Puckett, Kathleen
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPOfRTT 2.a. NAME OF CANDIDATE OR COMMITTEE
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2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
C!? er F~se~ N -7SSZ gy.~ 7ZY ~
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)
(WOOMM1515101VTg;S~ L
7. CATEGORY OR REPORT (Check one)
❑ ❑ ❑ ❑ 13 C3 13
FIRST SECOND THIRD FOURTH 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
/S • z/ l8
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
b n t of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code.
L-2 4 - -22-1 --?L dam, A0-
_7 k- signature of candidate date signature of political treasurer date
11. WI ES SIGNATURE
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signature of ' e date signature APWitness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $
b. TOTAL RECEIPTSTHIS PERIOD
c. TOTAL DISBURSEMENTS THIS PERIOD $
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $
RECEIVED _
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING ......................2LQU I.T.0011=................................................................. $
ELECTION
SS-1109 (Rev. 2/06) Page 1 of RDA 1159
4
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE
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2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
Z 5 Cv o fit' n~~ c~t./ C~d~ ~g2~e-, rT~/ 3 7 ~ ~lo.~ ~ Zlt' =10 )
4.b. CANDIDATE'S HOME AIIDRESS (d different than 4.a.)
Street or Rural Route City State Zip Code Phone
5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
131 t A-- C6 , y comki'l I'
7. RY OR REPORT (Check one)
SECOND FOURTH PRE- MI YEAR YEAR-END
QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
g. (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. Vwe 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, Vwe swear or affirm that no campaign contributions have been expended for the personal financial
TIhet o the candidate or for a y_
other
nonpolitical purpose as defined by the federal internal revenue code.
.
signature of candidate date signature of political treasurer date
11. TNESSSIG RE
64
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y lD-`e
signature of ss date sig u of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $ r
b. TOTAL RECEIPTS THIS PERM $ / LJ-ti
71J.
c. TOTAL DISBURSEMENTS THIS PERIOD '
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.)
e. TOTAL LOANS OUTSTANDING $ /
f. TOTAL OBLIGATIONS OUTSTANDING REoEwso.................................................................. $ ~
SS-1109 (Rev. 2106) APR 10 2018 ~ Page 1 of ~ RDA 1159
BLWWOOMY
SUMMARY PAGE - CANDIDATE
13. NAM F CAN 1 TE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD
FROM: TO: '3,
RECEIPTS
15. CONTRIBUTIONS (other than bans and interest)
a. Unitemized Contributions ($100 or less from each source this period) $
b. Itemized Contributions (over $100 from each source this period) $ dl)'
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 151.) $
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 (otherthan loan payments)
a. Expenditures ($>>100 or less each payee this period) (must be listed by category - e.g., printing, postage, gasoline)
$ C/0
v~ $
7A-/ J~F 67- $ Z
Z!17 C2',
$
$
9,
Total of Expenditures ($100 or less each payee) $ p2~ Z U
period)
b. Itemized Expenditures (Over $100 each payee this $
c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ y Y9
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 IN4QND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $
23.013LIGATIONS
--Cy
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 12A.) $
Page of
S5-1133 (Rev. 4102)
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. N M OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
- FROM: TO: ~g
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 al ame yWpdmary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City UDC / Std ZipC~e_,~y,5l Date of Contribution Aggregate This Election
(lam
Occupation
/ v
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 iddle 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 o Contribution
Last Name/OrganizationName ❑ 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. 2/06) Page of RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. M F C ND DATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
P FROM:? , /S T0: ~ ; 3/, /
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 Na Business Narne v
Address /~Gy 4J~ / 'I i ~~c~ 1
City state Zip Code
e2 /;;?W I .
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last N7 mess Name
Address-7 .S //~1 < < <1 3
City State
/J Zip Code 57 cu
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NamelBusiness 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 NarnelBusiness Name
Address
City State Zip Code
5. TOTAL ITEMIZED EXPENDITURES 7
(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.)
Amb,
SS-1129 (Rev. 4102) Page of RDA 1159
Appointment of Political Treasurer
For State and Local Candidates and Single-Candidate Committees
INSTRUCTIONS
The Appointment of Political Treasurer statement must be used to appoint a political treasurer as required by
the Campaign Financial Disclosure Act (T.C.A. § 2-10-105) for state and local candidates and single- candidate
political campaign committees. A state candidate may not receive or expend funds for an election until a
political treasurer has been appointed for that election. A local candidate pursuant to T.C.A 2-10-101, may be
exempt from completing this form, please check with county election commission for more information. A
candidate may appoint himself or herself as political treasurer. A new form must be filed if the treasurer is changed.
Candidates for state public office must file their original Appointment of Political Treasurer statement ONLY with
the Registry of Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360.
Candidates for local public office must file their original Appointment of Political Treasurer statement ONLY with
their county election commission.
1. Date: 2. Candidate First and Last Name: 3. Candidate e-mail address:
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4. Campaign Address and Phone: City State Zip Code Phone 91
02 is- Ccop ec- 14o Ijow ~7 _IDw.v5eenek TN 37 8 $Z ~~Os 7.zy -1027
5. Home Address and Phone (if different than item 4 above): City State Zip Code Phone
6. Office Sought (include district number, if applicable) 7. Party Affiliation 8. Election Year
3C l.OUV*y COMlr+llS+s~cn~~iS°~'F __~o LrA7t- oZo 1 8
9. Treasurer Name: 10. Treasurer e-mail address:
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11. Treasurer Address and Phone: City State Zip Code Phone
02 q 5 - Czr - o~el' d /~ow 7owys~e.rdQ 'TN 3782- IS1cS- 7z'f - tf 9
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
C~
Signature of Candidate -Signature of Treasurer
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AAk
RECEIVED Signature of Witness h Signature of Witness
er
M FES 5 2018 w
ELOUNT COUNTY
Registry of Election Finance ELECTION
SS-1120 (rev 12/2013) g
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