Hood, Tommy
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 12.a. NAME OF CANDIDATE OR COMMITTEE
tee- e (Z--t 4C *\f\ IF COMMITTEE, NAME OF CANDIDATE
3. ELECTION DATE
C) S
4.a. CAMPAIGN ADDRESS AND PHONE l
Street or Rural Route City State Zip Code Phone
IL -z -
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) S ' 3 ~rZ
Street or Rural Route City State Zip Code Phone
rr5. OFFICE SOUGHT (include district number, if applicable) S 6. NAME OF POLITICAL TREASURER (may be candidate)
7. CATEGO OR REPORT (Check one)
❑ ST
FIR SEND THIRD FOURTH _ ~ PRE ❑
ARTER QUARTER QUARTER- MID-YEAR YEAR-END
DARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
9. (Check one) Z 1 _ \
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. Itwe 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.
s
igna ture o candidate date sign re of politi~trasuur,,~
date
11. WITNESS SIGNATURE
signature of witness date
signatu of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT ` '
b. TOTAL RECEIPTS THIS PERIOD 1011..
$
CO I
c. TOTAL DISBURSEMENTS THIS PERIOD ..h 1 ~d
d. BALANCE ON HAND (12.a, plus 12.b. minus N) 4!~
o $ l
e. TOTAL LOANS OUTSTANDING T ~~T <61111,f co
f. TOTAL OBLIGATIONS OUTSTANDING
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
FROM: T0: Z
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) $ 0 -
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.) $
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. Itemized Expenditures (Over $100 each payee this period) $
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) $
U~
b. Itemized in-kind contributions (over $100 from each source this period) $ S '
U ~
c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) 5
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 121.) $
Alfflh SS-1133 (Rev. 4/02) Page 2 of
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
e dv FROM: _ - ( Ly T0. - Z ( - I
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
Last NamelOrganization Name Election ❑ General Election U
C
Address ❑ Runoff (Local Elections Only)
'j k L Q e err A kA
City State Zip Code Date of Contribution Aggregate This Election
v.
Occupation /06.
Employer
First Name Middle Name Contribution Received For. Amount of Contribution
Last Name/Organization Name Primary Election ❑ General Election V O
J Q.
Address L lZ ❑Runoff (Local Elections Only)
City 1 State ► ` Zip Code Date of Contribution Aggregate This Election
Oixupdon (j
Employer -
First Name iddle Name Contribution Received For: Amount of Contribution
Last am rganaaaon Name ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
Occupation
Employer
First Name 7 Middle Name Contribution Received or. Amount of Contribution
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 0Q)
(Carty forward to item 3. of next paged additional pages of this form are used.) f
(N this is the last page of contributions, this amount must be shown in item 15b. of summary.)
SS-1131(Rev. 2/06) Page of RDA 1159
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE
1. E OR COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: _ T0: _ -L \
Amount
3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 ff first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (inadnd contributions totaling more than $100 from any contributor during the period)
First Name T Middle Name In-Knd Contribution Received For. Value of In-Kind Contribution
Primary Election ❑ General Election
Last Nam Organization Name
- \ - ❑ Runoff (Local Elections Only)
gddr Date of h4(ind Contribution Aggregate this Election
City State , ` Zip Code Description of "nld-CConftutionn / A
Occupation Employer Jv v .cam ~~J\ / I L~~
First Name Middle 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 Eleclion
CRY State Zip Code Description of In-fond Contribution
Occupation Employer
First Name Middle Name InXind Contribution Received For. Value of In-Kind Contribution
❑ Primary Election ❑ General Election
Last Name/Organization Name
❑ Runoff (Local Elections Only)
Address Date of ln4Cind Contribution Aggregate this Election
City State Zip Code Desc npbon of In-l<ind Contribution
Occupation Employer
First Name Middle Name In-KKnd Contribution Received For. Value of In-Kind Contribution
❑ Primary Election ❑ General Election
Last Name/Organization Name
❑ Runoff (Local Elections Only)
Address Date of In-lOnd Contribution Aggregate this Election
City State Zip Code Description of W(Ind Contribution
Occupation Employer
First Name Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution
❑ Primary Election F] General Election
Last NamelOrgan¢atianName
❑ Runoff (Local Elections Only)
Address Date of In-ftd Cont ibuti Aggregate this Section
City State Zip Code Description of kWund Contribution
occupation m yer
5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS UJ
(Carty forward to Rem 3. of next page R additional pages of this form are used.) '
(If this is the last page of in4dnd contributions, this amount must be shown in item 22b. of summary.)
