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Allen, Andy CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF EPORT 2.a. NAME OF CANDIDATE OR CO MITTEE -)9 erg 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 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Str et or Rural Rpyute City j~ ty State Zip Code_ 1 Phone IK 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) C~rnr~~ ss jar--) r e~ 7. CATEGORY OR REPORT (Check one) ❑ [M; ❑ ❑ ❑ ❑ ❑ ❑ FIRST SEC',OfVD 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 DATE OF REPORTING PERIOD -'1 (0 ~ 0 - f y 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. Z"Vt 0'&~. signature of candidate dat sig pure of political treasurer d416 11. WITNESS SIGNATURE 'nil signature of witness dal signature of witness d e 12. SUMMARY a. BALANCE ON HAND LAST REPORT ~ GOV~ b. TOTAL RECEIPTS THIS PERIOD ...............................10~XQN......... $ $ 0 c. TOTAL DISBURSEMENTS THIS PERIOD 0 d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ LV e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ 4) SS-1109 (Rev. 2/06) Page 1 of -I- RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF EPO T 2.a. NAME OF CANDIDATE OR COM E h 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE -J I 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5. O FICE SOUGHT (include district number, if applicable) 6. NAME OF POLITIC L TREASURER (may be candidate) I~YV S ; LrY. ~Q n 7. CATEGORY OR REPORT (Check one) ❑ ❑ ❑ ❑ ❑ ❑ ❑ FIRST SECOND THIRD FOURTH PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER UARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD V 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. (DvIJAW4~,,- _ ql,;2111j, signature df-candidate date si ture of political treasurer date 11. WITN SS SIGNATURE "4'~ I L g-2~ 18 421 ignature o tness date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ ` o o b. TOTAL RECEIPTSTHIS PERIOD - -7'1 Y. S c. TOTAL DISBURSEMENTS THIS PERIOD .....................................................ry $ I ,a d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) ' ,P $ e. TOTAL LOANS OUTSTANDING $ 0 f. TOTAL OBLIGATIONS OUTSTANDING ................................1.r............. ~~.G~; .........yam............................ $ SS-1109 (Rev. 2/06) Page 1 of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATEOFREPORT 2.a. NAME OF CANDIDATE OR COMMITTEE a_ 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE -1_j 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) Ury-1 rw~ c~ C h 7. CATEGORY OR REPORT (Check one) ❑ ❑ ❑ ❑ ❑ ❑ ❑ AST 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 DATE OF REPORTING PERIOD l -L 3.31 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. ❑ 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. signs re of candidate dat si ture of politics treasurer d to SS SIGNATURE 11RITN., 2 - I Fs z signature of ftness date signature of witness ate 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTS THIS PERIOD c)(D V qq C) c. TOTAL DISBURSEMENTS THIS PERIOD $ " V d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) .0.~., 12 A~l~....... $ t O~ e. TOTAL LOANS OUTSTANDING ~..............t~.f}........ a.................................. $ cn ` ~ ! f. TOTAL OBLIGATIONS OUTSTANDING APR....d.... $ i Cr E"..01~'" SS-1109 (Rev. 2/06) Page 1 of I RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATEOFREPORT I2.a. NAME OF CANDIDATE OR COMMITTEE V~ - - \ 1 tr~r~ q 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 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) State Zip Code Phone Street or Rural Route City Inumbe?, 5. O FFICE SOUGHT (include disf applicable) 6. N~ OF POLITICAL TREASURER (may be candidate) 7. CATEGORY OR REPORT (Check one) ❑ ❑ ❑ FIRST SECOND THIRD FO TH PRE- PRE- MID-YEAR Y END QUARTER QUARTER QUARTER QU TER PRIMARY ENDING DATE OF REPORTING PERIODENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 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. .I-- 'z qon signatu of candidate d e s g ature of poll ica treasurer e 11. WITNESS SIGNATURE 4dt si9nat a of witness 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 .........................................0 ) $ cD VjVCFjVLlJ as' f. TOTAL OBLIGATIONS OUTSTANDING .........................u? ................................19..........