Samples, Steve
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE / DECEIVED
" 2~1 S S
scu',j 31
2.b. IF CO MI E, NAME OF CANDIDATE 3. ELECTION Dill
tfi 13LOUNTCOUMY
Wa':
SIXAMN
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code r_'Phone
j-L'7 arY CC w a
4.b. CANDIDATE'S HOME ADDRESS (if different th n 4.a.)
Street or Ri I Route City tate Zip Code Phon
mawl'y'llp VI _ ~
5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
~j . ' i 4 ~*A .Sa 5
7. CATEGOR OR REPORT (Check one
FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
l 1 rw_
9. (Check one)
a. WThis 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. 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
Finan ' I Disclosure Act. Additionally, I/we swear or affirm that no campaign contribution ave been expended for the personal financial
bene t f th a idate or for any other nonpolitical purpose as defined by the federal in al revenue code.
713 /4 '7131a4.
signature of candidate date signature of political treasurer date
11. WITNESS SIGNATURE
13122110 ? 3 ?~16
signature of witness date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $
b. TOTAL RECEIPTS THIS PERIOD $
c. TOTAL DISBURSEMENTS THIS PERIOD $
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ ✓I ~i
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2/06) Page 1 of 4__ 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
,'u~ -7 2a~~ S~_xve S
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.)
Street or Rural Route City State Zip Code Phone
b~~5-~~~ 6238'
W7 ~~rlyylolde marvoille -r 37&)q
5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
urv M,,ssib 3 5~+A S ee l~s
7. CA IVORY OR REPORT (Check one) El E3
FIRST SECOND THIRD FOURTH PRE- PRE- MI -Y AR YEAR❑-E
ND
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
S.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
An ~1~ j01~ Jury 307-
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. 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 o he candidate or for any other nonpolitical purpose as defined by the federal int al revenue code.
7 ZD tS
signature o didate date signature of politics treasurer date
11. WITNES SIGNATURE
3~1 7 .•1
signature of witness date signature of witness date
12. SUMMARY G~
a. BALANCE ON HAND LAST REPORT $ l~ t 1
-0
b. TOTAL RECEIPTS THIS PERIOD $
c. TOTAL DISBURSEMENTS THIS PERIOD $ rD
d. BALANCE ON HAND 12.a. plus 12.b. minus 12.c. $
e. TOTAL LOANS OUTSTANDING .R
. .....Z.GeII% $ y
JUL - 8 L_-)....................... f. TOTAL OBLIGATIONS OUTSTANDING
4~6noN N
SS-1109 (Rev. 2/06) Page 1 of RDA 1159
bit ~Wd
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDATE O COMMITTEE
ja-1 r 1 26 f S I S c° ca. vn (L° S
2.b. IF COMMI EE, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE State Zip Code Phone
Street or Rural Route City
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) State Zip Code Phone
Street or Rur I oute City
/a /7 rin e ar l VV
6. NAME OF POLITICAL TREASURER (may bcandidate)
5. OFFICE SOUGHT (include district number, if applicable)
n 5+ 5 1/~
G OR REPORT (Chec one) ❑ 1:1
7*RCYA
FIRST SECOND ❑ THIRD FOURTH PRE- PRE- MIDYEAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PBRIIMAERNDING DATE OF RE REPORTING PE SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD
ber ~ 2G~ an ua 1.5 ~D ~
9. (Check one)
a. [Q~ 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. [/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 contri lions have been expended for the personal financial
b fit of the candidate or for any other nonpolitical purpose as defined by the fe ra internal revenue code.
gaure of candidate date sdate
11. WITNE IGNATURE
date signature of witness date
signature of witness
12. SUMMARY
$
a. BALANCE ON HAND LAST REPORT
~0 s
b. TOTAL RECEIPTS THIS PERIOD $
c. TOTAL DISBURSEMENTS THIS PERIOD
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.)
e. TOTAL LOANS OUTSTANDING $ b
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2/06) Page 1 of 4- RDA 1159
i
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
[2.b. ATE OF REPORT 12.a. NAME OF CANDIDATE OR COMMITTEE
j fevv Sam
• 3. ELECTION DATE
IF COMMITTEE, NAME OF CANDIDATE
4.a. CAMPAIGN ADDRESS AND PHONE State Zip Code Phone
Street or Rural oute City
elr, ~I a78v~ g4~-(Z.38
4.b. CANDIDATE'S HOME ADDRESS (if different tha 4.a.) State Zip Code Phone
Street or Rural Route City
5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may bcandidate)
s am
7. CATE ORY OR REPORT (Che one) ❑ ❑ ❑ ❑ ❑
PRE- MID-YEAR YEAR-END
FIRST SECOND THIRD FOURTH PRE
QUARTER QUARTER QUARTER QUARTER PgRIIMAERNDING DATE OF REPORTING PER EMENTAL SUPPLEMENTAL
51
8.a. BEGINNING DATE OF REPORTING PERIOD e~ 3 Q a l i+
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. 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
Fina ial Disclosure Act. Additionally, Itwe swear or affirm that no campaign contributions ve been expended for the personal financial
ben it of didate or r any other nonpolitical purpose as defined by the federal int reven ode.
td S 1 ~O~S-1
date signature of political treasurer date
signature of candidate
11. WITNESS SIGNATURE I-; I I
~J signature of witness date
signature of witness tlate
12. SUMMARY " ~a t
a. BALANCE ON HAND LAST REPORT $
b. TOTAL RECEIPTS THIS PERIOD $
c. TOTAL DISBURSEMENTS THIS PERIOD $
J
$ 5
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.)