SS-1128 (Rev. 2/06) Page of RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
c- 4vc, -1 ~cA FROM: _ TO: ~ y
Amount
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 ff 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
Address I r
City State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Nam/Business Name
Address J ~J
3 S-
City State Tip Code
v\'
First Name Middle Name Purpose of Expenditure Amount of Expenditure
NameBusiness Name
e.
Address
City ` State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NarnetBusiness Name
Address b S U
City State Zip Code
CA ~~~o
First Name Middle Name Purpose of Expenditure Amount of Expenditure
LastName/Business Name \ q G
O
Add
City State Tip Code
3 ~5
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Las Name/Business Name
Address U v ~ s A"' Z
\ state Zip Code
5. TOTAL ITEM D EXPENDITURES 'v
(Carry forward to item 3. of next page if additional pages of this form are used.) 1 Z r~
(If this is the last page of expenditures, this amount must be shown in item 19b. of summary.)
AOL
SS-1129 (Rev. 4102) Page S of RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 1 2. REPORT COVERING THE PERIOD
FROM:~_(-liT0: 1- vY
mount
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 'lf 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
NameBusiness Name 0
Addr
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 NamerBusiness Name
Address
city State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NameBusiness Name
Address
CRY State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address
State Zip Cade
5. TOTAL ITEMIZED EXPENDITURES
(Carty forward to item 3. of next page if additional pages of this form are used.) C t (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) l
SS-1129 (Rev. 4102) Page of RDA 1159
ITEMIZED STATEMENT OF LOANS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: TO:
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more than $100 from any source during the period)
Complete the Following for the Source of the Loan
First Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance
(Beginning of Period) Received Payments (End of Period)
Last NamelOrganizadon Name
Address Loan Received For. Date of Loan
❑ 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)
First Name Middle Name First Name Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
City State Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
First Name Middle Name First Name Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
City State Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
First Name Middle Name First Name Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
City State Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
First Name Middle Name First Name Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
City state Zip Code City State Zp Code
Amount Guaranteed Outstanding unt Guaranteed 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.) Be innin of Period Received Payments End of Period
(Total loan payments should also be shown in item 20. on summary page.)
(Total outstanding loan balance should also be shown in item 12.e. on front page.)
SS-1132 (Rev. 4/02) Page ~ of RDA 1159
ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE I 2. REPORT COVERING THE PERIOD
FROM: -\"j~ T0; -L - \
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Incurred Payments Outstanding Balance
OBLIGATION (obligations totaling more than $100 owed to any (Beginning of Period) This Period This Period (End of Period)
person/vendor at the end of the reporting period)
10
Flrst Name Middle Name
Last Name/Business Name l O 1 C C' I C~ Q T 1
Add ~0 1\ \
City a Zip Code
Descriptio of obligation
Flrst Name Middle Name
Last Nam Business Name
Address
City State Zip Code
Description of Obligation
Flrst Name Middle Name
Last NametBusiness Name
Address
city state Lp Code
Description of Obligation
First Name Middle Name
Last NameBusiness Name
Address
City State Zip Code
Description of Obligation
First Name Middle Name
Last NameBusiness Name
Address
City State Zip Code
Description of obligation
4. TOTALS
(Total from Outstanding Balance - (End of Period) column must also be shown G q in item 23b. on summary page.) \ \ \
SS-1127 (Rev. 4/02) Page of RDA 1159
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 OMMITTEE, NAME OF CANDIDATE i 3. ELECTION DATE
J
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City 9 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. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
7. CAT GORY OR REPORT (Check one)
❑ ❑ ❑ ❑ ❑ ❑ ❑
F S 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. Uvve 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, Uvve 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.
signature of candidate date _ signature of political treasurer date
11. 1ITNESS SIGNATURE
/6 Hal
signature of witness date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $
ZZ -
b. TOTAL RECEIPTS THIS PERIOD _
c. TOTAL DISBURSEMENTS THIS PERIOD $ - 3
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ 0 / r
e. TOTAL LOANS OUTSTANDING . $
3touWM 2_/_
. COY F~
f. TOTAL OBLIGATIONS OUTSTANDING
r
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
,::ill-, N.1.. ~7 i__ _ _t • - FROM: T0:
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) $ 2 2- 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.) $ 1,1 As
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. Itemized Ex enditures Over $100 each a ee this eriod 5
p ( P Y P ) $
C)
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.) $ / / J r+
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.) $ Tr
SS-1133 (Rev. 4102) Page of
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. AME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: TO: Z
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 any contributor)
First Name Middle Name Contribution Received For: Amount of Contribution
Last Namer/Organization Name f rimary Election ❑ General Election X J+ % i `
t.
