DeBusk, Alan
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For Stale and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT I 2.a. NAME OF CANDIDATE OR COMMITTEE
Committe to Elect Alan DeBusk
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
Alan C. DeBusk 8/4/2016
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
709 Columbus St. Maryville TN 37804 865-984-8277
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)
Blount County Clerk Scott DeBusk - Primary Alan DeBusk - Alternate
7. CATEGORY OR REPO~IRT (Check one) 1:1 1:1
FIRST SECOND THIRD FOURTH PRE- PRE- MI EAR YEAR-END
DARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
4/1/2016 6/30/2016
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.
t -76 (//4
signature of candidate date signature of political treasurer date
11. WITNESS SIGNATURE
k)luo~6&_ 11 ""'U" -
signature of witness date signature of witness date
12. SUMMARY
0
a. BALANCE ON HAND LAST REPORT $
b. TOTAL RECEIPTSTHIS PERIOD 2,656
c. TOTAL DISBURSEMENTS THIS PERIOD $ 1,984.94
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ 671.06
e. TOTAL LOANS OUTSTANDING , . $ 0
>
f. TOTAL OBLIGATIONS OUTSTANDING .....................................................,I(J(,. 1... 140.65
1 X16 $
ELEC77ON
SS-1109 (Rev. 2/06) Page 1 of RDA 1159
SUMMARY PAGE - CANDIDATE
13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD
Alan DeBusk FROM: 4/1/2016 TO: 6/30/2016
RECEIPTS
15. CONTRIBUTIONS (other than loans and interest)
a. Unitemized Contributions ($100 or less from each source this period) $ 150
b. Itemized Contributions (over $100 from each source this period) $ 2,506
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 2,656
16. LOANS RECEIVED THIS REPORTING PERIOD $ 0
17. INTEREST RECEIVED THIS REPORTING PERIOD 0
18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ 2,656
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)
Gas $ 50.50
Community Food Connection $ 100.00
Supplies $ 84.72
Total of Expenditures ($100 or less each payee) $ 235.22
b. Itemized Expenditures (Over $100 each payee this period) $ 1,749.72
c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 1,984.94
20. LOAN REPAYMENTS MADE THIS PERIOD $ 0
21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 1,984.94
22.IN-KIND CONTRIBUTIONS
a. Unitemized in-kind contributions ($100 or less from each source this period) $ 0
b. Itemized in-kind contributions (over $100 from each source this period) $ 2,073
c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $ 2,073
23. OBLIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $ 0
b. Itemized Obligations Outstanding (Over $100 each) $ 140.65
c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 121) $ 140.65
SS-1133 (Rev. 4/02) Page 2 of I
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
Alan DeBusk FROM:4/1/20Funt
6/30/2016
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
A1etn - C
Last Name/Organization Name ❑ Primary Election General Election C)
Address G 14, ❑ Runoff (Local Elections Only)
7 Co S y s
Ciry Zip Code Date of Contribution Aggregate This Election
?-?soy
Occupation [I J~ / 26
Employer n L;. rl) nC ~~~Cy'~ ~
Ac r> A5 5; c c 4-62 7
First Name Middle Name Contribution Received For: Amount of Contribution
A/,~- ^ (f -
Last Name/Organization Name ❑ Primary Election )M-General Election 45K c o a
lC (3v Ski- ~~O a
Address ❑ Runoff (Local Elections Only) 70 C6 City '111 Y<<~~ e Stao~ zipCode J Date of Contribution Aggregate This Election
Occupation
UZ.u,~sZ ~ Z >d~~LC
Employer /
~SSGC'ccZ~tl
First Name ddleName Contribution Received For: Amount of Contribution
C.
Last am amza on Name Primary Election bi-General Election
Address ❑ Runoff (Local Elections Only)
0~ t!ot~~ 5~s 5~-
City n State Lp 3Code Date of Contribution Aggregate This Election
ar V~ Ttir 18o~F
Occupation O/
Employer
First Name Middle Name Contribution Received or: Amount o Contribution
te, , C .
