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Melton, Kenneth CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. AME OF CANDIDATE OR COMMITTE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone '32:2!21 4L-2~,,SL-t 4.b. CANDIDATE'S HOME ADDRESS (if different t n 4.a.) y Street or Rural Route City State Zip Code Phone 04 5. OFFICE SOUGHT (include district number, if applic 564-t 6. AM OF POLITICAL TREA E (may be andidate) '-S 7. CATEGORY OR REPORT (Check one) FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAEND QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD i- r, c rY 9. (Check one) a. This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- ures 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. 1/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 benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. ~ Y signature of candidate date signature of political treasurer date 11. aIGNATURE 8 J-4"VA - 2 1,1 -Y-(B_ signature of witness date signature of witness date 12. SUMMARY T All a. BALANCE ON HAND LAST REPORT V ~O $ b. TOTAL RECEIPTS THIS PERIOD .......................................p...a4'~............................................. $ FEe~ - c. TOTAL DISBURSEMENTS THIS PERIOD GOUT $ d. BALANCE ON HAND 12.a. plus 12.b. minus 12.c. $ e. TOTAL LOANS OUTSTANDING...... $ L f. TOTAL OBLIGATIONS OUTSTANDING $ SS-1109 (Rev. 2106) Page 1 of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DA^E OF REPORT 2.a. ME OF CANDIDATE R COMMITTE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural !~out City State Zip Code Phone ~dQ Cw 72 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street o~5ural Route City State Zip Code Phone 5. OFFICE SOUG T (include district numb if applicabIQL<4-6. NAME OF POLITICAL TREASURER (may be candie) ort IS v~ S rc 7. ,CATEGORY OR REPQRT (Check one) ❑ ❑ ❑ ❑ ❑ ❑ FIRST E_--I .4u THIRD FOURTH PRE- PRE- MI -YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD \ -~(.c - ) ~ Coo 9. (Check 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 file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an accurate accounting of campaign contributions and expenditures required to be reported by the candidate committee by the Campaign Financial Disclosure Act. Additionally, [/we swear or affirm that no campaign contributions have been expended for the personal financial nefit of the candidate or for ny other nonpolitical purpose as defined by the federal internal revenue code. signature of candidate date ignature of political treasurer date 11. WI ESS SIGNATURE dA q~ signature o witness date signature of witness date 12. SUMMARY 3 a. BALANCE ON HAND LAST REPORT b. TOTAL RECEIPTSTHIS PERIOD JUL.....................................$ c. TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ /J ~K e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ SS-1109 (Rev. 2/06) Page 1 of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATED REPORT_ 2.a. OF CANDIDATE OR COMMITTEE 415 - S C wwk.Q 2.b. IF CO MITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE ~6~ Street or Rural JRoute City / St / Zip Code P one 2 o t l c' S 17 4.. CANDIDATE'S HOME ADDRESS (if differe t than 4.a.) Street or Rural Route City State Zip Code Phone ~l~j N1 f' 5. F ICE SOUGHT (include distri number, if appli 6. NAME OF POLITICAL TREASURER (maybe candidate) r i f I U~ sJ'r ~Y> L?01.1415$ r u.s~"9 C/~A1~ / CATEGORY OR REPORT (Check one) 1:1 E] 1:1 1:1 FIRST SECOND THIRD FOURTH PRE- PRE- MI YEAR-END DARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD /(_1 r-I- I ~a - - s 9. (Check one) a. This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- ures 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 benefit of the candidate or for any other nonpolitical purpose as defined by the f 1 internal revenue code. 4 -4, f signature of candid to date ignature of political asurer date 11. WITNESS SIGNATURE signature of witness date signature of witness date 12. SUMMARY 2 a. BALANCE ON HAND LAST REPORT $ _ ~ ~ •~~`/fin !