Address, _ ❑ Runoff (Local Elections Only)
City St Zip Code Date of Contribution Aggregate This Election
7
Occupation L
Employer
First Name Middle Name Contribution Received For: Amount of Contribution
Last a me/Organization Name rimary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
1
C ,
~
:
City State Zip Code Date of Contribution Aggregate This Election
-ice S•.?'U.
Occupation
Employer
First Name t iddleName Contribution Received For: Amount of Contribution
Last Name /Organization ame rimary Election ❑ General Election
Address ` ❑Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
i
Occupation Employer
First Name Middle Name Contribution Received For: Amount of Contribution
Last Name/Organization Nam Primary Election ❑ General Election f
. ~ ---2- tLL+.
Address ❑ Runoff (Local Elections Only)
1
City State Zi~Code Date of Contribution Aggregate This Election
Occupation 5
Employer
5. TOTAL ITEMIZED CONTRIBUTIONS] GL%
(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. 2106) Page of RDA 1159
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: - - -_l& 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 In-Kin ntribution Received For: Value of In-Kind Contribution
Primary Election ❑ General Election d
Last Name/Organi ation Name F u_) -
~C~ ❑ Runoff (Local Elections Only)
Addre F\ Date of In-Kind Contribution Aggregate this Election
city state Zip~Ode } } Description of In-Kind Contribution 1 I r
Occupation A Employer LAC- L•{
First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution
rimary Election ❑ General Election
Last Name/Organization Name X /"-k, A- ~
u c_ ❑ Runoff (Local Elections Only) YYY"'
Address Date of In-Kind Contribution Aggregate this Election
City \ State Zip Code Description of In-Kind Contribution
liCj v • a- ~V7
Occupation Employer •YC.. r'~v
~'T
First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution
]`Primary Election ❑ General Election
LastName/OrganizationName 3j
❑ Runoff (Local Elections Only)
Address Date of In-find Contribution Aggregate this Election
city state Zip Code Description of In-Kind Contribution
Occupation Employer
First Name h Middle Name In-Kind C tribution Received For: Value of In-Kind Contribution
rimary Election ❑ General Election
Last Name/Organization Name. 4 -3 T ib
❑ Runoff (Local Elections Only)
Address Date of In-Kind Contribution Aggregate this Election ~}c
2_--k ii, Ste- L- Z.Ili. -
City Tte Zip Code Description of In-Kind Contribution
Occupation Employer
r
First Name Middle Name 'In-Kind Contribution Received For: Value of In-Kind on 'button
C/1- v lmary Election ❑ General Election 11 C
Last me/ rganization Name
CA- l El Runoff (Local Elections Only)
Address h Date of In-Kind Contribution . Aggregate this Election
l l~ ~c t lt~ .
City tate Zip Code Description of In-Kind Contribution
Occupation ~mployer
5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS 1
(Carry forward to item 3. of next page if additional pages of this form are used.) / Zi>
(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 E RDA 1159
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: T0:
Amount -z
3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0'rfftrst itemized page) Z
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than $100 from an contributor
First Name MiddieName Contribution Received For. Amount of Contribution
Last Name/Organization N\a rimary Election ❑ General Election 5
Address ❑ Runoff (Local Elections Only)
-t~
CRY j ~ State j LpCode Date of Contribution Aggregate This Election
Occupation 1O
Employer
FrstNa Middle Name Contribution Received For: Amount of Contribution
last Name/ nization me rimary Election ❑ General Election c
Address_ ❑ Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
Occupation f/
Employer
First Name iddleName Contribution Received Foy: Amount of Contribution
t an ame rimary Election E] General Election L Namelorg Z j `
Address Runoff (Local Elections Only)
City L~ State Zip Code Date of Contribution Aggregate This Election
Occupation 4 2-5
Employer
3
FrstName Middle Name Contribution Received or. Amount Contribution
Last Name/Organaation Name ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City State ZrpCole Date of Contribution Aggregate This Election
Occupation
Employer
5. TOTAL ITEMIZED CONTRIBUTIONS
(Carry forward to item 3. of next paged additional pages of this form are used.)