Last NamelOrganization Name ❑ Primary Election V~ General Election bc>
Address C ❑ Runoff (Local Elections Only)
D~ C~ ~u M SI.US S~-
City S Zip Code Date of Contribution Aggregate This Election
Occupation
V W ~'1.e r CL3 •
Employer yy
j~sSC~C rCr lyl
11~ *0
5. TOTAL ITEMIZED CONTRIBUTIONS
CC-
(Carry forward to item 3. of next page if additional pages of this form are used.) 2 r 3 C r
(If this is the last page of contributions, this amount must be shown in item 15b. of summary.)
I-' SS-1131(Rev. 2/06) Page `3 of 1 ( RDA 1159
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
Alan DeBusk FROMA/1/2016 TO: 6/30/2016
Amount
3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) Z, 3 C>
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
Last Name/Organization Name ❑ Primary Election I general Election
D -e 3 Us
Address ❑ Runoff (Local Elections Only)
70 ~l C (v ~1 h os S4"City State Zip Code Date of Contribution Aggregate This Election
'M c .
/'Iy V4(e
rN
Occupation
Employer
C ~SScC, v-7kes
Fi t Name Middle Name Contribution Received For: Amount of Contribution
Last Name/0 ization Name ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
Occupation
Employer
First Name fiddle me Contribution Received For: Amount of Contribution
as Name/Organization Name ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
Occupation
Employer
First Name Middle Name Contribution ece v Amount o Contribution
Last Name/Organization Name ❑ Primary Election eral Election
Address ❑ Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
Occupation
Employer
5. TOTAL ITEMIZED CONTRIBUTIONS 5bla b^
(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.)
SS-1131(Rev. 2/06) Page Ll of < < RDA 1159
.ra . )
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
Alan DeBusk FROM:4/1/2016 TO: 6/30/2016
moun
3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) $0.00
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 C In-Kind Contribution Received For: Value of In-Kind Contribution
Alan ❑ Primary Election ® General Election
Last Name/Organization Name $1,000
DeBusk ❑ Runoff (Local Elections Only)
Address 709 Columbus St. Dateotln-KWContribution 5/2/2016 Aggregate this Election $1,000
city Maryville StafN Zip Code 37804 Description of In-Kind Contribution
Occupation Employer Web development
Owner ACD Associates
First Name Lisa 7 Middle Name C In-Kind Contribution Received For: Value of In-Kind Contribution
❑ Primary Election ® General Election
Last Name/OrganizationName Gibson (wife) $200
❑ Runoff (Local Elections Only)
Address 709 Columbus St. Date ofin-Kind Contribution 6/7/2016 Aggregate this Election $ .
SwrN Zip Code 37804 Description of In-Kind Contribution
City Maryville 1
Occupation Employer Facility usage
Owner Smith Event Centers
First Name Lisa Middle Name C In-Kind Contribution Received For: Value of In-Kind Contribution
❑ Primary Election ® General Election
Last Name/Organization Name Gibson $200
(wife) ❑ Runoff (Local Elections Only)
Address 709 Columbus St. Date of In-Kind Contribution 6/14/2016 Aggregate this ElactiGn $829
City Maryville stat@.FN Zip Code 37804 Description ofln-KirdContribution Occupation ployer Facility Usage
Owner Smith Event Centers
First Name Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution
Lisa C ❑ Primary Election ® General Election
Last Name/Organization Name $280
Gibson (wife) ❑ Runoff (Local Elections Only)
Address 709 Columbus St. Date of In-Kind Contribution 6/27/2016 Aggregate this Election $829
city Ma ille State TN z~pcode 37804 Description of In-Kind Contribution
Occupation Employer Signs
Owner Smith Event Centers
First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution
Lisa C ❑ Primary Election IM General Election
$149
Last Name/OrganizationName Gibson (wife) ❑ Runoff (Local Elections Only)
Address 709 Columbus St. Date of In-Kind Contribution 6/29/2016 Aggregate this Election $829
city Maryville Stagy Zip Code 37804 Description of In-Kind Contribution
pan PloYar Advertisement
Owner
7 TOTAL ITEMIZED IN-KIND CONTRIBUTIONS
(Carry forward to item 3. of next page if additional pages of this form are used.) $1,829
(If this is the last page of in-kind contributions, this amount must be shown in item 22b. of summary.)