< $ l_N zn Cl) EL,QUNT COUNN SS-1109 (Rev. 2/06) ELTzCTION Page 1 of RDA 1159 b C` Wd Z V 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. Candidate First and Last Name: 3. Candidate e-mail address: 4. Campaign Address and Phone: City State Zip Code Phone 3V L S. Home Address and Phone (if different than item 4 above): City State Zip Code Phone j l1 ~2 n S ~r ~x~ t e 6. Office Sought clude district number, if applicable) 7. Party Affiliation 8. Election Year ~.0 rv~r s S , o~ ,S~► t j /a i • c ,~r~/c~ 9. Treasurer Name: 10. Treasurer e-mail address: 11. Treasurer Address and Phone: City State Zip de Phone lj'c~~2 l G►~~~~ Irv 3 95"x.3 3 s~ 12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature): . Oy Signature of Candidate Signature of Treasurer tr -97018 Signature of Witness f' Signature of Witness e Registry of Election Finance SS-1120 (rev 1212013) 740 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 12.a. NAME OF CANDIDATE OR COMMITTEE 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 da \e t i ~+I OJc \L 1 3 8 S3 ~S loS 3 ~sa~ 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) 7. CATEGORY OR REPORT (Check one) ❑ ❑ ❑ ❑ ❑ ❑ ❑ FIRST SECOND THIRD FO TH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QU TER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD /p~ I - lL/ 9. (Check one) a. XThis 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. sig atur f candidate date si t re of polite al treasurer date 11. WITNESS SIGNATURE 7 sign re of witness date sig ature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT ..........w;..........!:; $ Q 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 $ Ash, SS-1109 (Rev. 2/06) Page 1 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 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 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) m t s S~VVN Q r~rll ~r~ 7. CATEGORY OR REPORT (Check one) El 1:1 FIRST SECON0 13 D THIRD FOURTH PRE- PRE- MIDD❑YEAR YEAR❑-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD B.b. ENDING DATE OF REPORTING PERIOD 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. " 1 - t l o 1. 1 A A o- I GUI I signafureed candidate dat signat re of po itical treasurer dat 11. W)TNESS SIGNATUf5f S f signature o itness date sig at re of witnes date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ t b. TOTAL RECEIPTSTHIS PERIOD a TOTAL DISBURSEMENTS THIS PERIOD $ $ 3, d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) e. TOTAL LOANS OUTSTANDING $ L~ 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. DATE OF REPORT I 2.a. NAME OF CANDIDATE OR COMMITTEE -7 -So - \y V- - er 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE % =1.1~-1 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone ° ~ \ v(j I 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAM OF POLITICAL TREASURER (may be candidate) ' • y s tr-~ 7. CATEGO"' OR REPORT (Check one) 1:1 1:1 FIRST SECOND THIRD FOURTH PRE- 02- 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 \PJ " 9. (Check o ) a. This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- I 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. 1 1 signafuredf candidate date sign re o politic reas rer ate 11. WITNESS SIGNATURE r s' nature o` i ess date O N' A? PM signatu, v4tness date Ito r, ,15 ~ ~ a 12. SUMMARY 0fi t~` r a. BALANCE ON HAND LAST REPORT I, . U,.......... $ -AO b. TOTAL RECEIPTS THIS PERIOD $ O . c. TOTAL DISBURSEMENTS THIS PERIOD hd•.• b~ $ d. BALANCE ON HAND 12.a. plus 12.b. minus 12.c. $ e. TOTAL LOANS OUTSTANDING $ u f. TOTAL OBLIGATIONS OUTSTANDING $ SS-1109 (Rev. 2106) Page 1 of-A- RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 12.a. NAME OF CANDIDATE OR COMMITTEE I -1- ~ ,f-~j 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 Z t . fps 3 eS as 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) ~s on 61 n 7. CATEG Y OR REPORT (Check one) ❑ ❑ ❑ ❑ ❑ ❑ ❑ FIRST SE D THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QU TER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD VIA 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. signature of candidate date s nature of political easuret r date 11. WITNESS SIGNATURE signature of wi ness date signatu of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTSTHIS PERIOD $ 1 c. TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ e. TOTAL LOANS OUTSTANDING $ 0 f. TOTAL OBLIGATIONS OUTSTANDING $ V 0 SS-1109 (Rev. 2/06) Page 1 of t RDA 1159 r CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DAT OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE i u (A\ \'~.n 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 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5 OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) 3c.r, 1 l I? Il\ C~ ~s G rn 61 1 ❑ ❑ ❑ ❑ ❑ 7. CATEGORY-OR REPORT (Check one) FIRST SECOND THIRD FOURTH OE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BE\GIN~NING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTIN`G` PERIOD 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. Lot signatur candidate date si ture of political treasurer date 11. Y111TNESS SIGNATURE 1J ~ 28.14 signature of vKne\as date signature of witness date 12. SUMMARY G a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTS THIS PERIOD $ 0, 0 c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ e. TOTAL LOANS OUTSTANDING $ O f. TOTAL OBLIGATIONS OUTSTANDING $ 4D SS-1109 (Rev. 2/06) Page 1 of -I- RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.e. NAME OF CANDIDATE OR COMMITTEE 1_\ -y-1_\ p0\o-\ 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE x---1-1`-1 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route C" State Zip Code Phone 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) 7. CATEGORY R REPORT (Check one) ARS&r SECOND THIRD FOURTH PRE- PRE MY-YEAR YEAR-END QUARTER QUARTE-R QUARTER ARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD 3 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. LX1 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 benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. ? signature of candidate datiti nature of po itical treasurer d to 11. WITNESS SIGNATURE r 4 5 1 + 4 19- signature of wit date signature of 'tness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ O 7 b. TOTAL RECEIPTSTHIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ r L e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ 40 SS-1109 (Rev. 201) Page 1 of RDA 1159 « It 0'~ i i SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD FROM: T0: 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). $ SDO-O~ DO 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 $ 01 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 listed by category - e.g., printing, postage, gasoline) ~L Co $ $ $ $ $ Total of Expenditures ($100 or less each payee) L' . o rr b. Itemized Expenditures (Over $100 each payee this period) $ c. TOTAL EXPENDITURES (other than loan 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 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.) $ 23.013LIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ L c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 121.) $ M1133 (Rev. 4102) Page ~ of ~ _ ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD 11 FROM: _ To.,-. 2 - 1 . , Amount _ 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 f first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than $100 from an contributor Fil tame Middle Name Contribution Received For: Amount of Contribution ck { \ Last Name/Organization Name Primary Election ❑ General Election i O l~ w Z(S 3 V lJ Address ❑ Runoff (Local Elections Only) 5533 city State Zip Code Date of Contribution Aggregate This Election v \ y W Occupation Employer First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organizabon Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name 71e Contribution Received For: Amount of Contribution s a anus n Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Fmployer First Name Middle Name Contribution Received t--or. Amount of Contribution Last Name/Organizabon Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City Stale ZhpCode 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 . O v (If this is the last page of contributions, this amount must be shown in item 15b. of summary.) Amk SS-1131(Rev. 2/06) Page 3 of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD 11 FROM:-1 T0: - - ~l morn 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) 0 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 NamelBusiness Name C \ Cj r, O Address G S Zip Code j \ , 1y First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City Slate Zip Code a- First Name Middle Name Purpose of Expenditure Amount of Expenditure Las NamelBusiness Name