Citizens for Local Control of Alcohol Sales
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For Single-Measure Committees (SMC)
1. DATE OF REPORT 2. N1AMEOFCOMMITTEE ` L
/tL /7/._
~ 7 S
2. SHO T NAME O C MMI EE (IF APPLICABLE)
State Zip Code Phone
3. ADDRESS AND PHONE City
Street o+)Rural Ro C,! O~
JJ ~ ~'o.
4. MEASURES SUPPOR ED OR O POSED /
0 ;~Jliv LZ//Cr 5.BA AP INTED/
ER J
E OF POLITICAL TREA t7
6. CANE ORY OR REPORT Check one MI13EAR YEAR-END
FIRST SEC0 1:3 OND THIRD F TH PRIMPRE- ARY GEN PREERAL SUPPLEMENTAL SUPPLEMENTAL
QUARTER QUARTER QUAR R
QUARTER 7.B. END EOfEPORTINGPERIOD_
7.A.BEGINNINGD EE~OF ORTINGPERIOD S
(r' `io
S. (Check one)
(including ikind) received total or less A
contributions e
period. I do solemnly swear or affirm that al Disclosure contained e(items 10d.t Oent
A. This expenditures committee is total $1,000 exempt or from less for detailed this reporting disclosures p because
is true and that the committee has complied with all applicable provisions of the Campaign
and 10f must also be completed.)
g, This committee is required to file a detailed financial disclosure because contributions (including in-kind) received total more than
solemnly e accouling of all t ntributins an
total more than $1,000 for this reporting period. I d and
tamed accutit coldexpell
swear and/or expenditu are a complete an
turned in n this statement is true and that the following pamitte by the Campaign Financial Disclosure Act.
lures requried to be reported by political campaign
/ date
signature litical treasurer
g. WITNESS SIGNATURE i Lam
L
date
si nature of witness
10. SUMMARY
a. BALANCE ON HAND LAST REPORT $
. TOTAL RECEIPTSTHIS PERIOD $
b .
c. TOTAL DISBURSEMENTSTHIS PERIOD /J
$
d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.)
e. TOTAL LOANS OUTSTANDING J y.--
f. TOTAL OBLIGATIONS OUTSTANDING
RDA 1159
SS-1140 (Rev. 2106)
t
I
SUMMARY PAGE - SMC
11. NAME OF COMMITTEE (in Full) 12. REPORT COVERING THE PERIOD
FROM: TO:
RECEIPTS
13. 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) $ 7 ;7
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 13.a. and 13.b.) $ 40-
14. LOANS RECEIVED THIS REPORTING PERIOD
15. INTEREST RECEIVED THIS REPORTING PERIOD
16. TOTAL RECEIPTS (add 13.c., 14., and 15.) (must be shown in item 10.b.) $(G V
DISBURSEMENTS
17. EXPENDITURES (other than loan payments)
a. Unitemized 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. Itemized Expenditures (Over $100 each payee this period) $
S~S
c. TOTAL EXPENDITURES (other than loan repayments)(add 17.a. and 17.b..) $
18. LOAN REPAYMENTS MADE THIS PERIOD $
19. TOTAL DISBURSEMENTS (add 17.c. and 18.) (must be shown in item 10.c.) $
20.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 20.a. and 20.b.) $
21.LOANS
LOANS OUTSTANDING (must be shown in item 10.e.)
22.013LIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $
b. Itemized Obligations Outstanding (Over $100 each) $
c. TOTAL OBLIGATIONS OUTSTANDING (add 22.a. and 22.b.) (must be shown i item 10.f.) $
` ip SS-1145 (Rev. 4/02) RDA 1159 Page Z_ of ,
ITEMIZED STATEMENT OF CONTRIBUTIONS - SMC
1. NAME OF QOMITTEE /1 may/ 2. REPORTC VERINGTHE ERIOD
~~FROM:w TO/
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 Burin the eriod
M.I. La rganizatio ame Amount of Contribution
First Name .
L k,
Ciry ~ Zlglia- ZipJ
Occupation r
Employer
M.I. Last NamelOrganization Name Amount of Conlnbutim
First Name
Address
city State Zip Code
Occupation
Employer
M.I. Last NamelOrgani2atim Name Amount of contribution
First Name
Address
city State Zip Code
Occupation
Employer
M.I. Last Name/Organization Name Amount of Contribution
First Name
Address
city State Zip Code
Occupation
Employer
M.I. Last NameMrganization Name Amount of contribution
First Name
Address
city State Zip Code
Occupation
Employer
57OTAL 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 13b. of summary.)