SS-1128 (Rev. 2/06) Page of RDA 1159
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
Alan DeBusk FROM:4/1/2016 TO: 6/30/2016
moun
3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) $1,829
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 B In-Kind Contribution Received For: Value of In-Kind Contribution
Scott Primary Electron ® General Election
Last Name/Organization Name $244
DeBusk ❑ Runoff (Local Elections Only)
Address 309 Carter Ave Date ofln-WContribution 6/25/2016 Aggregate this Election 244
city Maryville statg„N zip Code 37803 Description oflnAnd Contribution
Occupation Employer l Advertisement
Agent Delta Airlines
First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution
❑ Primary Election ❑ General Election
Last Nam anization Name
❑ Runoff (Local Elections Only)
Address Date of In-Kind Contribution Aggregate this Election
city state Zip code Description of In-Kind Contribution
Employer
First Name fiddle Name In-Kind Contribution Received For: Value of In-Kind Contribution
❑ Primary Election ® General Election
Last Name/Organization Name
❑ Runoff (Local Elections Only)
Address Date of In-Kind Contribution Aggregate this Election
City State Zip Code Description of In-Kind Contribution
Occupation Employer
First Name Middle Name In-Kind C button Received For: Value of In-Kind Contribution
❑ Prima lection ® General Election
Last Name/Organization Name
❑ Runoff (Coca lections Only)
Address Date of In-Kind Contribution Aggregate this Election
City State Zip Code Description of In-Kind Contribution
Occupation Employer
First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution
Primary Election 29 General Election
Last Name/Organization Name
❑ Runoff (Local Elections Only)
Address Date of In-Kind Contribution Aggreg this Election
city State Zip Cade Description of In-Kind Contribution
Occupation Employer
=thisis ED IN KIND CONTRIBUTIONS
em 3. of next page if additional pages of this form are used.) $ 2,073
ge of in-kind contributions, this amo unt must be shown in item 22b. of summary.)
SS-1128 (Rev. 2/06) Page of _/L RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
Alan DeBusk FROM:4/1/2016 TO: 6/30/2016
mount
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
1
Last Name/Business Name
k 46 c, XdY~A
Address
City state Zip Code
Ix,
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address R~A
14
city I cr, W l State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name C
Address
~(pGl Wi0 KJ
City State Zip Code
gU-4 (1b K- 2
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name Z(~7
Address
city Stale Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
~c:c~ ~ / +~r31C1 ~~VS2('~tS r''j~> 3~` pcl
Address
city State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name r /
~4r ( ~ / N1es ~C` ~/.SZ S f Jl~ (v O~
Address
07
City S~ Zip Code
/ <v. -7
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to item 3. of next page 9 additional pages of this form are used.) 7 U
(If this is the last page of expenditures, this amount must be shown in item 19b. of summary.)
AfflkL
SS-1129 (Rev. 4102) Page 7 of /I RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
Alan DeBusk FROM:4/1/2016 TO: 6/30/2016
moun
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 Name/Business Name n , _ _ %r{~ y
Address Y SSO rZ e c- iRl v i ~f
City S L ^ S7-K Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name + A5
Address / 4-T0~;7~s 5 .
City 11 State Zip Code
o S TzJr' 7X
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address
City C~ State Zip Code
~(C oct TN. -7'7-7c>(
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address 6, 4, c
J v f 1 r> g
city State Zip Code
b L S du (-e /Q
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address ` n ~ ~ ~ ✓
2 7~ InS a ,rKC~~ S~',
City State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Vr, S+', P, l (
Address 2 7 3 (11 C' M Ci - l Sf.
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 expenditures, this amount must be shown in item 19b. of summary.)
