Kirby, Gerald L. i
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 12.a. NAME OF CANDIDATE OR COMMITTEE
&fXA Lad I RS C/
v_l
3. ELECTION DATE
2.b. IF COMMITTEE, NAME OF CANDIDATE ! , l
4.a. CAMPAIGN ADDRESS AND PHONE State Zip Code Phone
Street or Rural Route City
R , c,),*-ferZ 12S4.. ~cu ~s~, c l ~e L/✓- 3~7 "17 8~5=6'i/= 513 7Z
4.b. CANDIDATE'S HO E ADDRESS (if different than 4.a.) State Zip Code Phone
Street or Rural Route City ~
' A ~-e ~~lts /z~• ~ou~s ve lI~ int . 77 -7 R 5. OFFICE SOUGHT (include district number, if applicable) { 6. NAME OF POLIT CA,L TEASURER (may be candidate)
~'Uc~+~{` omm isS /JvJert Dlst~re~~o .
7. CATEGORY OR REPO11 RT (Check one)[, ❑ ❑ ❑
FIRST SECOND If- RD FOURTH PRE- PRE- MI YD❑EAR YEAR-END
QUARTER QUARTER QUARTER. QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING nATE OF REPPOTING PERIOD
7- 2.9 I q
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. Cd 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 nonp ' ical purpose as defined by the federal internal revenue code. ✓
date signatu of political treasurer date
signature of ndidate
A 11. ~NtT ES SIGNATURE
date signature of witness date
signature of wi Hess
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $
$ 631, 70
b. TOTAL RECEIPTST}.{ISPERIOD
c. TOTAL DISBURSEMENTS THIS PERIOD $
$
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.)
e. TOTAL LOANS OUTSTANDING
f. TOTAL OBLIGATIONS OUTSTANDING
Page 1 of RDA 1159
SS-1109 (Rev. 2106)
SUMMARY PAGE - CANDIDATE
13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIO
l~~l V! rr T -"1,FROM: _2-) T0: - J
RECEIPTS
15. CONTRIBUTIONS (other than loans and interest)
a. Unitemized Contributions ($100 or less from each source this period) $ 0
b. Itemized Contributions (over $100 from each source this period) $ 4 2 .7 1
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 6 ,31- 7 V
16. LOANS RECEIVED THIS REPORTING PERIOD
17. INTEREST RECEIVED THIS REPORTING PERIOD d
3/ /
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 category - e.g., 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 repayment:a)(add 19.a. and 19.b.) $ ,q
20. LOAN REPAYMENTS MADE THIS PERIOD FJ'
21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ L
22.IN-KIND CONTRIBUTIONS
a. Unitemized in-kind contributions ($100 or less from each source this period) $ U
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.) $ 0
23.013LIGATIONS
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.) $ C
AWk
S&1133 (Rev. 4/02) Page of
ITEMIZED STATEMENT OF LOANS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: T0:
r-l-ele,4Ld F2--,VW I -Z- 7, 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more than $100 from any source during the period)
Complete the Following for the Source of the Loan
First Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance
(Beginning of Period) Received Payments (End of Period)
Last Name/Organization Name
Address Loan Received For: Date of Loan
❑ Primary Election ❑ General Election
City IStale Zip Code
❑ Runoff (Local Elections Only)
List All Endorsers or Guarantors for Above Lcan (If more space is needed please attach a page)
First Name Middle Name First Name Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
City Slate Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
First Name Middle Name First Name Middle Name
Last NamelOrganizatiDn Name Last Name/Organization Name
Address Address
City State Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
7First me Middle Name First Name Middle Name
efOrga nizalion Name Last Name/Organization Name
Address Address
city State Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
First Name Middle Name First Name Middle Nama
Last Name/Organization Name Last Name/Organization Name
Address Address
City State Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
4. Totals for all Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans Loan Outstanding Loan Balance
(rota) bans received should also be shown in item 16. on summary page.) (Beginning of Period Received Payments End aloftriod)
(Total ban payments should also be shown in item 20, on summary page.)
(Total outstanding loan balance should also be shown in item 12.e. on front page.)