Page of RDA 1159
55-1141 (Rev. 2106)
I
ITEMIZED STATEMENT OF EXPENDITURES - SMCREPORT C VERING THE ERIOD
1. NAMF~O COMMITTEE FROM
21 ~ ~ l~ Cly l-o T~ Amodnt
3. TOTAL ITEMIZED EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (any expenditures totaling more than $100 to a sigle payee during the period,
must be itemized.)
Amount of Expenditure
Middle Name Purpose of Expenditure
First Na
Last Na a ess me % J y9'r)
Address
City §Jate' zi `A l
Amount of Expenditure
Middle Name Purpose of Expenditure
First Name
Last Na usiness Name
44-
Address
cit Zip Code
y
v v Amount of Expenditure
mmmmw~
Middle Name Purpose of Expenditure
First Name
LastNa ,usin ame ~S
Address J ' d29~
r ~11k- Zip Code
Ciry r
.'vrk' ~ ~ L r-~ Amount of Expenditure
Middle Name Purpose of Expenditure
;First e
sines Name
City Zip Code
lure
Middle Name urpose o xpen dure Amount o xpen
first Name
Last Nametbusiness Name
A
State Zip Code
Amount of Expenditure
Middle Name Purpose of Expenditure
First Name
Last NamelBusiness Name
Address
Ciry State Zip Code
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to item 3. of next page if additional pages of this form are used.)
If this is the last page of cam ai In expenditures this amount must be shown in item 17b. of summa .
Page of RDA 1159
SS-1142 (Rev. 4/02)
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For Single-Measure Committees (SMC)
1. DATE OF POR 2. NAME OF COMMITTEE
2. SH RTNA EOFCOM ITTEE(IFAPPLICABLE)
3. ADDRESS AND PHONE
Street Pral Rout City State Zip Code Phone
4. MEASURES SUPPORTED OR OPPOSED /
5.A. E OF POLITICAL TREASJRER 5.6. A APP NTED
6. CATEGORY OR REPORT (Check one ❑ ❑ ❑ ❑
FIRST SECOND THIRD FOURTH PRE- INN MID-YEAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
7.A. BEGINNING DATE F R PORTING PERIOD 7.B. ENDING DATE F RE RTING PERIOD
~ d Zvi
8. (Check one)
A. F-1 This committee is exempt from detailed disclosures because contributions (including in-kind) received total $1,000 or less AND
expenditures total $1,000 or less for this reporting period. 1 do solemnly swear or affirm that the information contained in this statement
is true and that the committee has complied with all applicable provisions of the Campaign Financial Disclosure Act. (Items 10d., 10e.
and 1 Of must also be completed.)
B. This committee 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. I do solemnly swear or affirm that the information con-
tained in this statement is true and that the following page(s) are a complete and accurate accounting of all contributions and expendi-
tures requried to be reported by political campaign committees by the Campaign Financial Disclosure Act.
sig ature I treasurer date/
9. WITNESS SIGNATURE
101Z,74
signature of witness ate
10. SUMMARY /
a. BALANCE ON HAND LAST REPORT $ 9~
b. TOTAL RECEIPTS THIS PERIOD 12.
C. TOTAL DISBURSEMENTS THIS PERIOD $
3p9 L
d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) $
$
e. TOTAL LOANS OUTSTANDING
f. TOTAL OBLIGATIONS OUTSTANDING
RDA 1159
SS-1140 (Rev. 2/06)
SUMMARY PAGE - SMC
11. NAME OF COMMITTEE (In Full) 12. REPORT COVERING THE PERIOD
FROM: TO:
RECEIPTS
13. 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 13.a. and 13.b.) $
14. LOANS RECEIVED THIS REPORTING PERIOD
15. INTEREST RECEIVED THIS REPORTING PERIOD
16. TOTAL RECEIPTS (add 13.c., 14., and 15.) (must be shown in item 10 _
DISBURSEMENTS
17. EXPENDITURES (other than loan payments)
a. Unitemized Expenditures ($100 or less each payee this perio (must be listed by category - e.g., printing, postage,
gasoline)
1\V $
$
Total of Expenditures ($100 or less each p ee) $
b. Itemized Expenditures (Over $100 eac payee this period) $
c. TOTAL EXPENDITURES (other than an repayments)(add 17.a. and 17.b..) $
18. LOAN REPAYMENTS MADE THIS RIOD
19. TOTAL DISBURSEMENTS (add c. and 18.) (must be shown in item 10.c.) $
20AWKIND CONTRIBUTI NS
a. Unitemized in-kind contributi s ($100 or less from each source this period).......... $
b. Itemized in-kind contributio s (over $100 from each source this period) $
c. TOTAL IN-KIND CONTRI UTIONS RECEIVED THIS PERIOD (add 20.a. and 20.b.) $
21.LOANS
LOANS OUTSTANDI (must be shown in item 10.e.)
