD 8.b. ENDING DATE OF REPORTING PERIOD
>vAo , .2, 1OJ Q/
9.(Check one)
a. 01 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. 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,I/we swear or affirm that no campaign contributions have been expended for the personal financial
nefit of the candidate or for any other nonpolitical purpose as defined by the federal internal re enue code.
,,? iiti ih c:v a
s nafule p �
of candidate date signature of political treas er date
11. WITNESS SIGNATURE
'7(kja_c_. Z1c-z„,,j9,), i I- 3-II. li0 filL/i-vt D 0,e_g_0,P i / —3 Z .
sigrfalure of witness date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $ / C fi d •dB
b. TOTAL RECEIPTS THIS PERIOD $ /f 00 .00
d789T
c. TOTAL DISBURSEMENTS THIS PERIOD .c.,r^ oI>>4. $ QQQ CO
d. BALANCE ON HAND(12.a.plus 12.b.minus 12.c.) �c e1(�b t $ /e e 7-c
NOV 2 `r
e. TOTAL LOANS OUTSTANDING pn R4 $ /COO• CO
r,Aunt I i•7 'R7
l�afg f
f. TOTAL OBLIGATIONS OUTSTANDING 0.414V. i $ /CCe7` e)t)
rfc*m,
,., v SS-1109 (Rev. 2/06) Page 1 al j RDA 1159
•
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
• For Single-Candidate Commlttees
1. DATE OF REPORT 2.a. MEOFCANDIDATE RCOMMITTEE
:. 0 1i�� I lies 41,,/tq
• 2.b. IF C TTE ,NAME OF CA !DATE LECTIO DATE
h't - le,L 0 --La) c 1 P.,
4.a.CAMPAIGN ADDRESS AND PHONE l
Stree or Route r City 11 __ .. State Zip Code Phone
3g 4 n Izih feral Le L�1 to Sift lice I-14 , 7?7 f 4G= -
4.6.CANDIDA i c a HOME ADDRESS(if dine nl ihan 4. ) 1 Phone
Street Rural Route City State Zip Code
5. OFFICE SOUGHT(incl de district n ber,if applicable) 6. OF POLITICAL T SURE (may be candidate)
JQ�C/(� 01&A I O ()alai i ( ) bye; r �
7. CATEGORYORROPORT(Checkone) in
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 D TE OF ORTING PERIOD
10li1-40 1- 101,3ffW -
9.(Check o )
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. 0 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.
r
• ,C 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,I/we swear or affirm that no campaign contributions have been expended for the personal financial
f benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code.
d1'47-
�11�Liz I / 2-e 9_of candidateate signature of political treasurer date
11. WITNESS SIGNATURE il7
signature of witness date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $�I ee ,ee
b. TOTAL RECEIPTS THIS PERIOD $//1 0 44 ,00
c. TOTAL DISBURSEMENTS THIS PERIOD $ 9 9 0` ce) •
d. BALANCE ON HAND(12.a.plus 12.b.minus 12.c.) $ /6 0 9 ' -c)
e. TOTAL LOANS OUTSTANDING $ G(,J d ��
f. TOTAL OBLIGATIONS OUTSTANDING $ / G) �1' • 04)
:<f' SS-1109(Rev. 2106)
z_!.y Page 1 of RDA 1159
FINANCIAL DISCLOSURE STATEMENT EXEMPTION
Pursuant to TCA 9 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: o
Candidate's Position: w.,a, t,11 ( e
olito
Residential Address: 80 t ✓i o
AAAi, t . V.-Var. -
City: State: TAI Zip: 37777
I hereby state that I meet the above qualifications for exemption and am
therefore exempt from filing financial disclosure statements.
andidate's Si ature Date
Witness s Signature Date
If my plans change and I realize I will spend more than $1 PM 12 ai n I
will immediately make a financial disclosure report. g
~G a 1* Lo
J
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, 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:
4"iA24 L C
4. Cagn Address and Pho Zip Co
e hone
0 50 4.t5 v~ c-5-1177 9"387-fit,
_AW 2!o& 5. Home Address and Phone (if different than item 4 aboIII!
ve . City State Zip Code Phone
6. Office Sought (include district numb r, if applic le) 7. Pa Affliat n
nY 8. Election n Year
C.rMo ` 'e,., , W:ryl (4-
]PQ c / of O l
9. Treasurer ame: 10. Treasurer e-mail address:
ryc7r2 w. w--lv CGS ,d e.~ C In rk ~c.~ G to . ~'1e.
11. Treasurer A dress and Phone: City State Zip Code Phone
a/ V ,L o u is u J l~ f'1-(, n s-t /oti is v ~l l e l I d 3177 7 R 8'3 -.2 s3
12. Candidate and Treasurer signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
Signat a of Candidate PM 1 Signature of Treasurer
.~4\ 1 { s
)
Signature of Witness 00 Signature of Witness
via
Registry of Election Finance
SS-1120 (rev 10/2010)