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Wynn, Gary L. CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT ` 2.a. NA OF CANDIDATE OR COMMITTEE Io 1 ~ 1 WUOO 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 a ~►~1~ 7 3-74z 0 4.b. CA I TES HOME ADDRESS (if different than ) Street or Rural Route Cit State Zip Code Phone far xik T& 3I %L 1 5. OFFICE SOUGHT Jude district number, if applicable 6. NAME OF POLITICAL TREASURER (may be candidate) C 1 5 C> 7. CATEGORY OR REPORT (Check one) ❑ FIRST SECOND IYIIRD FOURTH PRE- PR - MIDYEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD ~ 2 S . D 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, 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. ignature of candidate date signal re f political trea rarer date 11. WITNESS SIGNATURE A94 141V 0 L0. signature of witness date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTSTHIS PERIOD c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ n e. TOTAL LOANS OUTSTANDING $ . f. TOTAL OBLIGATIONS OUTSTANDING $ 4) SS-1109 (Rev. 2106) Page 1 of RDA 1159 ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: TO: 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more than $100 from any source during the period) Complete the Following for the Source of the Loan Fir me Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance n (Beginning of Period) Received Payments (End of Period) Last Name/Or ani tion Name I I V 2 Address Loan Received For: Dal AlLoaan ❑ Primary Election ❑ General Election City State Zip Code („n A^ QJ~ 1.`(l ❑ Runoff (Local Elections Only) 1 V}~~J List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page) LA ~ d1 Q 1C~ First Name Middle Name First Name Middle Name Last NamelOrganization Name Last Name/Organization Name Address Address State Zip Code City State Zip Code City Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding 4. Totals for all Loans (complete on last page of Itemized loans) Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Total loans received should also be shown in item 16. on summary page.) (Beginning of Period Received Payments End of Period (Total loan payments should also be shown in item 20. on summary page.) (Total outstanding loan balance should also be shown in item 12.e. on front page.) AWL SS-1132 (Rev. 4102) Page of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE 28 July 2014 Gary Wynn 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE Gary Wynn 7 August 2014 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone PO Box 4937 Maryville TN 37802-4937 865.983.6996 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 1822 Morganton Rd Maryville TN 37801-8437 865.983.6996 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) Blount County Commissioner District 1 Seat B Gary Wynn 7. CATEGORY OR REPORT (Check one) FIRST SECOND THIRD FOURTH PR - PRE- MIt-Y R 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 July 2014 28 July 2014 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 $1,000 for this reporting period. 10. I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an accurate accounting of campaign contributions and expenditures required to be reported by the candidate committee by the Campaign Financial Disclosure Act. Additionally, Itwe swear or affirm that no campaign contributions have been expended for the personal financial benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. '71 28 Jul 2014 28 Jul 2014 sign iure of candidat date ignatu of poli I asurer date 11. WITNESS SIGNATURE 0A.- -7/zellq g/-42 op~ gnature of witness date signature of witness date 12. SUMMARY 11 12 qAy a. BALANCE ON HAND LAST REPORT o,\., - 485.86 .........Q........... co RECEIVED r, 000 b. TOTAL RECEIPTS THIS PERIOD cn.......... v JUL 2 S 7014 r u, 632.43 c. TOTAL DISBURSEMENTS THIS PERIOD Ov...$ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) 6Yy $ 1118.29 e. TOTAL LOANS OUTSTANDING $ 0.00 f. TOTAL OBLIGATIONS OUTSTANDING $ 0.00 SS-1109 (Rev. 2/06) Page 1 of 1 RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD Gary Wynn FROM: 01 Jul 2014 TO: 28 Jul 2014 RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ 0.00 b. Itemized Contributions (over $100 from each source this period) $ 0.00 c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 0.00 16. LOANS RECEIVED THIS REPORTING PERIOD 0.00 17. INTEREST RECEIVED THIS REPORTING PERIOD 0.00 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) 0.00 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) wire stands for campaign yard signs $ 46.10 $ $ $ $ $ Total of Expenditures ($100 or less each payee) $ 46.10 b. Itemized Expenditures (Over $100 each payee this period) $ 586.33 c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 632.43 20. LOAN REPAYMENTS MADE THIS PERIOD $ 0.00 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 632.43 22AWKIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ 0.00 b. Itemized in-kind contributions (over $100 from each