Weatherbee, Eric
FINANCIAL DISCLOSURE STATEMENT EXEMPTION
Pursuant to TCA § 2-10-101(b) a candidate is exempt from filing financial
disclosure statements due to the following:
1. The service for the office which I seek is part-time and the compensation
is less than $1,000 per month,
AND
2. 1 do not plan to spend more than $1,000 on my campaign.
*Candidates running for Chief Administrative Officer (i.e. Mayor) of the county or
city are NEVER exempt from filing and should file the required campaign financial
disclosure reports regardless of compensation or spending.
CANDIDATE'S INFORMATION:
Candidate's Name: ~irLc wto(I'tek""
Candidate's Position: CouM4-yMt55"~n sa
Residential Address: I `3/3 br
City: Mary~~ ILA State: TN Zip: 1°3
1 hereby state that I meet the above qualifications for exemption and am
therefore exempt from filing financial disclosure statements. If any of the above
change and I no longer qualify as an exemption, I will file the required campaign
financial disclosure reports with my local election commission.
W [A4,,G.. 4/6 /Ig
Candidate's Signature 13910 yr r? Date
Witness's Si gnat e N Fo t rg
Date
a t,Nrc 9<1g
Fcr~ 0~ ~
~a2` t1 0K L9~
6
Print Form
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:
Ma rcl. 5 20 l g I L VJea ~'(nZd✓Ge Q (1L , v~1Ga ((~~,/~Ll ~o SnnGI I. Lo M
4. Campaign Address and Phone: City State Zip Code Phone
10M Souk-,c(,ff Dri ve 0co-p,l(e TrJ 3'7c603 865-3Cv-7vo3
5. 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 Affiliation 8. Election Year
Cam^~-f Cun~n^CcS~'or~ -Disr~jct S (ZeCL4tQI000,, 2_b
9. Treasurer Name: 10. Treasurer e-mail address:
m6yaa,., -t n4cl rnorjaq eq ~na 1 1, Lzm
11. Treasurer Ad ress and P ne: City State Zip Code Phone
I ~ Z N-IQ f wh v, k- 'I N 31 Y u 3 S'~s t - J] 33
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
Signature of Candidate GE Signatu e JoTreasurer
TO
,
Signature of Witness Signature of i ess
Registry of Election Finance
? SS-1120 (rev 12/2013)
ITF7 A;`
FINANCIAL DISCLOSURE STATEMENT EXEMPTION
Pursuant to TCA § 2-10-101(b) a candidate is exempt from filing financial
disclosure statements due to the following:
1. The service for the office which I seek is part-time and the compensation
is less than $1,000 per month,
AND
2. 1 do not plan to'spend more than $1,000 on my campaign.
*Candidates running for Chief Administrative Officer (i.e. Mayor) of the county or
city are NEVER exempt from filing and should file the required campaign financial
disclosure reports regardless of compensation or spending. i~Fo
CANDIDATE'S INFORMATION: UE8282418
F~ 77o
Candidate's Name: uric Wtaklity,
Candidate's Position: (AvAf-y St + SA -31°"^} (°~~Iy
Residential Address: IS13 50,t~,C[JF Drive
City: Maryville State: TN Zip: '37%o3
I hereby state that I meet the above qualifications for exemption and am
therefore exempt from filing financial disclosure statements. If any of the above
change and I no longer qualify as an exemption, I will file the required campaign
financial disclosure reports with my local election commission.
5/t,.1, Ljup 2 /2'g t/ 8
Candidate's Signature Date
2. '2
Witness's Signature Date
11/20/2014 THU 12:07 FAX
CAMpAICIN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate C Mlnlttees
2.a. NAME OF CANDIDATE OR COMMITTEE '
1. DATE OF REPORT I tv ` t~.YEL wL',-1"k//&
ELECTION DATE
((I`
2,b. IF COMMITTEE. NAME OF CANDIDATE
fit. r , w~&1~Uc,(~Zk Zip Code Phone
4.a. CAMPAIGN ADDRESS AND PHONE city State
3 ? fyu
street or Rural Route T U Ij 5
Z3 McvAt ~.;~^2 fy i irn~ J1 ary
Zip Code Phone
State
4.b. CANDIDATE'S HOME ADDRESS (if different iCatyn 4.a.
