Martin,Tanya
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. TE OF R PORT 12.a. O/ CANDIDATE O OMMITT E i
T1
3. ELECTION DATE
2.b. I COMMITTEE, NAME OF CANDIDATE
4.a. CAMPAIGN ADDRESS AND PHONE Z' Code Phone
Stre t or Rural outgr) Ci to ~
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) State Zip Code Phone
Street or Rural Route city
5. OFFICE SOUGH)(include district number, if applicable) 6. NAME OF POLITICAL TR SURER (may be candidate)
AlWaa l 1, 0 Alec !r_ f7 I-
7. CATEGORY R REPORT (Check one) ❑ ❑ ❑ ❑
FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. EGINN /N DATE OF PORTING PERIOD 8.b ENDING DATE OF REPORTING PERIOD
9. (C eck 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. [/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
enefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code.
MaAj_,_~ 4"d-116N
date
signal a of candidat date signature of political treasurer
11. WITNESS SIGNATURE
~►1 date
d signature of witness
signature of it ss
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $
b. TOTAL RECEIPTS THIS PERIOD $
c. TOTAL DISBURSEMENTS THIS PERIOD $
$
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.)
e. TOTAL LOANS OUTSTANDING ..................................r~,.,................................... $
f. TOTAL OBLIGATIONS OUTSTANDING $
rs~
_
~Y r~ b:_OlSPi1 GOl)icl~l V
RDA 1159
ELECTION cb Page 1 of __~J
SS-1109 (Rev. 2106)
tab Wd Z` ~
O
SUMMARY PAGE - CANDIDATE
13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. R PORT COVERING THE PERIOD
I FRO
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.) $ ~2 ej?)
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 categ~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 re a ments add 19.a. and 19.b. $ v
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.)
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
.w
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DAT OF REPORT / 12. ~ CyOF CANDIDA R COMfyll EE '
a"d 2.b. IF C MMITTEE, NA E OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Ro to Ci Stat Zip Code Phone
~Sx
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.)
Street or Rural Route City State Zip Code Phone
nn5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
V
7. CAT G RY OR REPORT (Check one)
❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑
FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a GINNING 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. Uwe do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an
accurate accounting of campaign contributions and expenditures required to be reported by the candidate committee by the Campaign
Financial Disclosure Act. Additionally, I/we swear or affirm that no campaign contributions have been expended for the personal financial
enefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue cod p.
yx)lle
sign ure of can mate date signature of political treasure da e
SS SIGNATURE
e~'~ nn
/D ~jLJ,~t Qh ! 0 1
signature of witness date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $
b. TOTAL RECEIPTSTHIS PERIOD $ C~
c. TOTAL DISBURSEMENTS THIS PERIOD $
d. BALANCE ON HAND (12.a. plus 12.b. minus 12:c $
e. TOTAL LOANS OUTSTANDING .....................PG r.............................................--....--.---......................$
f. TOTAL OBLIGATIONS OUTSTANDING $
4 SS-1109 (Rev. 2106) Page 1 of RDA 1159
SUMMARY PAGE - CANDIDATE
13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD
FROM: T0:
RECEIPTS
15. CONTRIBUTIONS (other than loans and interest)
a. Unitemized Contributions ($100 or less from each source this period) $ f (-r' F if Z
b. Itemized Contributions (over $100 from each source this period) $
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ r
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
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)
$
$ -V
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) $
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.) $
0 SS-1133 (Rev. 4102) Page A J
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE
1. NA F ~ANDIDATE OR COMMITTEE , 2. REPORT COVERING THE PERIOD
J FROM: T0: C / g
mount
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 Na Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution
&.2 A/ oc Aj ❑ Primary Election % General Election
Las N melo anizalionr~ me
Q jU ❑ Runoff (Local Elections Only)
~'C' V
Addre //5 I Date of In-Kind Contribution ` 91
16 ` 1 4 Aggregate this Electio
j 5 T Descriptioonn of In-Kind Contribution
Oc anon 1.21f
Employer ~lJ eb
Firs . rn ! . Middle Name In-Kind Contribution Received For: Valu of In-Kind Contribution
❑ Primary Election R General Election
La N /0 ani ti n Nam s y
❑ Runoff (Local Elections Only)
Ad~ Date of In-Kind ContributiAggreg th'
a lection
c~j 6v ~(J, /e, ;
Ci Ft~k o Description of In-Kind Contribution
ation LEmployer
F- led
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-find CoWbution 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 Contributi on
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 Descrptonofln-Kind Contribution
ccupation mp oyer
5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS
(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 o 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.
e-mail address:
1. Date: 2. Candidate First and last Name: 3. Can
Jar /Lo ~j e ik eJersoAj Sd A f Act
4. Campaign Address and Phone: City State Zip Code Phone
`J 5 ~ 141UA / ~cl J7~'(O
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
&U4Uq C~0/9
9. Treasurer N me: 10. Treasurer e-mail address:
00 `
` n 2_010 Ve 4ev (7
bra
(~Y-.7-4c/ltj
11. Treasurer Address and Phone: City State Zip Code Phone
/j 5 Z61. 06 & AMR
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness can 'date's signature):
S nature of Candidate Signa re reasurer
1 ~A 12 AM
4
Signature of Witness ^ Si re of Witness
co RECEIVED w
nio
2 go -,V,
;h
C7
Registry of Election Finance N $touS T C'
SS-1120 (rev 12/2013) ! ELEC~
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