source this period) $ 0.00 c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) 0.00 23.OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ 0.00 b. Itemized Obligations Outstanding (Over $100 each) $ 0.00 c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 121.) $ 0.00 AAWL SS-1133 (Rev. 4102) Page 1 of 1 ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD Gary Wynn FROM: 1 Jul 2014 TO: 28 Jul 2014 Amount 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 0.00 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than $100 from an contributor First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organizabon Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) CRY State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State 17jpCode Date of Contribution Aggregate This Election Occupation Employer First Name le-Name Contribution Received For: Amount of Contribution Last a aniza ion 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 of Contribution Last Name/OrganizationName ❑ 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 additional pages of this form are used.) $ 0.00 (If this is the last page of contributions, this amount must be shown in item 15b. of summary.) f- h A p ,3 SS.1131(Rev. 2106) Page 1 of 1 RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD Gary Wynn FROM: 1 Jul 2014 T0: 28 Jul 2014 Amount 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) 0.00 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period) ~7 First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Tip Signs wire stands Address for $ 46.10 244 Sill Street campaign yard City Alcoa State Zip Code signs TN 37701 First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name The Daily Times campaign Address 307 East Harper Avenue advertisements $ 288 00 in newspaper city state Zip Cade Maryville TN 37802 First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Matrixx Mail Service LLC mailer printed out Address 4430 Singleton Station Road a. $ 298.33 mailed out City State Zip Code Louisville TN 37777-4645 First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Nam/Business Name Address city state Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness 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.) $ 632.43 (If this is the last page of expenditures, this amount must be shown in item 19b, of summary.) SS-1129 (Rev. 4102) Page 1 of 1 RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE 28 July 2014 Gary Wynn 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE Gary Wynn 7 August 2014 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route city State Zip Code Phone PO Box 4937 Maryville TN 37802-4937 865.983.6996 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 1822 Morganton Rd Maryville TN 37801-8437 865.983.6996 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) Blount County Commissioner District 1 Seat B Gary Wynn 7. CATEGORY OR REPORT (Check one) FIRST SECOND THIRD FOURTH PR - PRE- MIDYEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD 27 April 2014 30 June 2014 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. Itwe 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, Itwe 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. 7 i 28 Jul 2014 - 28 Jul 2014 si ature of candid date sig ature of political tre urer date 11. WITNESS SIGNATURE 1 n -1 signature of witness date signature of witness dat 12. SUMMARY ~1 Ahh PA, ~ o ~ a. BALANCE ON HAND LAST REPORT ©\3~Q........... $ 0.00 b. TOTAL RECEIPTS THIS PERIOD `r~G.... 1Ptk M..... $ 600.00 10 V ~n V r~pN 1085.86 c. TOTAL DISBURSEMENTS THIS PERIOD .so $ _ - O ..w.~. $ 485.86 d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) e. TOTAL LOANS OUTSTANDING 000 0.00 f. TOTAL OBLIGATIONS OUTSTANDING $ SS-1109 (Rev. 2/06) Page 1 of 1 RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD 6nry Wynn FROM: 27 Apr 2014 TO: 30 Jun 2014 RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ 0.00 b. Itemized Contributions (over $100 from each source this period) $ 600.00 c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 600.00 16. LOANS RECEIVED THIS REPORTING PERIOD $ 0.00 17. INTEREST RECEIVED THIS REPORTING PERIOD 0.00 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) 600.00 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) printing $ 8.67 $ $ $ Total of Expenditures $100 or less each payee) $ 8.67 b. Itemized Expenditures (Over $100 each payee this period) $ 1077.19 c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 1085.86 20. LOAN REPAYMENTS MADE THIS PERIOD $ 0.00 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 1085.86 22AWKIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ 0.00 b. Itemized in-kind contributions (over $100 from each source this period) $ 0.00 c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $ 0.00 23.OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ 0.00 b. Itemized Obligations Outstanding Over $100 each $ 0.00 c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 