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Goins, Fred CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. .NAME OF CANDIDATE OR C MITjEE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rura 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. OOFF1IC~j SOUGHT (include district number, 'f applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) 7. CATEGORY OR EPORT (Check one) ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ FIRST SECOND THIRD FOURTH PRE- 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 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 ode. Id-1- q Zlcj,,s, o -nature of candidate date signatu of po itical treasurer date 11. WITNESS SIGNATURE signature of witness date signature of witness date 12. SUMMARY 0 a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTS THIS PERIOD $ Q 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 SUMMARY PAGE - CANDIDATE 13. NAME OF CA DIDATE OR M~MMITTEE (In Full) 14. REPORT COVERING THE PERIOD FROM:' - 4 _f T0: 0--ILf 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.) $ f S 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) Jrh oy 4' $ 21k IZ4(,a Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ 7, 1)31 ?6 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. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) SS-1133 (Rev. 4/02) Page of - - ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDID TE OR COMMI EE 2. REPORT COVERING THE PERT D FROM: Y0: 4-C 7-4 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 $100 from an contributor First Name Middle Name Contribution Received For: Amount of Contribution La Name/ Organization Name ❑ Primary Election El General Election _ ,43f e- V p (4. 777 Q ddress ❑ Runoff (Local Elections Only) Ci S ACIS-V , Date of Contribution Aggregate This Election Occupati '60 Employer 1 First Name Middle Name Contribution Received For: Amount of Contribution Lm I)- A 07 Last ame/Organization Name ❑ Primary Election ❑ General Election - 00 Address 'Dr ❑ Runoff (Local Elections Only) Ci Zip Code Date of Contribution Aggregate This Election JE Occupation ^ Employer .r FirCtame iddleNaL Contribution Received For: Amount of Contribution as a rganiza on ame ❑ Primary Election ❑ General Election L7 Ad ❑ Runoff (Local Elections Only) t .41 City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First (fit Middle Name Contribution Received or: mount of Contribution Last /Orgiknization Name ❑ Primary Election ❑ General ElectionC / 77//( t? Addre ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer ~{{JJJ 5. TOTAL ITEMIZED CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) (If this is the last page of contributions, this amount must be shown in item 15b. of summary.) 04- SS-1131(Rev. 2/06) Page of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates T •ForSingie-Candidate Cotntnittees 1. DATE OF REPORT 2.a. LAME OF CANDIDATE oR -E 2.b. IF COMMITTEE, NAlk$ OF CANDIDATE Q I' 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS ANO PHONE Street r ural R e ' city ` Slate Zip Code Phone 4.b. CANDIDATE'S HOME 'r ESS (d different than 4.a.) Sir t or Rural Route City State Zip Code Phone gFFFI S HT (Indud district number If applicable) 6. NAME OF PO IT1 TREASURER (may be candidate) (nI /JIL 7. CATEGORY REPORT(CheWcone 13 13 1:3 1-_3 1:1 10 FIRST SECOND THM FOURTH Pf;r- -PRO- 8.a. BEGINNING DATE OF REPORTING PERIOD QIAFt PRIMARY / MI YEAR YEAR-END 8.b. ENDING TE OF REPORTING ~ 9. (Check one, 2 a. ❑ This campaign Is exempt from detailed disclosure because contributions (Including "nd) received total $1,000 or less AND expendi tures total $1,000 or less for this reporting period. (Complete Items 12d., 12e. and 1N.) - b• This campaign is required to file a detailed financial disclosure because contributions (including in4dnd) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. Uwe do BOW" swear or affirm that the information contained in this caaccurate accounting of campaign contrftKftns and a to be r financial dLs candi report is true tee and that this report is an Financial Disclosure Act. Additionally. Vwe swear or affirm thatt no required