Aft
SS-1132 (Rev. 4102) Page of RDA 1159
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMI E 2. REPORT COVERING THE PERIOD
t° J FROM: . 01p,-4_1
Amount
L/ q (\j I 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) do
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totalin more than $100 from an contributor)
First Na-6; MiddleNa Contribution Received For: Amount of Contribution
v-, rcl /c ~j
Last Name/OrganizationN me ❑ Primary Election Y"' General Election 4L41.
dr
Address ❑ Runoff (Local Elections Only)
City i / Sew/, Zit e Date of Contribution Aggregate This Election
Occupation .s/ /
Employer
Fist Name Middle Name Contribution Received For: Amount of Contribution
Last Name/OrganizationName ❑Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
occupation
Employer
Fist Name ~`d"e Name Contribution Received For: Amount of Contribution
Last ganzatwn Nam ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City state Zip Code Date of ContrWion Aggregate This Election
occupation
Fist Name Middle Name Contribution Received For: Amount of CondrWion
Lase NameKkgadzation Name ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
Occupation
Emoop
5. TOTAL ITEMIZED CONTRIBUTIONS
(Carry (orv4vd to aem 3. of next page it addaionat pages of this lorm are used.)
(M this is the last page ol coruribuoorts. this amount must be shown in item 15b. o(summary.)
_ of RDA 1159
A
PaSS-1131(Rev. 2/06)
I `
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
2. REPORT COVERING THE PERIOD
1. NAME OF CANDIDAT OR CO MITT E FROM:7~vZG f 0~
rnoun
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period)
Purpose of Expenditure Amount of Expenditure
First Name Middle Name
Last N us' ess Name
~ J / 0 VI
Address®
CARY S ~j Zip Code
Middle Name Purpose of Expenditure Amount of Expenditure
First Name
Last N stress Name
Addms ~i
city Slate Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NaneBusiness Name
Address
City Stale Zip Code
Middle Name Purpose of Expenditure Amount of Expenditure
First Name
Last Name Business Name
Address
Gy Stale Zip Code
Middle Name Purpose of Expenditure Amount of Expenditure
First Name
Lass NanelBusiness Name
Address
City Stale Zip Code
Middle Name Purpose of Expenditure Amount of Expenditure
First Nave
Last NamelBusiness Name
Address
cy Slate Zip Code
5. TOTAL ITEMIZED EXPENDITURES I,f) ;
(Cary lorwad to item 3. of next page if additional pages of this brm are used.) ~~JJ
(M this is the last page of expenditures. this amount must be shown in item 19b. of summary.)
Page of RDA 1159
SS-1129 (Rev. 4102)
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates -
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE
GereA/_d Clqly?~ f LA- /V~d
3. ELECTION D E
2.b. IF COMMITTEE, NAME OF CANDIDATE
4.a. CAMPAIGN ADDRESS AND PHONE State Zip Code Phone
Street or Rural Route City
you i s l/e 3777 7 13 Z
/T f d e kJ~ f ry C
4.b. CANDIDATE'S HO ADDRESS (if different than 4.a.) State Zip Code Phone
Street or Rural Route City
c R eYf 014R V 3 vi
r.7 OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASUREfj (may be candidate)
IJI.S~I{1C~ I j IN ~ ~
RY Y OR REPORT (Check one)
CATE O
❑ MI EAR YEAR-END
FIRST SECOND THIRD FOURTH PRE-
ENDING DATE OF REPORTING PE SUPPLEMENTAL SUPPLEMENTAL
QUARTER QUARTER QUARTER QUARTER PRIMARY
8.a. BEGINNING DATE OF REPORTING PERIOD
-7- Ig 7" ? £.-i`r
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.
F. 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
b fit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code.