(ir this is the Last page of contributions, this amount must be shown in item 15b. of summary.)
SS-1131 (Rev. 2106) Page -5, of RDA 1159
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE
1. E OF CANDIDATE OR COMMITTEE 5 2. REPORT COVERING THE PERIOD
C-~= `t_ = c, r•, _ r.4 FROM: T0:
moun
3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0'rffirst itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-Wind contributions totaling more than $100 from any contributor during the period)
First Name Middle Name In-tend tribution Received For. Value of In-Kind Contribution
L CEPPrimary Election ❑ General Election _
Last Namel rgan Name
❑ Runoff (Local Elections Only)
Address Date ofln-KndContribution Aggregate this Election
City a Zip CAde Description of In Find Contribution 4 d.
Occupation EmP!oyef CL~`
t r
First Name Middle N 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 ln4nd Contnbution Aggregate this Election
City State Zip Code Description of In4Gnd Contribution
Occupation Employer
First Name Middle Name In-Kind Contribution Received For. Value of In-Find Contribution.
n Primary Election ❑ General Election
Last NamelOrganization Name
❑ Runoff (Local Elections Only)
Address Daleofln4ndContribution Aggregate this Election
City state ZrpCode DesaiptionoflnKndContdbution
Occupation Empioyer
gust Name Middle Name In find Contribution Received For. Value of In-Kind Contribution
❑ Primary Election ❑ General Election
Last Name/Organizatiar Name
❑ Runoff (Local Elecfi6ns`Only)
Address DateofIW4W ,orttribution Aggregate this Election
City State Zip Code Description ofln Find Contribution
Oocupatbn Employer
First Name Middle Name In-Kind Contribution Received For. Value of In-find Contribution
❑ Primary Election ❑ General Election
Last NamelOrganbationNcme
❑ Runoff (Local Elections Only)
Address Dateofln-tGndContribution Aggregate this Election
Cily Stale 7* Code DewriptionofIn-lend Contribution
Occupation
5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS V
(Carty forward to item 3. of next page Kadditional pages of this form are used.)
(If this is the last page of in-kind contributions, this amount must be sh m in item 22b. dsummary.)
SS-1128 (Rev. 2/06) Page ko of RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NA ; OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
vim- FROM: - TO:
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
Last NameBusin s Name n
Address
I c-,
I -A- City State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
NamelBU inessName
Address
lily state Zip Code
1 ~
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Nam ^ Z
Address ~ 'L. •~.i.rv~-~~. C~
City State Zip Code \ r 'rte
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name `
Address V,
City State
lc~. Zi Code
C\
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
1 r L l~ C 1~ r cf~
Address
1 V~
Gty State T`p Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NameBusiness Name
Address
City State Tip Code
5. TOTAL ITEMIZED EXPENDITURES
(Carty forward to item 3. of next page if additional pages of this form are used.) ,
Of this is the last page of expenditures, this amount must be shown in item 19b. of summary.)
Alah,
SS-1129 (Rev. 4102) Page of RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NA E OF CANDIDATE OR COMMITTEE ^ 2. REPORT COVERING THE PERIOD
A~_ C 1 L t,~ FROM: - k °l TO: - 3
moft
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) S, Z_
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
Cam-
Address h
Gty r ~ ate Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last N eBusiness me U~Na t° /
l> Tel ls' -
Address \n
City State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name 1 , ` L
Address I
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 NamelBusiness Name
Address
city State Zip Code
5. TOTAL ITEMIZED EXPENDITURES C k
(Carry forward to item 3. of next page if additional pages of this form are used.) O y 3 -
-Of this is the last page of expenditures, this amount must be shown in item 19b. of summary.)