Address ~L \ ~'n CGS I S \ c~V--~s G'Ty State Zip Code ay a 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 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 1 (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.) RDA 1159 SS-1129 (Rev. 4/02) Page of CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates Tor Single-Candidate Committees 1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE 2.b. IF COMMITTEE. NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE 1 Street or Rural Route City State 2 ZIP coos Phone 4.b. CAN IDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route Cfly State Zip Code Phone 5. OFFICE SOUGHT (Include district number, H ap plicable) 6. NAM OF POLITICAL TREASURER (may be candidate) lvVvti 0`e < r cry G n ~1~~ 4R 7. CATEGO Y OR REPORT (Chw* one) Q 1:3 .13 0 13 THM FOURTH PRE SST SEOONO F~ MID-YEAR yEgD. GENERAL 8.a. BEGINNING DATEOFREPORTING PERIOD 8b. BNDING DATE OF REPORTTtNG PERIOD 9.(Check one) a. ❑ This campaign is exempt from detailed disclosure because contributions Including iMcind) received total $1,000 or less AND expendi- tures total $1.000 or less for ft reporting period. (Complete items 12d.. 12e. and 12f.) b. i, This campaign Is required to file a detailed financial disclostue because conbUdions (incwding kAdnd) reoehmd total more than $1.000 and/or expenditures total more than $1,000 for ft-reporling period. 10. IAae do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this accurate acoounting of campaign contrtxAlons and experiftm required to be repotted by the candidate oottunlflee b the report is an Financial Disclosure Act. Additionally, Nwe swear or affirm that no ca Y Campaign benefit of the candidate or for any campaign contributions have been expended for the personal finantla! an nonpolitical purpose as defined by the federal kttemal revenue code. 2"1!5X~ S fr~\~ All 0 signatu of fdate dat s politk~ll astrter dal 11. YKINESSSIGNATURE PAII ml ~:l L, I~ '4 10 A signature da signature pf s dot 12. SUMMARY a. BALANCE ON HAND L AST REPORT » b. TOTALRECEIPTSTHISPERIOD c. TOTAL.DISBURSEMENTSTHISPERIOD a».....a,; ...»...................».......5 ' V D d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.)4 1 ~~J e. TOTAL LOANS OUTSTANDING » C TOTAL OBL.IGNTIONS OUTSTANDING 5 M1109 (Rev. 2105) Page 1 W ~ RDA 1169 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In FpII) 14. REPORT COVERING THE PERIOD 10: ~ . IS-1\1 RECEIPTS 15. CONTRIBUTIONS (other than bans and interest) a. Unltemized 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 Viand 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.) DD DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or less each payee this petiod) (must be listed by category - e.g., printing, postage. gasoline) 606,( AYl V CYVl(~~r~(t ihJDo $ U,Q $ S $ $ S S Total of Expenditures ($100 or less each payee) $ ~2 c)_oo b. Itemized Expenditures (Over $100 each payee this period) c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) 20. LOAN REPAYMENTS MADE THIS PERIOD O 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown In item 12.0 1 22.IN-KIND CONTRIBUTIONS a. Unitem'ized in-kind contributions ($100 or less from each source this period) $ KINO ontributions (over $100 from each source this period) $ 0 TOl'Aeed In-kind C. NTR BUTTONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $ 23.0BLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) b. Itemized Obligations Outstanding (Over $100 each) C. TOTAL OBLIGATIONS OUTSTANDING (add a. and 23.b.) (must be shown i item 121) . SS-1,33 (Rev. 4W) Page of i I ~ A o ~ RECEIVED -5, X02 A ` 'ointment of Political Treasurer ~j 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. 3. Candidate a-mail address: 1. Date: 2. Name of Candidate or Committee: City State Li ode Phone 4. Campaign Address and Phone: j t-- State Zip Code Phone 5. Home Address and Phone (if different than item 4 above): City 8. 6. office Sought (include district number, if applicable) 7. Party Affliation Election Year - 2 ~\'Ao~\Cu~ 9. Treasurer Name: 10. Treasurer e-mail address: Zip Code Phone 11. Treasurer Address and Phone: City State 12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer cannot witness candidate's signature): Signature of Treasurer Signature of Candidate Signat re of Witness Sign lure of Witness Registry or Election Finance SSA 120 (rev 10/2010)