/ date signatur of political treasurer date
signature o candidate
11. AS NATURE
signature of witness date
nature of witness date
8 g
g
r.12 SUMMARY
,
~ • / ~
y................... ~ o
a. BALANCE ON HAND LAST REPORT . $ .3
b. TOTAL RECEIPTS THIS PERIOD Q c_ ^a 26 00
~ -7 l9
c. TOTALDISBURSEMENTSTHIS PERIOD 5.......u1c...... $
d $ //93 30
d. BALANCE ON HAND (12.a. plus 12.b. minus 1 )
8 ~ g 5`1 0
e. TOTAL LOANS OUTSTANDING $
$ O
f. TOTAL OBLIGATIONS OUTSTANDING
SS-1109 (Rev. 2/06) Page 1 of RDA 1159
1
SUMMARY PAGE - CANDIDATE
14. REPORT COVERING THE PERIOD
13. NAME OF CANDIDATE OR COMMITTEE (In Full) LLdc/ FROM:
RECEIPTS
15. CONTRIBUTIONS (other than loans and interest)
X90 0~
a. Unitemized Contributions ($100 or less from each source this period) $
5 0. ~o
b. Itemized Contributions (over $100 from each source this period) $
~ lJ , U
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ sS`7f
16. LOANS RECEIVED THIS REPORTING PERIOD $
17. INTEREST RECEIVED THIS REPORTING PERIOD
$ 2 b =f0. c~d~~
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 category - e.g., printing, postage, gasoline)
l f-AP ie' 1C S $
$
$
$
$
$
$
$
Total of Expenditures ($100 or less each payee) $
y ~
b. Itemized Expenditures (Over $100 each payee this period) $`}q 7S. 79
X551 • S
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.)
22AWKIND 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.) $
FIA-b1i1gatiNons TOS
d Obligations Outstanding ($100 or less each) $ outstanding (Over $100 each) $ v
$ 0
c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.)
Page 2- of
SS-1133 (Rev. 4102)
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
Ld C u FROM: TO:' -2~-I
Amount
3, TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) ~f -.,30
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totaling more than $100 from an contributor
First Name Middle Name Contribution Received For: Amount of Contribution
Tfi v ~yl ~I "
Last Name/Organization Name ❑ Primary Election ❑ General Election 61-00. {r 0
43 1C t,e f'2 '
Address E3 Runoff (Local Elections Only)
,-12- l i,v' 54.
city Ste. Zip Code Date of Contribution Aggregate This Election
'404, l v l /e /,t/ 13 7,7 _7
Occupation ~ 7'~O YC t•
Employer
5 e L
First Name Middle Name Contribution Received For: Amount of Contribution
Last Name/Organization Name ❑ Primary Election 13 General Election SLR 0
_
Address k d. El Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
R v'I 7n/ 37 e3
Occupation - SJL~ J U
Employer
FirstName iddle Name Contribution Received For: Amount of Contribution
P rV ~ ~ k-
as ame rganiza on aTe ❑ Primary Election ❑ General Election
dd
Address ❑ Runoff (Local Elections Only)
City State LpEde Date of Contribution Aggregate This Election
/0 u S v Ile- 1 3.7
- / C L 5 CJ . ~U
Occupation ~J 7
m dyer / + 1
First Name Middle Name ontn ution ecetve or: mount o Contribution
Last Name/Organization Name ❑ Primary Election ❑ General Election
04A_ 4e /000
Address ❑ Runoff (Local Elections Only) 335-4, City State Zi Code Date of Contribution Aggregate This Election
Occupation '7 Z Y - / 4~
Employer L
5. TOTAL ITEMIZED CONTRIBUTIONS
(Carry forward to Item 3. of next page if additional pages of this form are used.) ] ~J
(If this is the last page of contributions, this amount must be shown In item 15b. of summary.)
SS-1131(Rev. 2/06) Page 3 of RDA 1159
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE
2. REPORT COVERING THE PERIOD
1. NAME OF CANDIDATE OR COMMITTEE FROM: TO:
mount
3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) period) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN KIND CONTRIBUTION kind contributions totaling more than $100 from any contributor e of In thend Contribution
Middle Name In-Kind Contribution Received For: Valu-
First Name ❑ Primary Election ❑ General Election
Last Name/OrganizationName ❑ Runoff (Local Elections Only)
Aggregate this Election
Date of In-Kind Contribution
Address
State Zip Code Description of In-Kind Contribution
City Occupation Employer
Value of In-Kind Contribution
Middle Name In-Kind Contribution Received For:
First Name ❑ Primary Election ❑ General Election
Last NamelOrganizationName ❑ Runoff (Local Elections Only)
Aggregate this Election
Date of In-Wrid Contribution
Address
State Zip Code Description of In-Knd Contribution
City
Occupation Employer
Value of In-Kind Contribution
Middle Name In-Kind Contribution Received For:
momm~
First Name ❑ Primary Election ❑ General Election
Last NamelOrganization Name ❑ Runoff (Local Elections Only)
Aggregate this Election
Date of In-Wnd Contribution
Address
State Zip Code Description of InAnd Contribution
city ccupation m Oyer
Value of In-Kind Contribution
Middle Name In-Kind Contribution Received For:
First Name Primary Election ❑ General Election
Last NamelOrganizationName ❑ Runoff (Local Elections Only)
Aggregate this Election
Date of In-Kind Contribution
Address
State Lp Code Description of In-Kind Contribution
City
Occupation Employer
Value of In-Kind Contribution
Middle Name In-Kind Contribution Received For:
First Name ❑ Primary Election ❑ General Election
Last NamelOrganizationName ❑ Runoff (Local Elections Only)
aggregate this Election
Date of In-rind Contribution
Address
State Zip Code Description of In-Knd Contribution
city
ccupa ion m Oyer
5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS
(Carry forward to item 3. of next page if additional pages of this form are used.)
