Jenkins, Douglas E.
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATEOF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE
~ECfM"C 2c ZC'l~ ~0U6- -Tc"NKINf
ELECTION
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. DATE e e
t ~/C- D lIc
4.a. CAMPAIGN ADDRESS AND PHONE City State Zip Code Phone
Street or Rural Route yt/
15`1 1 via L ~C k( ~~~~w I ct T 37 J
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.8.) State Zip Cade Phone
Street or Rural Route city 5. OFFICE SOUGHT (include district number. If applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
/t1►a yl'i((~' IT Y _5 C /4c'c~ C-,~ rq .~1,i P
7. CATEGORY OR REPORT (Check one)
FIRST SEO❑OND Tla 4M ~ PRE- MID-YEAR YEAR-END
QUARTER QUARTER ARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b.EENDING DATE OF REPORTING PERIOD
9.(Cho& 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 Me 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 int 1 revenue code.
date signature of political treasurer date
si nat re of candidate
11. WI ESS SIG TORE
12 Zo / z-
signature of witness date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $
b. TOTALRECEIPTSTHIS PERIOD :r.......................................3 13 55
3.3 .5 . tlf->
c. TOTAL DISBURSEMENTS THIS PERIOD •••••••••••••••3 -
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $
e. TOTAL LOANS OUTSTANDING $
I. TOTAL OBLIGATIONS OUTSTANDING 3
SS-1109 (Rev. 2106) Page 1 of RDA 1159
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SUMMARY PAGE - CANDIDATE
13. NAME OF CANDIDATE OR COMMITTEE (In Full)
T~)C LPL -3r Id S agTff"
RECEIPTS 15. CONTRIBUTIONS (other than bans and interest)
a. Unitemized Contributions ($100 or less from each source this period) $ 7 ~'S ' C`iCl
b. Itemized Contributions (over $100 from each source this period) $ 5c" PU
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.)
~ .3 SSc v
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.) $ , 3 Ss,t,'
DISBURSEMENTS
19. EXPENDITURES (other than loan payments)
a. Expenditures ($100 or less each payee this period) (must be listed by category C7 ~ A ~ r Y ry - e.g., printing, postage, gasoline)
t
Lt <r,P S ~ ~~5 ,rats) $ I &3
C-A l 5
$ 160
5T A C^ t'
A elva IANri: S $ S
$
s
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 3 S c>
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)
a TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.15.) (must be shown i item 121.)
AWIL
SS-1133 (Rev. 4102)
Page of
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT VERING THE PERIOD
T~J IJ FROM: p ,?t, TO: 17 -1 6 r'r le
3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized Page) lArnount . l
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more Ittan $100 from a contributor
First Name ► Contribution Received For. Amount of Cori bution
Last NamelOrga moon Name
❑ Primary Election General Election
Address ❑ Runoff (Local Elections Only)
C,y r~ f2 7 l L l f Zip Code Date of Contribution Aggregate This Election
Ooa4etan
Ci e S Ca
Employer
First Name 06A bfiddeName Contribution Received For. Amount of Conkbution
Last Nanwowntmbm Name
❑ Primary Election General Election
14cli A-5 ~
Address ❑ Runoff (Local Elections Ortty)
clty ~t I
&MM Z0 D0d8 Date of Contributlon Aggregate This Election
~R, rz r'z ~a oc:
First Name ,/1 ` Name Contribution Received For. Amount of Contribution
❑ Primary Election General Election 150, 00
Address ❑ Runoff (Local Elections only)
aA `r Zip code Date of centrbutien Aggregate This Election
Occupation I
First Name rNwme Name
o to n
last NamdOron Name ❑ Primary Election General Election
Address ❑ Runoff (Local Elections Only)
City Stale LPCude Date of Contribution
Aggregate This Election
Occupation
EffO%w
5. TOTAL ITEMIZED CONTRIBUTIONS
(Carry (award to item 3. of next page u adddwW pages of this arm are used.) i 6,- C? C)
(R RNs is ft last page of contrb Aws. RNs amount mist be shown in item 15b. of summary.)
SS-1131(Rev. 2/06) Page of RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE ! 2. REPORT COVERING THE PERIOD
C? N K I FROM: c 2 r, 11 TO: 11 Z o Zc / z_-
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) noun
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expend*m bteling more than $100 to any payee during the period)
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NameBusiness Name
M A T'l~ ~ `J l
Add+e t I.J i t Z 2
`tN f ►z~Ma0 , 02 • ` c,
~~vr Lr~(( Si►J ?7
Fast Name Muddle Name Purpose of Expenditure Amount of Expenditure
Last mess -
I'(A-r- r2 OuMAP~t Tic
address Z (Z C a l l s Co F j i 2 7 e (9 c~~ ° C;
Cyr A JCode
t^
Fast Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Naff"usiness Name
Address
Qty State Zip Code
First Name Middle Name Purpose of Experlddure Amount of Experiftre
Last Nann&Susirms Name
Address
all' State Zip Code
Fast Name Muddle Name Purpose of Expenditure Amount of Expenditure
Last Name/Busin ns Name
Address
City Slate Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address
CAy State zip code
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to ibm 3. o (next page IF additional papas of this tam are used.)
(r tlds k the last page of expenditures, this amaar must be shown in ibm 19b. or switrary.)
SS-1129 (Rev. 4102) Page of RDA 1159
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Appointment of Political Treasurer
?ezFor State and Local Candidates and Single-Candidate Committees
o 'd 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:
7 {y~ 1~ IYXJI l'
C ~J
4. Ca paig Address and Phone: City State Code Phone
150
S. Home Address and Ph a (if different than item 4 a : City State Zip Code Phone
6. Office Sought (include district num er, if applicable) 7. Party Affliation 8. Election Year
l
LC ~ ea" 0~ 1,
9. Treasurer Name: 10. Treasurer e-mail address:
11. Treasurer Address and Phone: City State Zip Code Phone
~S CP& S( r,ECo CdvpT 1(.f wi/vrrlt- rtiJ ,76o/ b&-c>
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
S-nat a of Candidate Signature of Treasurer
Signature of Witness Signature of Witness
Registry of Election Finance
SS-1120 (rev 10!2010)
FINANCIAL DISCLOSURE STATEMENT EXEMPTION
Pursuant to TCA 5 2-10-201(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 $500 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 INFORMATI N:
1
Candidate's Name: ICt ~ L'
l
Candidate's Position: ^ G
Residential Address:
City: Mrm SA K_ State: TN Zip:
I hereby state that I meet the above qualifications for exemption and am
therefore exempt from filing financial disclosure statements.
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t~,4 JJ,, 42
6an . ate !s ignature Date
~ 1 IZ
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. -
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