~--.L.`'~ C'S b. TOTAL RECEIPTS THIS PERIOD $ 6/z c. TOTAL DISBURSEMENTS THIS PERIOD $ _1 d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ e. TOTAL LOANS OUTSTANDING $/11 f. TOTAL OBLIGATIONS OUTSTANDING . $ w; R ECEMW SS-1109 (Rev. 2/06) ; Page 1 of RDA 1159 k JUL 15 = MOUNT' COUNTY ELECTION _ ,q J CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. N E F CANDIDATE OR COMMITT ' 2.b. IF C M ITTEE, NAME OF CAND3. ELECTION DATE 0 N bjhd 4.a. CAMPAIGN ADDRESS AND PHONE CC Street or Rural -Route City ~ . ~ State t ~ Zip Code Y~°i~o/n_e~ 4.b. CANDIDATE'S HOVE ADDRE S (if different than 4.a.) Street or Rural Rat City State Zip Code Phone e el WfFICE SOUGHT (include district number, if applicab~l.~ NAME F LITICAL TREASURER may be candidate) 7. CATEGORY OR REPO (Check one) / ❑ ❑ E3 LAY E3 [3 ❑ ED FIRST SECOND THIRD FO RI PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD 9. (Check one) a. jj;TThis 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 benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. signature of candidate date ignature of political treasurer date 11. SIGNAT URE U\, signature of witness date signature of witness date 12. SUMMARY , a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTS THIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) e. TOTAL LOANS OUTSTANDING $ ✓.v~ f. TOTAL OBLIGATIONS OUTSTANDING $ SS-1109 (Rev. 2/06) Page 1 of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STAT For State and Local Candidates EMENT -For Single-Candidate Corntnittees DATE OF REPORT 2.a. NAME OFCANOIOATEORCOMMI7TEE 2.b. IF COMMITTEE, NAME OF CANDIDATE e ~Z~ ( ~O~ C'~ m / /Y 'T' rn e- 3. ELECTION DATE 4.8. CAMPAIGN ADORESS AND PHONE 7 - / 14 Street or Rural Route CHy 3 Z J L 6L e S Slate Zip Code Phone 4.b. CANDIDATE'S HOME ADDRESS (4 different than GClS r~ ? Street or Rural Route City ,q M t, State Zip Code Phone S5. OFFICE SOUGHT (include distrks( number- ::7 :Ifflapprimble) ,itf1 6. NAME OF POLITICAL TREASURER (may be candidate) ,)caf $ ~~n1Ne-tom /YIe/fin/ 7. CATEGORYOR PORT(Chockone) 13 FIRST SECOND THIRD FOURTH PPF;S ❑ 8.a. B~ PRE- MI YEAR ~ GrJN~lG DATE OFREPORTING PERIOD MARY GFIJERAt YEAR-END 8b. ENDING _[~(1TEOF,PERIOD a 2 ' 9. (Chock one) ? a This campaign is exempt from detailed disclosure because contributions (nduding h4dnd) received total $1,000 or less AND expendi- tures total $1.000 or less for this reporting period. (Complete items 12d., 12e. and 12L) b. This campaign Is required to file a detailed financial disclosure bemuse contributions (including In-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting PwW. 10. Vwe do SOlenlniy swear or affirm that the information contained in this campa accurate accounting of campaign contributions and expenditures required to be~rnep nail disclosure report is true and that this report is an Financial Disclosure Act. Additionally. Uwe swear or affirm that nocampaign contributions s the have ca been expended for t for the by the Campaign benefit of the candidate or for any other nonpolitical purpose as defined by the federal .internal revenue code. personal financial signature of to T s date *61;~ture of 0zrd - / tree er date 11. WITNESS GNATURE sill lure of ss / s lure of witrress date 12. SUMMARY a. BALANCE ON HAND LAST REPORT b. TOTAL RECEIPTS THIS PERIOD SBURSEMENTS THIS PERIOD , d. BALANCE ON HAND (12.a. plus 12.b. minus 12.a r e. TOTAL LOANS OUTSTANDING f. TOTAL