(If this is the last page of in-kind contributions, this amount must be shown in item 22b. of summary.) Page of RDA 1159
SS-1128 (Rev. 2106)
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
' m hJ ~Ll h. FROM: TO: y_ 2 - J
A L d ' mount
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period)
First Name Middle Name Purpose of Expenditure Amount of Expenditure
~~1~1 S ft YvL L v~~ ~..5 U
17,),),4 : ~?P -
. 3
Last Name/Business Name l I N +-e tc
Address ~ 11 ~02 A✓/2 F. 't
road eye Cn v S•i
City State Zip Code
7 -7~ 1% a "
Middle Name Purpose of Expenditure Amount of Expenditure
First Name
rov `~crA 44 s,y~ p r
Last Name/Business Name Z 41 X 4 y -S r g N S r, 4 G/ p
A AFL n • -c-
T ~~S
<'N
~,ixr
Address 400 0 r -f r r✓ a
Y'q v tr?/✓ fR fiu r~ 9Zc~•
City state Zip Code
v u ,'s It 7 7 7
First Name Middle Name Purpose of Expenditure ~y Amount of Expenditure
; g'~x 2 ~ y~ ~
Last Name/Business Name 10
CR Rc~j P ~ V
X 9 n w ~
/y "q Se c 'c 1500 ~
Address /11 A4 f L O~
~fY3c% Srn1 -to,,l 5fi} /r t-' RJ ~7a~ , BANNCI-'S
City State Zip Code X D
L c~c~1s u® lle._ 7 7
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NameBusiness Name
Address
City State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NamelBusiness Name
Address
City state Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address
City State T"cle
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to Item 3. of next page if additional pages of this form are used.) ~y~► j "7 Q
(If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) ~J r/V / l
SS-1129 (Rev. 4102) Page S of RDA 1159
ITEMIZED STATEMENT OF LOANS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
FROM: r-
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more than $100 from any source during the period)
Complete the Following for the Source of the Loan
First Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance
(Beginning of Period) Received Payments (End of Period)
Last Name/Organization Name
Address Loan Received For: Date of Loan
❑ Primary Election ❑ General Election
city State Zip Code
❑ Runoff (Local Elections Only)
List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page)
First Name Middle Name.
rirst Name Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
City State Zip Code city State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
First Name Middle Name First Name
Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
City State Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding ~7 First Name Middle Name First Name Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
City Slate Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
First Name Middle Name First Name Middle Name
Last Name/Organization Name Last Name/Organization Name
Address Address
city State Zip Code City State Zip Code
Amount Guaranteed Outstanding Amount Guaranteed Outstanding
4. Totals for all Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans Loan Outstanding Loan Balance
(Total loans received should also be shown in item 16. on summary page.) (Beginning of Period Received Pa menu End of Period
(Total loan payments should also be shown in item 20. on summary page.)
(Total outstanding loan balance should also be shown in item 12.e, on front page.)
AMIL
SS-1132 (Rev. 4/02) Page f9 of RDA 11159
ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
IV ~A FROM: TO:
3. COMPLETE THE APPROPRIATE ITEMS FOR EA H ITEMIZED Outstanding Balance Debt Incurred Payments Outstanding Balance
OBLIGATION (obligations totaling more than $100 owed to any (Beginning of Period) This Period This Period (End of Period)
person/vendor at the end of the reporting period)
First Name Middle Name
Last NamelBusiness Name
Address
City State Zip Code
Description of Obligation
First Name Middle Name
Last Name /Business Name
Address
City State Zip Code
Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
city State Zip Code
Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
ci y State Zip Code
Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
City State Zip Code
Description of Obligation
4. TOTALS
(Total from Outstanding Balance - (End of Period) column must also be shown
in Item 23b. on summary page.)