22.013LIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $
b. Itemized Obligations Outstanding (Over $100 each) $
c. TOTAL OBLIGATIONS OUTSTANDING (add 22.a. and 22.b.) (must be shown i item 10.f.) $
RDA 1159 Page Of
&4' k SS-1145 (Rev. 4102)
ITEMIZED STATEMENT OF CONTRIBUTIONS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: TO:
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 Burin the eriod
First Name M.I. Last Name/Organization Name Amount of Contribution
Address
City State Zip Code
Occupation
Employer
First Name M.I. Last Name/OrganizationName Amount of Contribution
Address
City State Zip Code
Occupation
Employer
First Name M.I. Last Name/Organization N e 1, Amount of Contribubon
Address
City State Zip Code
Occupation
Employer
First Name M.I. Last Name/ nizatan Name Amount of Contribution
Address
City State Zip ode
Occupation
Employer
First Name M.I. Last Name/Organization Name Amount of ConWWbon
Address
City State Zip Code
Occupation
Employer
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 13b. of summary.)
SS-1141 (Rev. 2/06) Page of RDA 1159
a
ITEMIZED STATEMENT OF EXPENDITURES - SMC
2. REPORT OVERING THE PERIOD
1. NAME F COMMITTEE
FROM:
f(~ TO:17aZI
7 Amount
3. TOTAL ITEMIZED EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (any expenditures totaling more than $100 to a sigle payee during the period,
must be itemized.)
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NamelBusines W j
Address kk
city ~~nn S Zip Code
W~
Middle Name Purpose of Expenditure Amount of Expenditure
First N 7
Last Na stness Nam
Address ,
A
City Sta Zi od
~ c" Amount of Expenditure
First Name Middle Name Purpose of Expenditure
La usiness Name
400
Address S2- ~f
City JAY 4Code
P. To, of E nditure Amount of Expenditure
First Name Middle Name rPos xPe
Last NameBysge~ss N~e~
Address GG
City Zip Code
Middle Name urpose o Expenditure Amount o Expenditure
rrsl ame
Last Name/Business Name
Address
City State Zip Code
Purpose of Expenditure Amount of Expenditure
First Name Middle Name
Last NameBusiness Name
Address
City state Zip Code
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to item 3. of next page if additional pages of this form are used.)
If this is the last page of campaign expenditures, this amount must be shown in item 1m of summary.
Page of~ RDA 1159
;{,s~- SS-1142 (Rev. 4102)
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING PERIOD
FROM: TO:
Amount
3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any contributor during the period)
First Name Middle Name Description of In-Kind Contribution Value of In-find Contribution
Last Name/Organization Name
Address
City State Zip Code
Occupation
Employer '
First Name Middle Na. Description of In- Contribution Value of In-Kind Contribution
Last Name/Organization Name
Address
City Slate J I God
Occupation
Employer
First Name Middle Name Description of In-Kind Contribution Value of lr Knd Contribution
Last Name/Organization Name
Address
City State Zip Code
Occupation
Employer
First Name Middle Name Description of IrAnd Contribution Value of IMGnd Contribution
Last NamelOrganization Name
Address
City State Zip Code
Occupation
Employer
5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS
(Carry forward to item 3 of next page if additional pges of this form are used.)