Street or Rural Route
g. NAME OF POLITICAL TREASURER (may be candidate)
5. OFFICE SOUGHT (include district number, if applicable)
- , sir ~;!v(•~vJ
ltx L S(Invui 1, t l ❑
nn,r fyv ❑
7. CATEGORY OR REPORT (Check one) 131 MID-YEAR YEAR-END
GENERAL SUPPLEMENTAL SUPPLEMENTAL
13 13 THIRD FOURTH PRE- PRE
FIRST SECOND PRIMARY
QUARTER QUARTER 8.b. ENDING DATE OF REPORTING PERIOD
8.a. BEGINNING DATE OF REPORTING PE UARTER RIOD UARTER i 7-/3, /1
;o/~ l inf
g. (Check one)
Camplete items 12d.. (including d) received total $1,000 or less AND expendi-
This campaign is exempt from detailed disclosure because
a. Briod
lures total $1,000 or less for this reporting p
This campaign is required to file a detailed finanl reporting isrpe because contributions (including in-kind) received total more than $1.000
b. ❑
and/or expenditures total more than $1,000 forthis
1p 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
ex expenditures required to be reported by the candidate
expended for the personal financial
mmittee by the accurate accounting of campaign contributions and
Financial Disclosure Act. Additionally, I/we swear or affirm that no efined by campaign contributions have been co Campaign
the federal internal revenue code.
benefit of the candidate or for any other nonpolitical purpose as d b r4+
f:r _--V- / date
signature of political treasurer
` date
signature of candidate
11. WITNESS SIGNATURE
signature of witntsS date
date
signature of witness
V. SUMMARY
L\ $
RF./ .L.
,.ti' D
a. BALANCE ON HAND LAST REPORT +,o• • ~ Gam'
........i...y.j $
v 1
b. TOTAL RECEIPTSTHIS PERIOD ,t;•-•••-I' u',~,(~`J'
gip....
c, TOTAL DISBURSEMENTS THIS PERIOD
L~ +~tQiV
ti< $
d. BALANCE ON HAND 02.a. plus 12.b. minus 12.0
e. TOTAL LOANS OUTSTANDING D
N $ _
ky............ .
f. TOTAL OBLIGATIONS OUTSTANDING
/pN 1) Page 1 of RDA 1159
SS-1109 (Rev. 2106)
~~~~ll p(6~~
10/27/2014 MON 7: 53 FAX 0001/001
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE
o (,Wot r 2.2, 2-(714- Cows... t~ 4~ rvi ~r t 4.rl:c Vj-A0 1412' t
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
'yrl. _"Je- ,•er~u
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City Stale Zip Code Phone
623 f\Ao^jonvery l-,(KA-c Mary,, Ikt TcA ~~$03 360-' 003
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)
rnveyv~IUL irrl~ ycllvof 601Vd /ay,cRft~ QCsxi5
7. CATEGORY OR REPORT (Check one)
❑ ❑ ❑ ❑ ❑ c>?f ❑ ❑
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
of,+V10 i 11 1, 2014 0(,tabt r 2 5,'2_0 ( +
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 cannddidate` or for any other nonpolitical purpose as defined by the federal internal revenue code.
