Gardner, Trevis
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:
4. Campaign Address and Phone: City State Zip Code Phone
: ZM MEMOR(Al, TOR4G7 (YIOROLLF, Tip 57803 665-Q81--099
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
6U JK Co &Aap o`= EDUC-477c)PA DeX- $
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9. Treasurer Name: 10. Treasurer e-mail address:
'~~J15 D-aAPWE_2 CSELF) IRE\ib ND- GARCKSF-r-~
11. Treasurer Address and Phone: City State Zip Code Phone
ZZA MWOR4,L, 1DR4E_ MaROU-e, 19 -',-110, 266-mi- O V
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
Signature of Candidate
Signature of Treasurer
t /
Signature of Witness Signature of Witness
Registry of Election Finance NAk 0 R ?(]1;
SS-1120 (rev 10/2010)
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FINANCIAL DISCLOSURE STATEMENT EXEMPTION
Pursuant To TCA § 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 candidates 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 Name: I 'Fiji V*t%
Candidate Position: T*dy&N~ Ca . 4-i-A ~1S"r
Residence Address: 224 MgaIZ t ,Prt _ ~~2
City: State: zip: 3- e03
I hereby state that I meet the above qualifications for exemption and am therefore exempt
from filing financial disclosure statements.
Candidate Signature Date
Witness 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.
MAR p