Duck, Samuel David (write in for cc 3 seat b)
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 12.a. NAME OF CANDIDATE OR COMMITTEE
Z)19 e-7 3 1 Sfl m U6 L I Cie
2.b. IF COMMITTEE, NAME OF CANDIDATE =33.EELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
32 f~ 513~A i 115? V MAR i VZ LL - (-3 7 ¢
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) G ~S 7~6
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)
CCMn41 5Sj0/VC 17.15 773C7 5441 tL 1) V( /
7. CATEGORY OR REPORT (Check one)
❑ ❑ ❑ ❑ ❑ CK ❑
FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAREND
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
2v(y VI 2c714V 725
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. D 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.
-IAal 04yiV ~2014o'25) ~ VA4 Ave Z car v ray
signature of candidate date signature of political treasurer date
11. WIT ESS SIGNATURE
~'3('1LJ a `-731-c
signature of witness date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT . d
DO 0 .
b. TOTAL RECEIPTS THIS PERIOD
c. TOTAL DISBURSEMENTS THIS PERIOD....... 6......~/~~ $-8p, 66
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.~ ~1...{.t...Ot.,.F,..~ $
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2/06) Page 1 of RDA 1159
7
SUMMARY PAGE - CANDIDATE
13. NAME OF CANDIDATE OR COMMITTEE (In Full)
:1 5FFRR REPORT COVERING THE PERIOD
M: ZCtV04a~ T0: ,THE
2
RECEIPTS
15. CONTRIBUTIONS (other than loans and interest)
a. Unitemized Contributions ($100 or less from each source this period) $ V
b. Itemized Contributions (over $100 from each source this period) $
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) 7, 6
16. LOANS RECEIVED THIS REPORTING PERIOD $
17. INTEREST RECEIVED THIS REPORTING PERIOD C
18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) p 7. 66
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)
Total of Expenditures ($100 or less each payee) $ b
b. Itemized Expenditures (Over $100 each payee this period) $ 0766
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.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.)
Agmth
SS-1133 (Rev. 4/02)
Page of
t
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
M V 6 l FROM: T0: Z~, 7 2
A o t
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 NaAmAen Middle Name Contribution Received For: Amount of Contribution
LCiNa~ organization Name El Primary Election C General Election Y00,00
Address ❑ Runoff (Local Elections Only)
City State J L'pCode Date of Contribution Aggregate This Election
Occupation ` C 04 Q 1
Employer 0
FirstN a Middle Name Contribution Received For: Amount of Contribution
ENE L
Last Name/Organization Name ❑ Primary Election General Election
t)'i R I
Address ❑ Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
Occupation
oft70 i Gr?
Employer
First Name fiddle Name
54 L/ C C Contribution Received For: Amount of Contribution
as am
rgamza on Name ❑ Primary Election General Election
()VLr 66
Address ❑ Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
Occupation
oyef 7 U 1' 66
First Name Middle Name Contribution Received For: Amount o ontnbution
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 r~
(Carry forward to item 3. of next page if additional pages of this form are used.) y~
(If this is the last page of contributions, this amount must be shown in item 15b. of summary.) (J o
4) SS-1131(Rev. 2/06) Page of RDA 1159
t
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
M V C- L DV C'r FROM: 7
~T0; q
mown
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page)
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
/"Address 'V r ~ ' 4V
j IIN 6
City (-Of j Slate 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
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 j~
(Carry forward to item 3. of next page if additional pages of this form are used.) 00 C b
(If this is the last page of expenditures, this amount must be shown in item 19b. of summary.)
SS-1129 (Rev. 4102) Page of RDA 1159
it
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:
)-ClMC ~(~~~~'iu
4. Campaign Address and Phone: City State Zip Code Phone
A.0P if
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
C( C 'v I ` ~G,~1-t~ZSSfc'rv tDTS"~~fC7 5 Sri~c X V~~.M C: 2-0 1 ti
9. Treasurer Name: 10. Treasurer e-mail address:
11. Treasurer Address and Phone: City State Zip Code Phone
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
_jetw~ P44 patJ V<tv._
Signature of Candidate Signature of Treasurer
e<n
Signature of Witness Signature of Witness
Registry of Election Finance
SS-1120 (rev 1012010)
7 t, r
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
4~11~ 361C
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 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
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 ca idate or for any other nonpolitical purpose as defined by the federal internal revenue code.
A.A Acl' Z°Cy() rri
lqD l0 LM/IN4
signature of candidate date signature of political treasurer date
11. WITNESS SIGNATURE
a
L/lignature of witness ate signature of witness dat
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.) $ C'. L
e. TOTAL LOANS OUTSTANDING $ oc"
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2/06) Page 1 of RDA 1159