Ag"k
SS-1127 (Rev. 4102) Page 7 of RDA 1159
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE) e
"4q /a rv'
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DAT
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
Z Z v t- rt/ . 37777 65 -6
FS I -q,37 2-
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.)
Street or Rural Route City State Zip Code Phone
S ~~e~~ DA c1 ~d « Ile- jZ7 -,2-2
~E y
5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
l~l S tR rr ~ ~
iJ tl YL/ ~ ~ CA" -1c rn
7. CATEGORY OR REPORT (Check one)
FIRST SEND THIRD FOURTH PR - 1:1 PRE- MID- El YEAR YEAR-1:1END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING 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. Ilwe 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 an other nonpolitical purpose as defined by the federal internal revenue code.
7- 7-
signature of candida a date signatur of political treasurer date
11. WITN SS SIGNATURE
signature of witness date signature of witness Ate
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $
b. TOTAL RECEIPTSTHIS PERIOD $ 3 I SG . 00
c. TOTAL DISBURSEMENTS THIS PERIOD $ 1~U
d. BALANCE ON HAND 12.a. plus 12.b. minus 12.c. $ J G'~Jl~c~ ! D
e. TOTAL LOANS OUTSTANDING $ 0
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2106) Page 1 of 7 RDA 1159
SUMMARY PAGE - CANDIDATE
13. NAME OF CANDIDATE OR COMMITTEE (In Full) . 14. REPORT COVERING THE PERIOD
ku/V'Q FROM: TO:
RECEIPTS
15. CONTRIBUTIONS (other than loans and interest) 4&'~ 0
a. Unitemized Contributions ($100 or less from each source this period) $
b. Itemized Contributions (over $100 from each source this period) $ 16"0U
~J
C. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $
16. LOANS RECEIVED THIS REPORTING PERIOD $ G
17. INTEREST RECEIVED THIS REPORTING PERIOD $
3
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 category - e.g., printing, postage, gasoline)
('net, e S t'~l /V7 e e'c--r $ Lf 3 7L)
/Yl~~z'~.,JS l2oo.n - ~D~iScil ll~ i ~~>►v ?-~:4ri$ ~ f~.a~
$
$
$
$
$
Total of Expenditures ($100 or less each payee) $ q 3.
b. Itemized Expenditures (Over $100 each payee this period) $ C')
C. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $
20. LOAN REPAYMENTS MADE THIS PERIOD $ U
3
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.) $ U
0 SS-1133 (Rev. 4102) Page Y of 7
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
2. REPORT COVERING THE PERIOD
1. NAME OF CANDIDATE OR COMMITTEE ~ ! T0: ~
FROM: /
e~ ~Lc~ Amount
3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totaling more than $100 from an contributor Amount of Contribution
Middle Name Contribution Received For:
First Name
❑ Primary Election ❑ General Election
Last Name/Organization Name
❑ Runoff (Local Elections Only)
Address
Date of Contribution Aggregate This Election
City State Zip Code
Occupation
Employer
Contribution Received For: Amount of Contribution
First Name Middle Name
/I/`( E' { ❑ Primary Election General Election s~ C)
Last Name/Orga ation N.me
L-f + n
❑ Runoff (Local Elections Only)
Address - -
l 3~
Date of Contribution Aggregate This Election
City State Zip Code
v fle 4f
Occupation
~~,E lr~~d
Employer
Contribution Received For: Amount of Contribution
First Name fiddle Name
~ k'111 ~ C) C>
El Primary Election ~3eneral Election 1 6 L) 6 .
Last NamelOrganiz
to s ❑ Runoff (Local Elections Only)
Address _ f W ~ >
city stagy Zip Code Date of Contribution Aggregate This Election
49a 5us'll•e Irv 3- ~,-Z3 _I`t
Occupation
S..0 I - in ~c6
mp Dyer
Middle Name Contribution Received For: Amount o ontrlbution
First Name
Last Namelorganization Name ❑ Primary Election ❑ General Election
❑ Runoff (Local Elections Only)
Address
State Zip Code Date of Contribution Aggregate This Election
City
Occupation
Employer
5. TOTAL ITEMIZED CONTRIBUTIONS
(Carty forward to item 3. of next page if addit onal pages of this form are used.)
