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Jones, Carlons Don Jr. ctsTq•. APPOINTMENT OF POLITICAL TREASURER k.0. RE 7: For State and Local Candidates and li " .".. Single-Candidate Committees asc• Tennessee Bureau of Ethics and Campaign Finance RECEIVED WRS Tennessee Tower,26th Floor 312 Rosa L.Parks Avenue JAN 0 5 2024 Nashville,TN 37243 (615)741-7959 Registry.lnfo@tn.gov Blount Co Elections 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 candidate may appoint himself or herself as political treasurer.A new form must be filed if the treasurer is changed.Some local candidates may be exempt from completing this form.Local candidates should check with the county election commission for more information. Candidates for state public office must file their original Appointment of Political Treasurer statement ONLY with the Registry of Election Finance at the address above. Candidates for local public office must file their original Appointment of Political Treasurer statement ONLY with their county election commission. 1.Date: 01/07 11 \ .l� 2.Name of Candidate or Committee: C► Z4.�oc V � )&1� i7 3.o EmaSil: (,eu,5 ruses (p/►za-ii cone 4.Campaign Address: 1420 Vsli City: N v, // r� State: %J Zip Code: 33770� Phone: q65—a citr'6 304 5.Home Address:(check here if same as above Et City: State: Zip Code: Phone: 6.Office Information: Title of Office Sought: 1c,t,,L 4,4 c-,04— er r a'CJ District Number,Municipality,or County Where Office is Located: Party Affiliation: i GI-arC-- Election Year: '70 2 ci 7.Treasurer Name: C,r1 1(No, C Y\ 8.Treasurer Email: C1 t S+VIR_hodcy„ l ct CO -(0.,hoo.kiwn 9.Treasurer Address: Vet k j' i\ w\\\d\ j� --C � C AYCj� �City: Mcom V .k\\ State: rN Zip Coder 2 �1 )�q((P Phone: a€pc '— 'Lb j " °C V`1 to 10.Campaign Fund.Identify the banking institution where campaign funds are deposited. Include the last 4 digits of the ba account number. DO NOT include the complete account number. ''-'"1, Cnjcl' f.(\ S c))a� O CAVY\- — CoULYI.-k( 6-S71 SS-1120(Rev.07/23) 11.Candidate and Treasurer Signature:(BOTH signatures must be witnessed.A treasurer cannot 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 Commission must be notified of any change in this information. Signatur(o `S g ature of Treasurer Signal re of Witnkss Signature of Wit ss SS-1120(Rev.07/23) 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. I 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: Cam-- )6 S '© J �.Y _-S' �/;, Candidate's Position: P�56 --- s?,- n,,,, l,,,,, ((ut4 C Residential Address: `7(020 (,c)croc y al't t, City: /YJ 19/lie_ State: TN - Zip: 3 7g D T 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. c5//S/Rod Candidate Signatu Date faii ) lial4c)./7 `k) 3//5iti-2.- Witn t ess Signature o, t .4 Date T.' '' c' 02 r cs�► Tc9 \ :,='; -C)r e��- tier \ v�=' w 9S 6"1" 2/ 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: 3/l-S/07c2 Dc•O Lb a s fo..)ea$6 rua.1 4.Campaign Address and Phone: City State Zip Code Phone 4.2.0 Ma ur! T:4, 37 `f- g k'29C C3© 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 Affliation 8.Election Year 9.Treasurer Name: 10.Treasurer e-mail address: cam, 5� r c9& CQ„i�J • MC �m 11.Treasurer Address and Phone: City State Zip Code Phone `6-3 ( COrll o 0; i[., "1/3 12.Candidate and Treasurer Signature(both signatures must be nessed. 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 lection C mission must be notified of any change in this information. Signature andidate Signatur of Treasurer 4/44r_J /I4.GU4 � _A 1718 i9 2 17QA Signature of Witness vv.) Signature o Witness 1W nF)7 1` i , Registry of Election Finance SS-1120 co (rev 10/2021) itoNi 5 2