(If this is the last page of in-kind contributions, this amount must be shown in item 20.b. of summary)
SS-1143 (Rev. 2106) Page J of / RDA 1159
ITEMIZED STATEMENT OF LOANS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: TO:
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Loans Loan Payments Outstanding Balance
LOAN (loans totaling more than $100 owed to any person/business at the end of (Beginning Received This (End
the reporting period) of Period) This Period Period of Period)
First Name Middle Name
LastNameBusiness Name
Address
City State Zip Code Date of Loan
First Name Middle Name
Last NamelBusiness Name
Address
City State Zip Code Date o oan
First Name Middle Name
Last NameBusiness Name
.Address
City State Zip Code Date of Loan
First Name Middle Name
Last NameBusiness Name
Address
City State ZipCode Date of Loan
First Name Middle Name
Last NamelBusiness Name
Address
City State Zip Code Date of Loan
4. TOTALS
(Total from "Outstanding Balance - (End of Period)" column must also be shown
in item 21 on summa a e.) I
Page of~ RDA 1159
SS-1146 (Rev. 4102)
ITEMIZED STATEMENT OF OBLIGATIONS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: TO:
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Payments Outstanding Balance
OBLIGATION (obligations totaling more than $100 owed to any personivendor at (Beginning Incurred This (End
the end of the reporting period) of Period) ThisPeriod Period of Period)
First Name Middle Name
Last Name/Business Name
Address
City State Zip Code
Description of Obligation
First Name Middle Name
Last NamelBusiness Name
Address
City State Zip Code
Description of Obligation ~7 First Name Middle Name
Last Name/Business Name
Address
City State Zip Cb~d?
Description of Obligation
First Name Middle Name
Last NamelBusiness Name
Address
city State Zip Code
Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
City State Zip Code
Description of Obligation
4. TOTALS
(Total from "Outstanding Balance - (End of Period)" column must also be shown
in item 22.b on summa page.)
.
L' , ' SS-1144 (Rev. 04/02) Page of ~ RDA 1159
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For Single-Measure Committees (SMC)
2, NAMEOFCOMMt'REE
j. DATE REPORT Red, White and Food
10-10--20]201 .4
2. SHORTNAMEOFCOMMITTEE(IFAPPLICABLE)
Zip Code Phone
NE Slate
3. AD R SS ND city 37201 615-244-4994
Sire at or Rural Route Nashville TN
150 Third Ave. S., Suite 1700
E P T P ED
A. M
of wine in retail food stores-
S.B. pATEAPPOINTED
Referendum to allow the sale
❑
6.A. AMIEOFP ITCALTREASURER 8_27_2014
Matthew Scanlan ❑ ❑ YEAR-END
a one MID YEAR
❑ S O D RD F U PRE- ~ SUPPLEMENTWSUPPLEMENTAL
(GARTER QUARTER PRIMARY GENERAL
FIRST QUARTER 1 B E1 .11 ATE-1 . PORTINGPERIOD lbit QUARTER 30, 2014
7 . A. BEGINNING DATE OF REPORTING PERI00 geptember
July 1, 2014
8, (Chock ono) including in-klnd) received total $1,000 or less AND
swear or affirm that the Information contatnednthis ssttate e t
committee Is exempt from detailed disciorting because coole my s
A. stied. I do selemnty i n Financial Dtsdosure Act. (Items
o(pendilures total $1,000 or less for this reporting P licable provisions of the Camps 9
is true and that the committee has complied ~vi1h all applicable
and jot must also be completed.)
ation co •
re because period. 1 do so contributions lemnly (including swear in-for affirm rm that received the total intorm more t
rftt file a detailed financial disdesu
to
$1000 000 for this reporting p orate accounting of all contributions and expendl
B. l This 0 andlor committee is exile required nditures Intel more than $ age(s) are a complete and acc
latnal Disclosure Act.
tollowing pcommittees by the Campaign F(nanci
,ad lures in this denuded statement t o botement Is reported true by and that political the campaign
~/fly
a ure of political treasurer
0, WITNESS SIGNATURE I uI y
date
signature of in
00
10. SUMMARY HANDLASTREPORT .
e. BALA14CEON ISP£RIOp 00
b, TOTAi-RECEIPTSTH -1-71. 43
$ l- r
TOTALDISBURSEMENTSTHISpERIOD . $
c NANO (10.a, plus 10.b. minus 10.c.)
d. BALANCE ON L Z O
$
TOTAL LOANS OUTSTANDING $
e.
f, TOTAL OBLIGATIONS OUTSTANDING
RDA 1159
y SS-1140 (Rev. 2106)
r
r
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For Single-Measure Committees (SMC)
1. DATE OF R OR 2. NAME OF COMMITTEE/
e: fj j~r✓a J
2. SHOT ME OF COMMITTEE (IF APPLICABLE)
3. ADDRESS AND PHONE
eet or Rur oute City State Zip Code Phone
4. MEASURES SUPPORTE OR OPPOSED
INTED
5. EOFPOLITICALTREASU 5.13. DATVAPW
i j2ftlz-l// ~41,1 CATEGORY OR REPORT ( c one ❑ ❑ ❑ 13 FIRST SECOND THIRD FOURTH PRE- PRE- MIDYEAR YEAREND
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
7.A.BEGINNING DATE OFRE RTIN PERIOD 7.B. ENDING ATEOF EPORTING PERIOD
z9 loi 9 3~ ~
8. (Check one)
A. M This committee is exempt from detailed disclosures because contributions (including in-kind) received total $1,000 or less AND
expenditures total $1,000 or less for this reporting period. I do solemnly swear or affirm that the information contained in this statement
is true and that the committee has complied with all applicable provisions of the Campaign Financial Disclosure Act. (Items 10d., 10e.
and 1Of must also be completed.)
