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Girard, Peter
Print Form 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.Name of Candidate or Committee: 3.Candidate e-mail address: " Q 6d i 04-e.Pe1�ci ,rcar� .c'z',�, 442,D 4.Campaign Address and Phone: City State Zip Code Phone pc.9 . 63,x - g -77;‘,(.2ns42=-,4,1 -r-ic, 3-7 igz bS 3)2 -b-3)0 5.Home Address and Phone(if different than item 4 above): City State Zip Code Phone g.-) s? S -e ht-141'i 7 3 / 7o nS ei 7/1-2 3)gg,Z bL-,_s - _3 )2,-- 6y-- 1 i 6.Office Sought(include(/ district number,if applicable) 7.Party Affliation 8.Election Year P.2 h t /1 11 C in C©M/h:Ls'"h is4 f 7 g Q n , d 0 9 a 9.Treasurlere Name: 10.Treasurer e-mail address: 11.Treasurer Address and Phone: City State Zip Code Phone CO, (.O x 3 b? nu91) 1ki- P '?N 37 K i los-3 -631 y y '73 ' ` i, , , 12.Candidate and Treasurer Signature(both signatures must be witnessed. Treasurer can not witness candidate's signature): I certify under the penalty of perjury that the information given on this form is true and accurate.In addition,I understand that the Registry of Election Finance/County Election CommifiR�mu t be notified of any change in this information. ��•�,0�'�NO A L��s''� l -� �`• STATE•.••�pG Signature of Candidate OF ;m- Signature of Treasurer * ' TENNESSE _ ---;C'.... PUBL.IC ./A.„...i-tA/4"-P-a-44-14-- gi4/4477-6- Signature of Witness -''i�Ty''••••"'•O4 � 'ISignature of Witness ri/iiifpF'B / / / I 'j] Registry of Election Finance SS-1120 1 • MAR 2022 ', �A}! (rev 10/2021) Z v C) cg, nrnutI'I'COUNri St 1 T-N, ELECTION cb c"9. fie +