011-VI +
04) 2~ /1 Iq
signature of candidate date signature of political treasurer date
11. WITNESS TURE
co 1cvv^ t,(11 2.511 f
si lure of witness dale signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $ (b • a S
b. TOTAL RECEIPTS THIS PERIOD I aS • p
c. TOTAL DISBURSEMENTS THIS PERIOD $
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ 65
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $
f
> SS-1109 (Rev. 2106) Page 1 of RDA 1159
0001/006
10/14/2014 TUE 14:50 FAX
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
Tor Single-Candidate Committees
1. DATE OF REPORT 12.8. NAME OF CANDIDATE OR COMMITTEE
0-- to 2.01+ CAmMi+ u .h 4lcc kr[cUltt~{1ntZhu
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
zt,ri G wu xtlq rtm' NOV 4 2014
4.8. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route city state Zip Code Phone
W Mont orvi'Al L41r. Mav-y\/,'lu TN 1'{•`603 360' 3
4.b. CANDIDATE'S HOME ADDRESS (d 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 c (nnol ~V&'4 cw s(5
7. CATS RY OR REPrO~RT (Check one) ❑ ❑ ❑ ❑
FIRST SECOND THIRD FOURTH PFD PRE MID-YEAR YEAR--END
QUARTER QUARTER QUARTER QUAR PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.8. BEGINNING DATE OF REPORTING PERM 8.b. ENDING DATE OFREPORTING PERIOD
7/1/14 9(3014
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. (36 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, Uwe swear or affirm that no campaign contributions have been expended for the personal financial
benefit of the candidate or for any other nonpottGeal purpose as defined by the federal internal revenue icode.
VJuII R9 l0/1 c 4 ' j ' L u/ t Z.i)t !r
signature of candidate date signature of political treasurer dato
11. WITNESS SIGNATURE
/
14
signature of witness date signature of witness date
12. SUMMARY ~j
a. BALANCE ON HAND LAST REPORT S L-
b. TOTAL RECEIPTS THIS PERIOD
c. TOTAL DISBURSEMENTS THIS PERIOD t f t t• Z q
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ (b~ S
e. TOTAL LOANS OUTSTANDING $ _ - r
f. TOTALOBLIGATIONS OUTSTANDING $
QD SS-1109 (Rev. 2/06) Page 1 of RDA 11159
0002/006
10/14/2014 TUE 14:51 FAX
SUMMARY PAGE - CANDIDATE
13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING T14E PERIOD
COMM i{ t(j TV 4 (tcl- 4166 vJt u{ tnPrbca FROM: 4 TO: q ;u l 4
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 loans and interest)(add 15.a. and 15.b.)
16. LOANS RECEIVED THIS REPORTING PERIOD $
, nS
$ '
17. INTEREST RECEIVED THIS REPORTING PERIOD $
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)
Vo t( (-,tCordS - 6 fount (-ovamy $ 4-o. oo
C' J5
Wtt75~~1 - wr(yL11.t1~2lc~t+rC)ckOOI t.:700? V4 GbM $ 3°l 9S
u/tlo5, to t~{tLtnGCMt~I f utPy ~ti $ 29 •p°
clwol~ my f-u5 $ ~ o . t70 '
$
$
$
$
Total of Expenditures ($100 or less each payee) $ «T S
b. Itemized Expenditures (Over $100 each payee this period) $ I i S 1' 2~
c. TOTAL EXPENDITURES (other than ban repayments)(add 19.a. and 19.b.) $ 1 (t Z 4
20. LOAN REPAYMENTS MADE THIS PERIOD $
21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ l 24
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) $ fb
b. Itemized Obligations Outstanding (Over $100 each) $
o TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $
v,W SS-1133 (Rev. 4102) pie -2- 0 4
U003/006
10/14/2014 TUE 14:51 FAX
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2ING THE PERIOD
LOMMitTCL 'l•» cvc+ rtrkL lljmtlAey7(c TO: c (~o l4'
Amo unt
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 Rece ived For: Amount of Contribution
k~tsfiI
Last Name/Organization Name ❑ Primary Election ❑ General Election
vVQ a {~Lt t r bu 1,00o. o u
Address ❑ Runoff (Local Elections Only)
I~ S l WQS fi Nl,'lllrs Cove Rd
City State Zip Code Date of Contribution Aggregate This Election
wr:.ttAAA s~ -3I- se6
Occupation ~l
RN ~~i5~2of~- 'OD o. oO
Employer
I O VI/~'~ M~nrt~rlp 1 l-tosp' ~a l
First Name Middle Name Contribution Received For: Amount of Contribution
Ctrl 6
Lest NamelOrganizationName ❑Primary Election d General Election
W ~ {'tit, rlo.ee ~ 2 03. V-
Address ❑ Runoff (Local Elections Only)
bL3 i'V~orV{' orv~try I.un.e
Coy State TCode Date of Contribution Aggregate This Election
MArll \j N- lt.c - -j l ~ X03
Occupation CAP r6 to tNn f I r 2v i q 2 V3.