BA This committee 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. I do solemnly swear or affirm that the information con-
tained in this statement is true and that the following page(s) are a complete and accurate accounting of all contributions and expendi-
tures requiied to be reported by political campaign com by the Campaign Financial Disclosure Act.
4z?.
ignature of tical treasurer ate
9. WITNESS SIGNATURE
signal a of witness date
10. SUMMARY
a. BALANCE ON HAND LAST REPORT $
cx.~
b. TOTAL RECEIPTS THIS PERIOD $
~7
c. TOTAL DISBURSEMENTS THIS PERIOD $ A d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) $ Is
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1140 (Rev. 2/06) RDA 1159
SUMMARY PAGE - SMC
11. NAME OF COMMITTEE (In Full) 12. REPORT COVERING THE PERIOD
FROM: g TO: JO
RECEIPTS
13. 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) $ LU,Q~U
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 13.a. and 13.b.) $ 14. LOANS RECEIVED THIS REPORTING PERIOD
15. INTEREST RECEIVED THIS REPORTING PERIOD
16. TOTAL RECEIPTS (add 13.c., 14., and 15.) (must be shown in item 10.b.) $
DISBURSEMENTS
17. EXPENDITURES (other than loan payments)
a. Unitemized Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage,
gasoline)
$ rY
$
$
$
$
Total of Expenditures ($100 or less each payee) $
b. Itemized Expenditures (Over $100 each payee this period) $ _?2_ r `I
c. TOTAL EXPENDITURES (other than loan repayments)(add 17.a. and 17.b..)
18. LOAN REPAYMENTS MADE THIS PERIOD
19. TOTAL DISBURSEMENTS (add 17.c. and 16.) (must be shown in item 10.c.) $
20AN-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 20.a. and 20.b.) $
21.LOANS
LOANS OUTSTANDING (must be shown in item 10.e.)
22.013LIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $
b. Itemized Obligations Outstanding (Over $100 each) $
c. TOTAL OBLIGATIONS OUTSTANDING (add 22.a. and 22.b.) (must be shown i item 10.f.) $ 16
`t` SS-1145 (Rev. 4102) RDA 1159 Page of
ITEMIZED STATEMENT OF CONTRIBUTIONS - SMC
1. X_OFze;-, COMMITTEE 2. REPORT VRING THE E IOD
/OJ~ /J FROM: TO~ O~;4 4 Z jV
Am un
3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totalin more than $100 from an contributor Burin the eriod
First Name M.I. Last,Uur~Dganza'on ~G Amount of Contribution
Address
~ 7~'/ o ,mfr/
City State Zip Code
O.pation /y yti
Employer
FirstName M.I. LastNa rganizabonNa Z/ Amount of Contribution
Address , L
Ciry Sta Zip Code w
Occupation
Employer
First Name M.I. Last an' Na / Amount of Contribution
Address T J ' V
1 ~ L
City / State Zip Cod
c (/W
Occupation
Employer
First Name M.I. Las anizabon me Amount of Contribution
Address P
i W
State Zipcode
City
A4
Occupation
Employer
First Name M.I. Last Name/Organization Name Amount of Contribution
Address
city state Zip Code
Occupation
Employer
530TAL ITEMIZED CONTRIBUTIONS ~y
(Carry forward to item 3. of next page if additional pages of this form are used.) Q~
(If this is the last page of contributions, this amount must be shown in item 13b. of summary.)
SS-1141 (Rev. 2/06) Page of RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - SMC
1. NAM OF COMMITTEE / 2. REPORT ERING TH P RIOD
I2Z- l A,; FROM: ~ T09
Amount
3. TOTAL ITEMIZED EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (any expenditures totaling more than $100 to a sigle payee during the period,
must be itemized.)