121.) $ 0.00 SS-1133 (Rev. 4102) Page 1 of 1 ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: 27 Apr 2014 TO: 30 Jun 2014 Amount 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 0.00 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than $100 from an contributor First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organizabon Name ❑ Primary Election ® General Election The Blount County Democratic Party $ 500.00 Address PO Box 6552 ❑ Runoff (Local Elections Only) City Maryville State Zip Code Date of Contribution Aggregate This Election TN 37802-6552 Occupation 13 June 2014 Employer First Name Mary Middle Name Contribution Received For: Amount of Contribution Last NamarOrganization Name Brehm ❑ Primary Election ® General Election $50•00 Address 717 Harold Drive ❑ Runoff (Local Elections Only) City Maryville State Zip C3 803 Date of Contribution Aggregate This Election Occupation 13 June 2014 Employer First Name Nanc le Name Contribution Received For: Amount of Contribution Y Last Name/Organization ame ❑ Primary Election ® General Election Neilson $50'00 Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Seymour TN 37865 Occupation 16 June 2014 Employer First Name Middle Name Contribution Received or: mount of 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 additional pages of this form are used.) $ 600.00 (If this is the last page of contributions, this amount must be shown in item 15b. of summary.) SS-1131(Rev. 2106) Page 1 of 1 RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD Gary Wynn FROM: 27 Apr 2014 TO: 30 Jun 2014 moun 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) 0.00 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period) First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Tip Signs campaign yard Address signs dr $ 576.19 244 Gill Street wire stands City Alcoa State Zip Code 37701 TN First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamWBusiness Name Office Depot / store # 623 copies d printouts Address 727 Brenda Drive of flyers & handouts $ 8.67 City State Zip Code Alcoa TN 37701 First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness Name The Blount County Democratic Party donation to the Address Blount County $ 501.00 PO Box 6552 Democratic Party City State Zip Code Maryville TN 37802-6552 First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamefBusiness 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 First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBusiness 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.) $ 1085.86 (If this is the last page of expenditures, this amount must be shown in item 19b, of summary.) ADhk SS-1129 (Rev. 4/02) Page 1 of 1 RDA 1159 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 checkwith 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: 13 J,)t.,t e- 201} G4~ x,,, ha `fi~owiet~ r evi G met 4. Campaign Address and Phone: City State Zip Code Phone p b, Gox `M37 Mqr v:1(P__ -N 3` OZ-iiiS7 S. Home Address and Phone (if different than item 4 above): City State Zip Code Phone 6. Office Sought (include district number, if applicable) 7. Party Affliation 8. Election Year Ct to a ~ 0 M Wt 5 S i C tit v 0-r 20H 9. Treasurer Name: 10. Treasurer e-mail address: C ~ Q, h v\ wY0n? q (a ~w,;ss or, L- c harte_r. Y)g 11. Treasurer Address and Phone: City State Zip Code Phone 12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurercan not witness candidate's signature): c Signature of Candidate Signature of Treasur ,:a - Signature of Witness Signature of Witness Registry of Election Rnance SS-1120 (rev 10/2010) ~Y6 to ri Wd Zl ll Q` FINANCIAL DISCLOSURE STATEMENT EXEMPTION ~UQ ppv p 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: Ar "V v~►~ Candidates Position: Residential Address: Z r4ir o n ~d City: PIL~, lIP_ State: TN Zip: 37~Sd I hereby state that I meet the above qualifications for exemption and am therefore exempt from filing financial disclosure statements. Apr 2o) Candi ate's Signature ate r !Z)D, &A / Z0 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. 12 A M p cFe `L 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 their county election commission. 1. Date: 2. Name of Candidate or Committee: 3. Candidate e-mail address: l 2vr`t lTa vtri A44YV , w L b I~So~-F4, ne-t 4. Campaign Address and Phone: Ci State Zip Code Phone -3 790 i 3.6 6,!1'6 S. Home Address and P ne (if different than item 4 above): City State Zip Code Phone 6. Office Sought (include district number, If applicable) 7. Party Affliation 8. Election Year c w4 (o~:1sSfoo Jeu f 201q 9. Treasurer Name: 10. Treasurer e-mail address: K szl~ y lwr~rX 11. Treasurer Address and Phone: City State Zip Code Phone 12. Candidate and T asurer Signature (both signatures must b witnessed. Treasurercan not witness candidate's signs ure): Signature of Ca didate Signature of reasurer Signature of Witness Signature of Witness Registry of Election Finance SS-1120 (rev 10/2010)