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Bain, Sophia Diane CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. OA OF RE T 2.a. NAME OF CANDIDATE R COMMITTEE 1-- a.,(p lo , -),, o ; 0_ V\ e, tiCOP_O-i Ai • . 2.b. IF OMMI EE,NAME OF CANDIDATE 3.ELECTION DATE 0.h e c�, ,t� 5 I 5 i 1 06L)-- 4.a.CAMPAIGN ADDRESS AND PHONE Street or Rura oute ri,tyj State— Zip Code Phone I 6 bre ( a. p r� u� ��, 1 N ?C 1 � Qb5 )9g02..-�'5o 4.b.CANDIDATE'S HOME A DRESS iif fferent than 4.a.� I treet or ral Route City _gate ZipCode Pho e Rik.9,e, QA , iniavith 11e, 11,1 So i (?i, 5 6ifot- 07,43 5. OFFICE SOUGHT�(nclude distriat number,if applicable) 1 6. NAME OF POLITICAL TREASURER(may be(=di ate) t)tLU& ( D w►2t ►J SAIDek kcra V t5-t't(--t3 Li i O- A e... 6 0. , N 7. CA GQRY OR REPORT(Check one) R 0 SECOND T0 HIRD 0 FOURTH ', 0 0 0 YEAR PPE -END R-END QUARTER QUARTER QUARTER QUARTER '- •f.' GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a.BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD Perte :lea1 I-,i;3313i ,2 Q, , 9.(Ch ck one) a. 4f 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. 0 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. i)6 i e e A_AAN Q—, 46...,...v.-) ///016 .71),zq .,,,,,,,,,,... ,r, ,c5„, - /G.:Li e v signature of candidate data signature of political treasurer date 11 WITNESS SIGNATURE ,.tL V 2°aa signature of witness date signature of witness date 12. SUMMARY '272829 -" a. BALANCE ON HAND LAST REPORT �2 $ b. TOTAL RECEIPTS THIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD $ v P� d. BALANCE ON HAND(12.a.plus 12.b.minus 12.c.) $ © — e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ — — t � SS-1109(Rev.2/06) Page 1 of RDA 1159 FINANCIAL DISCLOSURE STATEMENT EXEMPTION Pursuant to TCA § 2-10-101(b) a candidate is exempt from filing financial disclosure statements due to the following: 1. The service for the office which I seek is part-time and the compensation is less than $1,000 per month, AND 2. 1 do not plan to spend more than $1,000 on my campaign. *Candidates running for Chief Administrative Officer (i.e. Mayor) of the county or city are NEVER exempt from filing and should file the required campaign financial disclosure reports regardless of compensation or spending. CANDIDATE'S INFORMATION: Candidate's Name: Candidate's Position: Residential Address: Stater Zip: IQ1~ City: I hereby state that I meet the above qualifications for exemption and am therefore exempt from filing financial disclosure statements. If any of the above change and I no longer qualify as an exemption, I will file the required campaign financial disclosure reports with my local election commission. .APR ~ 291a Air Candi ate's Signature Dat q,CQ(~ Witness's Signature Date Appointment of Political Treasurer ~rJ`~b~oe 5 to and Local Candidates and Single-Candidate Committees For 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 rsuant political treasurer has been appointed for that election. A local candidattepu scion foor more -10-10 , ma Abe exempt from completing this form, please check with county election comformation. candidate may appoint himself or herself as political treasurer. A new form must be filed if the treasurer is changed. 37243tement ONLY with Candidates for state public office must file their original Appointment of Political Treasurer the Registry of Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, Candidates for local public office must file their original Appointment of Political Treasurer statement ONLY with their county election commission. 3. Candidate e-mail address: 1. Date: 2. Candidate First and Last. Name: ' ~ Q Q f N ~ ~C~OUCJ ~ M ff r ~ ~ r ` u LO nla, V1 e, 0- St ate Zip Co de Pon 51 SzSS'~3 4. Ca paig Address and Phone: City H _ f C~' I l e l ti :3~1~~~ I C~ r~" y4l Zi Code Phone State p 5. Home Address and hone (if erent than item 4 above): ity 8. Election Year 6. Office Sought (include district number, if applicable) 7. Party Affiliation ; ~ ~ D Ito ~~n f to ( &a D16- r;Cf3 ~b~ ^q t 9. Treasurer Name: 10. Treasurer e-mail address: i a- bi CA, I ~ 1300..1 l1~ ~ ~ Cl. h~ ~ ~ Ck l ~ ® C ~I ©u r ~ ~ 11. Treasurer Address and Phone: City State Zip Code Phone t d ~5 ar r X7$0 {gb.~J W natures must b witnessed. Treasurer can not witness candidate's signature): 12. Candidate and 7r asurer Si ature (both slg Signature of Treasurer Signature of Candidate Signature of Witness Signature of Witness Registry of Election Finance SS-1120 (rev 12/2013)