OBLIGATIONS OUTSTANDING S U SS-1109 (Rev, 2/05) Payee 1 0(__q__ RDA 1169 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD ~c°/✓/V~ 1(~ 41e- ~-afvl C'4L'4 {4 J n1 FROM: -2 / ?T0: RECEIPTS 15. CONTRIBUTIONS (other than bans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) $ --c. TOTAL CONTRIBUTIONS (other than loans 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.) $ DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or less each payee this period) (must be fisted by category - e.g., printing, postage, gasoline) fJ~ 5't CrU N. JFA W K ~ $ $ ~S 0 $ .Z S $ $ Total of Expenditures ($100 or less each payee) $ S, C) G/~ Itemized Expenditures (Over $100 each payee this period) $ f!D O 7 c. TOTAL EXPENDITURES (other than ban repayments)(add 19.a. and 19.b.) $ Z 0. LOAN REPAYMENTS MADE THIS PERIOD No e- -21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.0 2- D 22AWKIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ b 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) $ d a TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) 0 SS-1133 (Rev. 4102) Page of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD Ke n/,V,< I/, FROM: -7- TO: nt 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if fast itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION canbrbutions lotafing more than $100 ftfn a RstName Wd*Name ConWtKAon Re*eW For. Anoint of ConbtKoBon A n/ d- %X I ?I Last Na Mon I ❑ Primary Election fOb-netal Election -S Address ❑ Runoff Tocal Ele ' 1 -7 L/ WA ~A -A aA' lap Code Date of Ccj" . Aggregate Ti" Election O=pa5a, /YV Eapayu ~ l Contribution Received For. Anoint of WV- NMM Election AfGeoeral Election s l f~~ D~ aRunoff (Local Elegy Onto Cky lee Date of Conn button ( Aggregate This Election r 7, (j ' \ r Fk*Nam Name Cadrfbotion Received For. Around of Co*bution ❑ Primary Election General Election / CJ Address ❑ Runoff (Local Ebcbo rs Only) Cky Sbb ZpCode Date of Conftulion Aggregate This Election OcwW*n Fist Na W"4 Name or Amount o L" Nw4M%w&s5m Name ❑ Primary Election lGenorai Election ( S .O3 Ad&m , 1 ❑ Runoff (Local Elections Only) Cky LOn wode Date of ConUbutimr Aggregate This Election owupsfim 5. TOTAL ITEMIZED. CONTRIBUTIONS l (p (p C( (Carry brward b Nam & of rant page 90665oeat popes of 1* ram are used (UM is he fast papa of oartrbusons, his amount must be dawn in Item 15b. of summery.) 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 e k. m 7~OvU C4m.4/21jivi FROM: -7 2 TO: moon 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 H fits( Itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expe"*;res btarirq more Von 5100 b any payee during ft period) Frst Name piddle Name Purpose of Expertdilure Amount of ExpwWku e Last flamefBus'rness Name 32- c L~ Address O - ,A f '-I /4 t' 2 ~ (f °L • / C* zip Code 41 <2 ~ l 1 e. Ste' First Name Middle Name Purpose of Expe ea ne Amount O(Exp Wkwa Lest NxnalBusiness Name /7 L ~f Ll V Gj , - r%p Address p e .~l 01~ (f A rAp l nl L C le 2 f'4 f4 py SW Zlp Code LDu rs / e -/';U 77 7 7 First Name Kiddie Name Purpose 0(Egendidre Amount o(Evemkn Lad Nsn~ l s c LjeR Address City a* zip code First Nine trrdae Name Purpose o(Egw d M Amount of EgwWlbtre L.st NamaBskias Xwe Address civ stale z t eda Fret Name Iiddle Name Purpose of Expw4ture Amount o(Expwdlure Last NamelBuskress Name Address civ Stale LP Code Fled Name piddle Name Purpose of Expenditure Amount of ExpenffiUre Last NamefBusiness Name Address (py Stste Zp Code 5. TOTAL ITEMIZED EXPENDITURES (Carry b,*wd b item 7. ofmA papa t addff W pages of tk fom, are used J C 2 J T ` (Ktris N tie Wd page o(rurperdkm, this woo must De stmen In item 19tx of arrmary.) AlMh SS-1129 (Rev. 4/02) Pape of RDA 1159 - t CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT I 2.a. NAME OF CANDIDATE OR COMMITTEE ' /u /Z CJ I ~V L'4rn 1l / 4/ 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DA E eiLIW e th . In e ~ fa ov - 7- 4.a. CAMPA N ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 3 DL /-Owes F,-,vk Rd /oa <st"',je '7-1%.l -3/7/7/7 94 6- a7, 8 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone Sr9 m ~ 5. OFFICE SOUGHT (include district number, if applic ble) NAME OF POLITICAL TREASURER (may be candidate) ~r Sfl~/C~ BLc~u~u7 C~u.n/7 Cn~nm SSl~~c'i. S«i~ B /'Mrn/N c nl 7. CATEGORY OR REPORT (Check one) FIRST SECOND THIRD FOURTH PRE- _ ❑ ❑ MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING D E OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD ~ / I 9.(Check 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. fK 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. Uwe 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 be fit o he candidate or for any other nonpolitical purpose as defined by the federal internal reven ode. - /C signature of candidat date #ignature of political treasurer date 11. W SS SIGNATURE sign of witness date re of witness date 12. SUMMARY 3 6 5 6 7, a. BALANCE ON HAND LAST REPORT b. TOTAL RECEIPTS THIS PERIOD ......c........ A %I c. TOTAL DISBURSEMENTS THIS PERIOD Q4~ „i...., d. BALANCE. ON HAND (12.a. plus 12.b. minus 12.c.) $ o e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ 0 9D SS-1109 (Rev. 2/06) Page 1 of RDA 1159 1 SUMMARY PAGE - CANDIDATE 14. REPORT COVERING THE PERIOD 13. NAME OF CANDIDATE OR COMMITTEE (In Fuld ,c 9 FROM: 7 _ TO: t1lJ/V e 7 -to ry RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ $ b. Itemized Contributions (over $100 from each source this period) c. TOTAL CONTRIBUTIONS (other than loans 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.) DISBURSEMENTS 19. EXPENDITURES (other than loan payments) category - e.g., printing, postage, gasoline) a. Expenditures ($100 or less each payee this period) (must be listed by Total of Expenditures ($100 or less each payee) $ .7 3.4 b. Itemized Expenditures (Over $100 each payee this period) .•.••••••••••Z7, 3 TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and %b.) $ O 20. LOAN REPAYMENTS MADE THIS PERIOD $ ~ 42_7--3 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) 22.IN-KIND CONTRIBUTIONS this period) -kind contributions ($100 or less from each source $ a. Unitemized in -kind b. Itemized in-kind contributions (over $100 from each source this period • $ D c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) .••••••••••••••••..23.OBLIGATIONS 0 $ a. Unitemized Obligations Outstanding ($100 or less each) ...•••••••••••••.•••"""Q b. Itemized Obligations outstanding (Over $100 each • ' ' ' ' ' t AL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown I item 12.f.) c. TOT Page of SS-1133 (Rev. 4102) ITEMIZED STATEMENT OF EXI'EMDITURES 1. NAMEOFCANDIDATEORCOMMITTEE - CANDIpA1-E fl C~s4/Yl 2. REPORT COVERING THE PERIOD 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if FROM: 4. COMPLETE THE APPRppRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE _ T0; mown n first itemized page) First Name IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIllilI (expenditures totaling more than $100 to any payee during the period) Last Name/Business Name Middle Name Purpose of Expenditure . I C ~S Amount o/Expenditure Address M /i"I- , S J g`~ Fp} 17 N v (J d C Z`o NC ~ ~ lJ v city .3 '-4t•/ CN L~ L (l S' r5~ r l / StateZi Code First Name N ?_7 7 Middle Name Last Name/Business Name Purpose of Expenditure Amount of Address t~ ! xX V /~.J Expenditure v©c~ /x'1,4 r < «f 5 City 7iiit~anl i~ Cl r [ { f 5 L / / S✓tate6 Zp Code U 1,c First Name ! 