SS-1129 (Rev. 4102) Page ?8j
of RDA 1159
1
ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: - k, T0:
3. COMP ETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Incurred Payments Outstanding Balance
OBLIGATION (obligations totaling more than $100 owed to any (Beginning of Period) This Period This Period (End of Period)
person/vendor at the end of the reporting period)
First Name Middle Name
Last NamelBusiness Name 1 ~1 ._1 { / z/ f } O Cj
Jlo P D ( r
Address
Z;
City State Zip Code
v,.a
Des ' tion of Obligati
First Name Middle Name
Last Name/Business 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
First Name Middle Name
Last Name/Business 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
4D in item 23b. on summary page.) C
SS-1127 (Rev. 4/02) Page 1 of C1 RDA 1159
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 !E_ e c.
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
VV-
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route \ City State Zip Code Phone
\0111 C~a vane !J r Luv .S v, 1~e t~ `3~~-~ S_33Z-'.,A
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)
L
7. CATEGO OR REPORT (Check one)
❑ ❑ ❑ ❑ ❑ ❑ ❑
FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YE - ND
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
U 4- 1-2--31-
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.
l-3,
signature o candidate date signatu of political treasurer date
11. WITNESS SIGNATURE
-Ig
signature of witness date signature of witness date
12. SUMMARY
RECEIVED
a. BALANCE ON HAND LAST REPORT $
b. TOTAL RECEIPTS THIS PERIOD JAN 3 1 2018
..U...N.....COUN7y...................................................... $
b Ld1"
C. TOTAL DISBURSEMENTS THIS PERIOD ~CT(PN............................................. $
1
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ .
e. TOTAL LOANS OUTSTANDING $ L-
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2/06) Page 1 of RDA 1159
At-
SUMMARY PAGE - CANDIDATE
13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD
e_ 2 Tl~ I J FROM//- _ TO: -31-11
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.) $
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. Itemized Expenditures (Over $100 each payee this period) $
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) $ `J q, 3
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 CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
e - v L I- -e L. - FROM: -14 T0:
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
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
First Name Middle Name Contribution Received For: Amount of Contribution
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
First Name lv~ iddle Name Contribution Received For: Amount of Contribution
Last ame rganization 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 Received or: Amount o Contribution
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 '
(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. 2106) Page of RDA 1159
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
OawyL&'~ e e_ FROM://-/ T0: Z- ) -
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 In-Kind Contribution Received For: Value of In-Kind Contribution
U. i1 - td Primary Election ❑ General Election 5
Last Name/Organization Name
~ ❑ Runoff (Local Elections Only) ~
Address Date of In-Kind Contribution Aggregate this Election
City \ S Io Zi Code Descriptionofln-Kind Contribution
Occupation Employer ` _ I l
CA, S\5k,\"c~ ~c cU~ L UJ .S v`1\.O-
First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution
Primary Election ❑ General Election
Last Name/OrganizationNa e e~ L3 U S
❑ Runoff (Local Elections Only) ~1'
Address Date of In-Kind Contribution ( _ - Aggregate this Election
State Zip Code Description of In-Kind Contribution
City
L" 1- Q1
U 0
Occupation Employer -~.,v
A \gjCS M~ v C;r l~o,~ C7~C~ilts ~~'+r7
First Name Middle 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 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 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 1:0 n of In-Kind Contribution
occupation I Employer
5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS 3
(Carry forward to item 3. of next page if additional pages of this form are used.) L
(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 EXPENDITURES - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: j. -jj TO: Z _
Amount
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
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
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business 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 expenditures, this amount must be shown in item 19b of summary.)
SS-1129 (Rev. 4102) Page of RDA 1159
ITEMIZED STATEMENT OF LOANS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: TO:
e - ck/-(q "/fi
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more than $100 from any source during the period)
Complete the Following for the Source of the Loan
First Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance
(Beginning of Period) Received Payments (End of Period)
Last Name/Organization Name
Address Loan Received For: Date of Loan
❑ 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)
First Name Middle Name First Name Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
City State Zip Code City State Zip Code
Amount Guaranteed Outstanding mount Guaranteed Outstanding
First Name Middle Name First Name Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
City State Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
First Name Middle Name First Name Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
City State Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
First Name Middle Name First Name Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
City State Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
4. Totals forall Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans LoaOutstanding Loan Balance
(Total loans received should also be shown in item 16. on summary page.) Be innin f Period Received Payments (End of Period
(Total loan payments should also be shown in item 20. on summary page.)
(Total outstanding loan balance should also be shown in item 12.e. on front page.)