Employer
COnex~S Mrtiv~a A rn0,.} ~,OMPGtn
First Name ddleName Contribution Received For: Amount of Contribution
Sa S a>1
Last a rgamzatron Name ❑ Primary Electron LJ General Election
.~~n1S ~2,17u• U~
Address E] Runoff (Local Elections Only)
1bL1 Cgrp[~3-r'~r5 C~farla. 2d
e Date of Contribution Aggregate This Election
cod
City state rj3-4-%io
N\ wryVrliic 1'rJ 3
Occupation
rtktrr~ BffS/2ol~ ~-zoo ,0p
Employer
First Name M die Nama Contribution eceive or: mount of Contribution
Last Name/Or9anizationName ❑ Primary Eteclion ❑ General Election
Address ❑ Runoff (Local Elections Only)
oly State Zip Code Date of Contribution Aggregate This Electon
Occupation
Employer
5. TOTAL ITEMIZED CONTRIBUTIONS 2 g
(Carry forward to hom 3. of next page d additional pagos of this form aro used.) 1 T D3
(If this is the fast page of contributions, this amount must be shown in item 15b. of summary.)
q-,J' SS-1131(Rev. 2106) Page of.. 4._, RDA 1159
/2004/006
10/14/2014 TUE 14:52 FAX
U005/006
10/14/2014 TUE 14:52 FAX
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
Lb Ato 4(ut4r u.Wt,a{w4" FROM: -7(t(1f TO: 11;o t4-
moun
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 ff first itemized Page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ffEM(ZED EXPENDITURE (expendibmes WAing nw e ft) $100 b any payee during the period)
1111115
Flrat Nine ►Addb Name Purpose of Expenditure Amount of Experift e
lest Namelt3usiness Name
ytAOte d~•tke „5•conk ~JvlrcVta~l of yarl~ 5,INS
Address I U4- 4- Y 6 (vd
St* zip code
ftµ5~r^ T
X 5%
Frst Name M4* Name Purpose of Expenditure Amount of Expenditure
Last N&TWOuslness Name
Ma n?-f3. Gone /
(1~(L~1a~ OT M0.4 AC'S
"~d"~5 s I Pc,c~ ft' c ~4v(nvtl, 5,~,-te 4 `JJ
C4 State Zip Code
S <<StiY 147 tzq 3o4
Fast Name viddte Name Purpose of Expenditure Amount of Expenditure
Last NamelBvskwss Name
V a s ~-a s t n ~',ioM 11 t Ld
Address t4 th r C VA A 0 ° k ~k r0s St 6 fl
city Scala zip code
~Ca ref M l ~~dl$o
First Name MAidde Name Purpose of Expenditure Amount o(Experdture
Last Namelfiusiness Name
Address
City State Zip Codo
First Name WWO Name Purpose of Expendbre Amount of Exper t to
last NameBusinm Name
Address
City stale zip Code
Fkst Name Aiddfe Name Purpose of Expenditure Amount of Expenditure
Last NamcMusiness Name
Address
City 61310 4 Code
5. TOTAL ITEMIZED EXPENDITURES q
(Carty forward b rem 3. of next papa W addkiiNW pages d this term are used.) (J S 1
(If Oft IS ttie last pope of axpard&AW, lhls amount mull be Otorm In Nom 19b. of sunvnwy,)
ah 4- SSA 129 (Rev. 4112) Pape of 4 -
SSA 1159
L0006iuub
10/14/2014 TUE 14:52 FAX
ITEMIZED STATEMENT OF LOANS - CANDIDATE
2. REPORT COVERING THE PERIOD
1, NAME OF CANDIDATE OR COMMITTEE FROM: TO:
C,n~Mrrilu iv ~t(cct ctr~c WklA~Wfv-" '4111 t¢ 1[3v/(+
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (bam loWuv more then $top tram any source during ft period)
Ct1ele ft Following fur the Soume of the Loan „ Outslanditp Loaf Batanoe
F►4ddio Name Outstand ng loan 8alar>ce po Payments (Encl of Period)
(Be9 irwn9 of Pergd)
arvzation Necnc
Loan Received For. Dale ciLoan
Addr ess
❑ PdmacY Election ❑ cow ad FJoction