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/
Address
Va-? 71
City / State Zip Code
c- I
First Name Middle Name Purpose of Expenditure Amount of Expenditure
L. a iness Name ,
Address /
City
45;~~4AX lp'd Sta Zi Code
U
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
rst Name Middle Name Purpose o Expenditure Amount o Expenditure
Last NameBusiness Name
Address
City Stale Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address
City Stale Zip Code
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to item 3. of next page If additional pages of this form are used.),
If this is the last page of campaign expenditures, this amount must be shown in item 17b. of summary.)
RDA 1159
SS-1 142 (Rev. 4102) Page * of __q__
J
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING PERIOD
FROM: TO:
Amount
3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE enter $0 if first itemized a e
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any contributor during the period)
First Name Middle Name Description of In-Kind Contribution Value of In-Kind Contribution
Last NamelOrganization Name
Address
City State Zip Code
Occupation
Employer
First Name Middle Name Description of In-Kind Contribution Value of In-Kind Contribution
Last NamelOrganization Name
Address
City Stale Zip Code
Occupation
Employer
First Name Middle Name Description of In-Kind Contribution Value of In-Kind Contribution
Last Name/Organization Name
Address
City State ip Code
Occupation
Employer
First Name Middle Name Description of In-Knd Contribution Value of In-rand Contribution
Last Name/Organization Name
Address
City State Zip Code
Occupation
Employer
5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS
(Carry forward to item 3 of next page if additional pges of this form are used.)
(If this is the last page of in-kind Contributions, this amount must be shown in item 20.b. of summary.)
SS-1143(Rev.2106) Page of RDA 1159
ITEMIZED STATEMENT OF LOANS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: TO:
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Loans Loan Payments Outstanding Balance
LOAN (loans totaling more than $100 owed to any person/business at the end of (Beginning Received This (End
the reporting period) of Period) ThisPeriod Period of Period)
First Name Middle Name
LastName inessName
Address
City State ZipCode Date of Loan
First Name Middle Name
LastNameBusiness Name
Address
City State Code Date of Loan
First Name Middle Name
Last NamelBusiness Name
Address
City State ZipCode Date O Nan
Fast Name Middle Name
Last NameBusiness Name
Address
City State ZipCode Date of Loan
Fast Name Middle Name
Last NamelBusiness Name
Address
City State Zip Code Date of Loan
4. TOTALS
(Total from "Outstanding Balance • (End of Period)" column must also be shown
in item 21 on summa page.)
...s
SSAU6 (Rev. 4102) Page of RDA 11159
Y
ITEMIZED STATEMENT OF OBLIGATIONS - SMC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: T0:
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Payments Outstanding Balance
OBLIGATION (obligations totaling more than $100 owed to any person/vendor at (Beginning Incurred This (End
Period) This Period Period of Period)
the end of the repotting period)
First Name Middle Name
Last Name/Business Name
Address
Stale Zip Code
CAY
Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
Stale Zip Code
City Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
State Zip Code
city
Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
GH fate Zip Code
Descr ption of Obligation
boommmom~
First Name; Middle Name
Last Nameame
Address
OA' State Zip Code
Desaiptio otObligation
4. TOTALS
(Total from 'Outstanding Balance - (End of Period)" column must also be shown
in item 22.b on summa page.)
SS-1144 (Rev. 04/02) Page of RDA 11159
APPOINTMENT OF POLITICAL TREASURER
For Single-Measure Committees
INSTRUCTIONS
This form must be used to appoint a political treasurer as required by the Campaign Financial Disclosure Act (T.C.A. §2-10-105)
for single-measure committees. No funds may be received or expended for a future election until a political treasurer has been
appointed. Anew form must be filed if the treasurer is changed.
Single-Measure Committees supporting or opposing statewide referendums must file an original of this form with the Registry of
Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360. Single-Measure Committeess supporting
or opposing local referendums must file an original of this form with the local county election commission in the county where the
election is to be held.
1. Dafte 2. Name of Committee 7l
3. Address and Phone Street or Rural Route City State Zip Code Phone
4. Measure Sup orte or Opposed 5. ElecPon Date
6. Treasurer Name
l
7. Treasurer Address and Phone Stre or Rural Route City State Zip Code Phone
8. Appointing A on y reasurer Signature (Both signatu s must be wit essed. Treasurer can not witness signature.)
Signature of Appoint' g A rity Signature o reasurer
t ~
Signature of Witness Sig tur f itnes
o, 10 11 ~2 qM
~o ~ ,off
RECEIVED
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SEP
N ~
~ iS .,US',YI LUUtY i't ~
ELECTIOA' °j
b ~v
0
Wd Zl lL
Registry of Election Finance
SS-1107 (Rev. 8/04) RDA Pending