contributions reported the been exp nded f a the Campaign benefit of the ca campaign have been e e for any other nonpoklml purpose as defined by the federal internal revenue ~e for the personal financial si nature of candidate date i'signature of political easurer date 411.ESSS SIGNATURE ignature of witness date 9 10 11 ? ~ ~ signature of witness date 12. SUMMARY ~ v ~ RECEIVED a. BALANCE ON HAND LAST REPORT A V TOTALRECEIPTSTHIS PERIOD ~t3~jyCT/o rwly....... .4n $ a TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) e. TOTAL LOANS OUTSTANDING f. TOTAL OBLIGATIONS OUTSTANDING SS-1109 (Rev. 2106) page 1 or RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF INDIPAT'n RCOMMITTEE (In Full) 14. REPORT COVERING THE PERIOD y1 FROM: TO: 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 bans and interest)(add 15.a. and 15.b.) cv 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.) $ , ~c$7 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) $ $ $ s $ ad Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ ~ 7 C. TOTAL EXPENDITURES (other than ban repayments)(add 19.a. and 19.b.) $ `J . 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) $ J b. Itemized in-kind contributions (over $100 from each source this period) $ -5 / c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) 3 5/ 23.013LIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ a TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown f item 12.f.) SS-1133 (Rev. 4102) Page of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME CANDI ATE JCOMMrE , 2. REPORT COVERING THE PERIOD FROM: TO: PA. t 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first (tertni A page) 4. COMPLETE THE OPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION oon6 cbutioos Waling more than $100 from a contributor Frs~ttame Iw;ddle Name Contriboli" For. Arnount of Contribution least Na tan Name ❑ Primary Election ll Gencrai Election ill / I e ❑ Runoff (Local Elections Only) . /l Date of ContKution Aggregate TNs Election Csaparan Emptoya .7' t M Lftk Name ConMbu6on Received For. Anoint of ConMbution J wme ❑ Primary Election P'Generel Election ~00 D Rune (Local Elections OnW qty V v / / LpCO& Date of Cantrdxdion Aggregate This Election Fr*Nwm trams Contribution Received For. Amount of C *bubon ❑ Pdnwry Election ❑ General Election Aidress ❑ Runoff (Local Elections Only) qty Stab Zip Code . Dade of Canfrnbu6on Aggregate This Election FiRlName Mae NOW Contribution Roceived or Amount of Contribution tmst NamdOrpaNaeon Name ❑ Pdewty Election ❑ General Election Address ❑ Runoff (Local Elections Only) City Stale 7p Code Date of Confrikkon Aggregate This Bection 0="6m FrvbYw 5. TOTAL ITEMIZED. CONTRIBUTIONS lC~ torwmd b tlern d nezl pays / eddi6ond pages d ~ tam ae used ly t k is fast papa dawftu5om flits wnaat must be dawn in nom 15b. d wwn&ryj SSA W (Rev. 2106) Page of RDA 1159 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 doe ~a end more than $1,000 to get elected to office, the candidate does no mpaign Financial Disclosure Reports." RECEIVED N JUL i 1~?4 w r y CANDIDATE'S INFORMATION: Candidate's Name: r r n, M Z~ a Candidate's Position: a~ 10 a k 7w- 7 Residential Address: Ed. City: ~ i1 ' State: TN Zip: :17 l I hereby state that I meet the above qualifications for exemption and am therefore exempt from filing financial disclosure statements. J)6~ 6-30-1. Candidate's Signature Date -P.U- 3o - 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. p 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: 4. Campaign Address and Phone: City State Zip Code Phone . (01 TN /NO J's - -6 ~ "'2 '_5 JA ~ P #m ' ~V~ V S 5. Home Address an P n if different than item 4 above): City State Zip Code Phone 6. Office Sought (include district number, if applicable) 7. Party Affliation 8. Election Y(e/ar Otk-, 4y Scl., 16ar d1j'-4:jz7 reasurer Name: 10. Treasurer e-mail address: 11. Treasurer Address and Phone: City State Zip Code Phone Sam 12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature): Signature of Candidate Signature of Treasurer Signature of Witness Signature of Witness Registry of Election Finance SS-1120 (rev 10/2010)