SS-1132 (Rev. 4/02) Page--(,a-,f RDA 1159
ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
- FROM: I~- TO: Z-3
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Incurred Payments Outstanding Balance
OBLIGATION (obligations totaling more than $100 owed to any (Beginning of Period) This Period This Period (End of Period)
person/vendor at the end of the reporting period)
First Name Middle Name
Last Name/Business 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
First Name Middle Name
Last Name/Business 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
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 23b. on summary page.)
SS-1127 (Rev. 4102) Page of RDA 1159
DOLLAR GENERAL STORE 417933
3413 LOUISVILLE RD ~S J
LOUISVILLE, TN 37777-3738
/ (865) 337-8185
SMITHFIELD SAUS BISC E 4.25 N
070800405893-112
BF BROCC CHS CKN BRE E *4.00 N
073461285019-112
'REGULAR PRICE 4.25
DOLLAR TREE STORES IN C, FP 015958983787-110501 2.00 s
M MS PN SUP 10.70Z 1 E 3.25 S
Store# 545 (865) 982-7798 040000513056-110
1135 Hunters Crossing STORE DISCOUNT 0.25-S
Alcoa TN 37701-1852 M MS PN SUP 10.70Z 1 E 3.25 S
040000513056-110
STORE DISCOUNT 0.25-S
DESCRIPTION OTY PRISE TOTAL SNICKERS FS 10.590Z E 3.50 S
- - 040000505334-110
TBLCVR 54X108 1 1.00 1.00T LAYS REGULAR 8OZ E 2.95 N
TBLCVR 50108 1 1.00 1.00T 028400199148-110
TABLECOVER 1 1.00 1.OOT DORITOS COOL RANCH 9 E 2.95 N
TABLECOVER 1 1.00 1.00T 028400641326-110
LA 0 9.6 E 3.50 !J
Sub Total $4.00 028400645249-110 *3.75 N
SALES TAX $0.39 EASY CHEESE CRACKER E
044000045517-110
Total $4.39 ULAR
Debit Card $4.39 ARTSK GLITTER SH 1.65 S
************3354 Approved 672125013731-140
Purchase Swiped POSTER BOARD BLACK 0.80 S
Auth/Trace Number: 145816/043204 079784546882-140
ARTSKILLS GLITTER SH 1.65 S
672125013731-140
Thank You for Shopping at Dollar Tree ARTSKILLS GLITTER PO 2.00 S
672125045190-140
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672125013588-140
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w For complete rules, eligibility and sweepstakes * 430000036233-140 1 .00 S
w period and previous winners please visit w ARTSKILL PAINT SLUR
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w w 672125036624-140
w We will gladly exchange any unopened item w ASKILLS GLITTER BOAR 1 .00 S
w with original receipt. We do not offer refunds. w 672125045183-140
ASKILLS GLITTER BOAR 1.00 S
672125045183-140
ASKILLS GLITTER BOAR O 1.00 S
5524 00545 04 004 21654198 11/18/17 10:54 672125045183-140
Sales Associate:Genie ASKILLS GLITTER BOAR 1.00 S
672125045183-140
SUBTOTAL 1J $59.50
Taxi $3.71
Tax2 'jq $1.44
TO TAL SALE $64.65
DEBIT $64.65
************4980
EXPIRY: CHIP r
PIN BYPASSED l~C[
AUTH# 219028 ,^C
REFERENCE# 30002001143
AID# AOOOOOOO042203
SIGNATURE CAPTURED ELECTRONICALLY
TOTAL SAVINGS
$0.50
ITEMS 28
2017-11-17 17:10:50 17933 02 3411
Little Cates
1741 West Brwdwai, 37801
Phone 865-984-8999, Stare 10 0M01-025
Order #5479M
Sat, Nov 18, 2017 02:08m
Your Cashier Today is Spencer S.
RECEIPT REPRINT 11/18/17 2:08pm
Ito
Classic - Price
Chem Classic Cheese $5'00
Classic. Pepe oni
$5. DO
Italian Cheese Bread_ $4.00
2 Dippers $1.0
Buttery Garlic Dip
Buttery Garlic Dip
Crazy See $1. DO
' Item Count ~ - 7
General Sales $2.05
Taxable Subtotal
Tax Total $21. DO
2.
Total'
Ckh $23.05
I $25.,
! -$1.95