7.17 / Last Name/Business Name Middle Name Purpose of Expenditure Amount of Expenditure Address cfty State Zip Code First Name Middle Name Purpose of Expenditure Last Name/Business Name Amount of Expenditure Address City State Zip Code First Name Middle Name EWENN~ Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code 5. TOTAL ITEMIZED EXPENDITURES (Carry forward to item 3. of next page if additional pages of this form are used.) (if this is the last page of expenditures, this amount must be shown in item 19b. of summary.) SGA129 (Rev. 4102) Page of RDA 1159 r T e ' 1 ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEEL 2. REPORT COVERING THE PERIOD ~P Ale L T ~ Aj e4M i4) Af FROM: T0: _Z r Amount 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totaling more than $100 from an contributor FirstWorre- Middle Name Contribution Received For: Amount of Contribution Last Na j4Organi tion Name ❑ Primary Election General Election v Addfess// / ❑ Runoff (Local Elections Only) City ShV L' e a~ Date of Contribution O Aggregate This Election Occupation ~i $ Employer First Name Middl Name Contribution Received For: Amount of Contribution N ti A/O( Y Last Name/Organization Name ❑PrimaryElection N General Election i 000 171 As 5 Est J Address ❑ Runoff (Local Elections Only) _3U7 River, G'! ri4 ivl A City State Zip Code Date of Contribution LO u s , -7 7 7 Aggregate This Election Occupation l~ >e d Employer First Name iddle Name Contribution Received For: Amount of Contribution as am anaa on Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name Middle Name Contribution Received or: mount o Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS (Carry forward to Item 3. of next page if addifional pages of this form are used.) (If this Is the last page of contributions, this amount must be shown in item 15b. of summary.) SS-1131(Rev. 2/06) Page of RDA 1159 VRIIL~IPli 79YIG$i~~.1.~. isz:- , iL•~yy7i.so:SJl.ra--ry.IL i~ 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." 1 0 1014 CANDIDATE'S INFORMATION: Candidates Name: e X9 Candidates Posit ion-A0,0,v 2,1 Residential Address city: 4vt~; f(, I State: TN Zip: I hereby state that I meet the above qualifications for exemption and am therefore exempt from filing financial disclosure statements. Candidate's Signature bate of - ~-)L 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. Appointment of Political Treasurer For State and Local Candidates and Single-Candidate Committees INSTRUCTIONS Fla intment of Political Treasurer statement must be used to appoint ign Financial Disclosure Act (T.C.A. § 2-10-105) for state and local candid ties and single- candidate mpaign committees. A state candidate may not receive or expend funds for an election until a easurer has been appointed for that election. A local candidate pursuant to T.C.A 2-10-101, maybe m completing this form, please check with county election commission for more information. A may appoint himself or herself as political treasurer. A new form must be filed if the treasurer is changed. s 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; Candidate a- mail address: 4. Cam ign Address and P one: J~~ C c~ L`U f~ Cih' State Zip Code Phone S. Home Address a Td Phone (if different than item 4 above): Ci U 7 tY State Zip Code Phone 6. %jime Sought (include district number, ifapplicable) 7. Party Affliction 8. Election Year 10. Treasurer -mail address: L/A ddress and Phone: rCandidate me: v` r City Sta a Zip Code Phone nd Treasurer Signature (both signatures must be witnessed. Treasurercan not witness candidate's signature): Signature of Candidate Signature of Treasurer Signa ure of Wi s Signature Witness Registry of Election Finance SS-1120 (rev 10/2010)