SS-1129 (Rev. 4102) Page of ( RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
Alan DeBusk FROM:4/1/2016 TO: 6/30/2016
moun
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)
lll~
Middle Name Purpose of Expenditure Amount of Expenditure
First Name
Last Name/Business Name <
V
Address rw c.,i
City ~J State Zip Code
I~ I I It ~,v. WA 2 s
Middle Name Purpose of Expenditure Amount of Expenditure
First Name
Last Name/Business Name Q
Address -7
City State Zip Code
(,dc, (+k0-11 W 2 l
Middle Name Purpose of Expenditure Amount of Expenditure
st Name
Last Na usiness Name
Address
City State Zip Code
First Name Purpose of Expenditure Amount of Expenditure
Middle Name
Last Name/Business Name
Address
City State Zip Code
Middle Name P se of Expenditure Amount of Expenditure
First Name
Last Name/Business Name
Address
City State Zip Code
Middle Name Purpose of Expenditure Amount of Expenditure
First Name
Last Name/Business Name
Address
City State Zip Code
EENWEEM~
5. TOTAL ITEMIZED EXPENDITURES, j
(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.)
Page of RDA 1159
AML
SS-1129 (Rev. 4102)
ITEMIZED STATEMENT OF LOANS - CANDIDATE
2. REPORT COVERING THE PERIOD
1. NAME OF CANDIDATE OR COMMITTEE
Alan DeBusk FROM4/1/2016 T0. 6/30/2016
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more than $100 from any source during the period)
n Balance
Complete the Following for the Source of the Loan Loan Outstan!offLPPefinod))
First Name N/Outstanding Loan Balance Loans menu (E(Beginning of Period) Received Payments
Last Name/Organization Name
Loan Received For. Date of Loan
Address
❑ Primary Election ❑ General Election
City State Zip Code
❑ Runoff (Local Elections Only)
List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page)
Middle Name First Name Middle Name
F' t Name
Last Na Organization Name Last Name/Organization Name
Address
Address
State Zip Code
City State Zip Cade City Amount Guaranteed Outstanding
Amount Guaranteed Outstanding
Middle Name First Name Middle Name
First Name
Last NamelOrganization Name Last Name/Organization Name
Address
Address
State Zip Code city State Zip Code
City
mount Guaranteed Outstanding
Amount Guaranteed Outstanding
Middle Name First Name Middle Name
First Name
ast Name/Organization Name
Last Name/Organization Name
Address Addres
city Slate Zip Code City State Zip Code
Amount Guaranteed Outstanding
First Name Amount GuaranteedOu ding
Middle Name First Name Middle Name
Last Name/Organization Name Last NamelOrganization Name
Address
Address
State Zip Code City S Zip Code
City
Amount Guaranteed Outstanding Amount Guaranteed
m Outstanding
4. Totals for all Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans Loan Outstanding Loan Balance
(Total loans received should also be shown in item 16. on summary page.) (Beginning of Period Received Pa menu End of Period
(Total loan payments should also be shown in item 20. on summary page.) N/A
(Total outstanding loan balance should also be shown in item 12.e. on front page.)
Page of r RDA 1159
AML
SS-1132 (Rev. 4102)
ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE
2. REPORT COVERING THE PERIOD
1. NAME OF CANDIDATE OR COMMITTEE FROM: 4/1/2016 TO: 6/30/2016
Alan DeBusk
(End of ing PeriOnce
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding of Period) DThislPeriod ThPayments is Period Outstanding
OBLIGATION (obligations totaling more than $100 owed to any (Beginning
personlvendor at the end of the reporting period)
Middle Name
First Name
Last Name/BusinesSName Facebook $0.00 $140.65 $0.00 $140.65
Address 1601 Willow Road
State ZPCode
city Menlo Park
CA 94025
Description o b igation
Advertising charge billed on 6/30/201
t Name Middle Name
Last Name ess Name
Address
gtate
City Zip Code
Description of Obligation
First Name le Name
Last Name/Business Name
Address
City State Zip Code
Description of Obligation
First Name Middle Name
Last NameBBusiness Name
Address
City State Zip Code
Description of Obligation
First Name Middle Name
Last NameBusiness Name
:A:ddre:ss
City State Zip Code
Description of Obligation
4. TOTALS $0.00 $140.65 $0.00 $140.65
(Total from Outstanding Balance - (End of Period) column must also be shown
in item 23b. on summary page.)
Page of ~ RDA 1159
SS-1127 (Rev. 4/02)