C4 stare 4code
❑ ff (local Ew-tom Oeky)
Runo
Usi m Endorsers or Guaranlors torAbove Loan (If more space is needed please attach a Page)
Nano Fasl Name Mi6dte flame
Fsst Name
t-l NamaA~g Nan>e
Las( Name/Organization 7LW*
Addra55
Address
Clb
Slate LP Code c'h ( Guaranteed Outstanding
IAddk Name Fnt N&-m M ddb Name
First karma
Last NanelO w iration Name Last NanefOroanUetion Name
Address Address
tifale Lp Code ay Stabs Zip Code
(2y
AmrwM (iuaanloed Ovfstx~ing Guaatleed Outstand"ag
lidd{eNW* FirslName MiddieNano
fkst Narsue
lest NarnNOrgardzatiat Name last Na iagardzetioe Name
Address Address staig zip Colo Stolle zip Code
city
Amount Grsaanleed Outstandirq Guaranbad fkRstarding
Ir4ddk Name First :~~N-
First Name
-Last addle Name
Natnelorg"mW Name (Lest e
Address
Address
State Zp code Cdy Stab BP Coda
C+n'
m mint Guaranteed Outslard rg GuaranWed Ou-slew
Loess Loan Ou-standngleanBalarKe
4. Touts ford Loam (eotnpieCe on last page o(ketttkred 1ptlni) WtstandingLoanB nn M Reoelvod p of
Mm 113664
(focal loans reoetved should also be shown in item 16. on umnwy Page.)
i-Cm 20, on trxswnary page.)
(W ban pWments shook slso be shown In
(Total outsW4gv ban batarre 000 also be srwwm h Men 14s.On kont page.)
® 1159
SS-1132 (Rey. 4102) Psge of RDA
Appointment of Political Treasurer
For State and Local Candidates and Sing le-Candidate
INSTRUCTIONS
The Appointment of Political Treasurer statement must be used to appoint a political treasurer as required by - can the Campaign Financial Disclosure Act R not receiveao expend funds for an elecgon until did ate
political campaign committees. A state candidate may
political treasurer has been appointed for that election. A local candidate pursuant to T.C.A 2-10-101, may be commission
for
more exempt from completing this form, pleas check with county
ft al t easu a rIA new form mu t be filed if the treasulrer is changed.
candidate may appoint himself or herself po
t of Political Treasurer statement ONLY with
Candidates for state public office must file their original Ap 1 Nashville, TN 37243-1360.
the Registry of Election Finance, 404 James Robertson P
~ ~alah of li 'cal Treasurer statement ONLY with
Candidates for local public office must file their on Al's ,
their county election commission. ( 'j(y',`
c-' IU~Ni ti
3. Candidate e-mail address:
1. Date: 2. Name of Candidate or Committ e"
f1 C n.a~ l - ~prn
Sul L2~ "Lola- ~;riG lIJ ~t1'lnC'fbt¢ Wd a
~ City State Zip Code Phone
4. Campaign Address and Phone: `~bs - 36~ , ~p3
I~Nn~ yvrlle TO 303
(72.3 Mon{~~:v.ery
State Zip Code Phone
S. Home Address and Phone (if different than item 4 above): City
licable) 7. Party Affliation 8. Election Year
6. Office Sought (include district number, if app Z p l 4
6 d (4 p,nl, lican
10. Treasurer a-mail address:
9. Treasurer Name:
rnA L 1 . Lt7 M
o,.~d rc x~ xis P
x ~ S Code Phone
City State Zip C
11. Treasurer Address and Phone:
it3 to ~u5""L Dr i \Je
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
r_
Signature of Treasurer
Signature of Candidate
cl~" Vl)
Signature of Witness
Signature of Witness
10 Registry of Election Finance
SS-1120 (rev 10/2010)