Carver, Richard A. 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:
Candidate's Position: Lou Kio (154,V
Residential Address: f2/4 /Jyale" ,4v,7
City: ,/►2Cryvjlk State: TN Zip: 3 703
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.
IV/7/7,e'2.
Candidate Signature Date
Witness Signature Date
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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:Jj
gi,c
raaro
4.Campaign Address and Phone: City State Zip Code Phone
f 2/6 Q,.e,l eoit /rre "IV; -1-Al 3>017 Us4,J)
5.Home Address and Phone(if different than item 4 above): City State Zip Code Phone
Wt•
6.Office Sought(include district number,if applicable) 7.Party Affliation 8.Election Year
Sitse/P--/-6"016 4;445 n
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9.Treasurer Name: 10.Treasurer e-mail address:
as,(jV 14."1 -rN
11.Treasurer Address and Phone: City State Zip Code Phone
5--1
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 Commission must be notified of any change in this information.
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Signature of Candidate `2 `�. Signature of Treasurer
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Signature of Witness 00ylY I Signature of Witness
j Registry of Election Finance SS-1120
,/ (rev 10/2021)
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FINANCIAL DISCLOSURE STATEMENT EXEMPTION
o moo;.
Pursuant to TCA S 2-10-101(b) a candidate is exempt from filing financial
disclosure statements:
"If a candidate is seeking an office for which service is part-time,
compensation is less than $1,000 a month, and the candidate does not spend more
than $1,000 to get elected to office, the candidate does not have to file Campaign
Financial Disclosure Reports."
CANDIDATE'S INFORMATION:
Candidate's Name: J
Candidate's Position: ~un ~►r~ ;`S5~®
Residential Address: Z 4VwmJ14f,1c
City: i
' 3 State: TN Zip: )r03
I hereby state that I meet the above qualifications for exemption and am
therefore exempt from filing financial disclosure statements.
~y
Candidate's Signature Date
c
Witness's Signature Date
If my plans change and I realize I will spend more than $1,000 on my campaign, I
will immediately make a financial disclosure report.
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, maybe
exempt from completing this form, please checkwith 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 f Can idate or Committee: 3. Candidate a mail address: /
4. Campaign Address and Phone: City State Zip Code Phone
016 jAdjV',r)61(0V(
5. Home Address and Phone (if different than item 4 above): City State Zip Code Phone
F
Z_~ wef
6. Office Sought (include district number, if applicable) 7. Party Affliation 8. Election Year
9. Treasurer Name: 10. Treasurer e-mail address:
11. Treasurer Address and Phone: City State Zip Code Phone
d / At xi"'.
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
Signature of Candidate Signature of Treasurer
CEIVEC
Signature of Witness Signature of Witness
t.
Registry of Election Finance G V
SS-1120 (rev 1011010) Wd ZL 0~ 5