(If this is the last page of contributions, this amount must be shown in item 15b. of summary.) (D
Page ~ of ' RDA 1159
SS-1131(Rev. 2106)
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NAME OF CANDIDATE OR QOMMITTEE 2. REPORT COVERING THE PERIOD
a / ~G( h/ FROM: - /T0: _ _
mount
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period)
First Name Middle Name Purpose of Expenditure Amount of Expenditure
(vPi`~ -Pei I.,,-
Last Name/Business Name ~ K e. ( (J Q
/ e S~ j'Yl e e t `f' - 1
Address
City State Zip Code
Try 3':7
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name , R" t ff L ry
~GulSLi (r!1~ ,Jt,Jl1~ /q~L Merf rye,
1Zooht g
Address -
36-2k) il/E C,k el,
City State Zip Code
40CkiS~'~ lj 7nil 7777
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address
City State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NamelBusiness Name
Address
city State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last NamelBusiness Name
Address
City State Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address
city state Zip Code
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to Item 3. of next page If additional pages of this form are used.) Cy
(If this is the last page of expenditures, this amount must be shown in item 19b. of summary.)
SS-1129 (Rev. 4102) Page of RDA 1159
SCANNED
IMMMEM
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 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:
Nit.
4. Campaign Address and Phone: City State Zip Code Phone
~Zzo %L X777 37Z-
5. Home Address and Phon (if different than item 4 above): City State Zip Code Phone
5 Co Sca r le 1-I-cf,s R u Ile 7tJ 3 Aga I ~i g ~I 38~~
5. Office Sought (include district number, if applicable) 7. Party Affliation 8. Election Year
C?A~ 4 I ,
Irl~"~ " 1(~ 2 D 1
(641) SS (U °2 l-r
9. Treasurer Name: 10. Treasurer e-mail address:
11. Treasurer Address and Phone: City State Zip Code Phone
g-& 7
Z J !~G iq tr'i'te: r~`. G-LC1 /SL l'L, 77L' Dr / J / Z
12. Candidate and Treasur r Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
P. 4
Signature of Candi a gnature of Treasurer
Si a re of Witn s nature of it ss
Registry of Election Finance 4- " r'eo(ed dr (oil to/14
SS-1120 (rev 1012010)
~Ar
FINANCIAL ()ISCLOSURE STATEMENT EXEMPTION
Pursuant to TCA § 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:
~ yk~ 1 / 55rfC'~~ 5 eAY~
Candidates Position: C
Residential Address: A(~-- /e7l G A ks T~
City: map-(j r/ r //r State: TN Zip: 3 1 °
I hereby state that I meet the above qualifications for exemption and am
therefore exempt from filing financial disclosure statements.
Candidates 5' ature Date
it ss'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.
JUiv 13 101 ~ 4 >
N
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 of Candidate or Committee: 3. Candidate e-mail address:
A1-3 6:~I# ~ • ~ r b K>irkYCco'4/ol@19TT. /1/e
4. Campaign Address and Phone: City State Zip Code Phone
5. Home Address and Phone (if different than item 4 above): City State Zip Code Phone
saw e,
6. ice 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
.5
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
1712
Fj6z
Signature of Candidate Signature of Treasurer
d~
Signature of Witness Signature I ness
RECEIV D
0 Registry of Election Finance `BLOS STX0Uim
SS-1120 (rev 10/2010) 9LECTION
Wd Z! ll 0~
FINANCIAL DISCLOSURE STATEMENT EXEMPTION
Pursuant to TCA § 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: LJ i° ~''q /C/ 4
Candidate's Position: S~0
Residential Address: A
City: A 11,Y / State: TN Zip:
I hereby state that I meet the above qualifications for exemption and am
therefore exempt from filing financial disclosure statements.
a,,,_kfA/
Candidate's Sig Date
Witness's Signatur Date
If my plans change and I realize I will spend more than $1,000 on ~Ivc aron q~n, I
will immediately make a financial disclosure report.
"Ec, IVED
DEC 0 9 201?
F'J
AM, 'W
Wy Z~ Ll 0~ 6 0