$
e. TOTAL LOANS OUTSTANDING
04
a
f. TOTALOBLIGATIONSOUTSTANDING $
Page 1 of J_ RDA 1159
SS-1109 (Rev. 2106)
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE
2 614 I C1 . e Sarre ~s
2.b. IF C MMITTE ,NAME OF CANDIDATE
3. ELECTION DATE
7j ~D
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
/217 ~ 7a v1Ik TN 3780 M16- ,gifZ/
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.)
Street or Rural Route City State Zip Code Phone
5 OFFICE OUGHT (include dis ict number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
uN t~"~uss~"' is 3 SeaE A e Sa des
ATE ORYORREPORT( heck one)
FIRST SECOND THI0D FOURTH 7}l 0 PRE- PRE- MIDYEAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
.~T 1111 "I'll' ! 201 2 g 26
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. 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
Financi isclosure Act. Additionally, I/we swear or affirm that no campaign contributio ave been expended for the personal financial
benef h can i to or for any other nonpolitical purpose as defined by the federal i e a e code.
7
signature of candidate date signature of political treasurer
date
11. WIT SS SIG TURE
r-
1 7 2y ! N _ 7
signature of witness date signature of witness i y
dat
r13A CE ON HAND LA ST REPORT ~O RECEIVE a
$ 3 .35
JUL 2 9 2014
b. TOTAL RECEIPTS THIS PERIOD M I y
$
4fl t~Tl•
c. TOTAL DISBURSEMENTS THIS PERIOD
B E O N ...,,1:' Q
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) .................Wd ZI lV 3! 35
$
e. TOTAL LOANS OUTSTANDING Q
$
f. TOTAL OBLIGATIONS OUTSTANDING
$
SS-1109 (Rev. 2/06) f
Page 1 of / RDA 1159
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REP T 2.a. NAME OF CANDIDATE OR COMMITTEE
ui x.01 S J 7 s
2.b. IF COM TTEE, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rur I Route City State Zip Code Phone
i rldKi aw 1/ 65 ~G- )95e
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.)
Street or Rural Route City State Zip Code Phone
I
5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
' 74 Sbeqe 5a (tom
❑ ❑ ❑ ❑ ❑
7. CATEGORY OR REPORT (Check one)
FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END
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. [~f 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. Uwe 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
Finan6pl, Disclosure Act. Additionally, Itwe swear or affirm that no campaign contribution v n expended for the personal financial
benefi a can i r for any other nonpolitical purpose as defined by the federal in er reve code.
7 7-`
signature of candidate date signature of political treasurer date
11. WITNE TURE
L
-71/La
signature of witness dat signature of witness da e
12. SUMMARY C~
a. BALANCE ON HAND LAST REPORT $ ` 2S
b. TOTAL RECEIPTS THIS PERIOD !J►/ . Uo
6A
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 $
SS-1109 (Rev. 2106) Page 1 of RDA 1159
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAME OF A DIDATE 0~'OnMMITTE A]FROMV~Zj-jq- RT COVERING THE PERIOD
TO:J,
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 any contributor)
First Name`, Middle Name Contribution Received For: Amount of Contribution
Last Name/O izationNa a Primary Election El General Election
~dm__~3z ❑ Runoff (Local Elections Only)
Cdy Ma y u 1 i t(; State A Z Code Dale of Contribution Aggregate This Election
occupation
Employer J'~7!
First Na.~V Middle Name Contribution Received For: Amount of Contribution
Last Namnizatiioon Name nmary Election 1:1 General Election
q?v , , t)
Address ❑ Runoff (Local Elections Only)
121 yr 0r-
city Stet!,L , Zip Code Date of Contribution Aggregate This Election
Mdni'mov 17AJ A7 96
,patien -rU p~,duC1~,~
Employer
First Name iddie Name Contribution Received For: Amount of Contribution
fvr&c
s am an a n am ❑ Primary Election ❑ General Election
07~ 6r) ess ~viduala vll
Address ❑ Runoff (Local Elections Only)
City State Zip Code Date of Contribution Aggregate This Election
Occupation
Employer
First Name Middle Name Contribution eceive For. mount of Contribution
Last Name/Organization Name ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections only)
city State Zip Code Date of Contribution Aggregate This Election
Occupation
Employer
5. TOTAL ITEMIZED CONTRIBUTIONS 'ZDD1
(Carry forward to item 3. of next page if additional pages of this form are used.)
(If this Is the last page of contributions, this amount must be shown in Rem 15b. of summary.)
SS-1131(Rev. 2106) Page of RDA 1169
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NAME OF DIDATE 0 MMITTEE 2. REPORT COVWE. RING THE ERIO
a?te IYn ~5 FROM L7 / TO:oblyll2l
mou t
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
Last NameB siness N V I 9
Address I ffakp~jc butt City k SN taLp Zi Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last /Business Name . ,
X AW& i%Itj1,/v~ cor- 90
Address /
ol 1640
City 6(/U/ ,u d is l State _ Z a7ip-7Code
-7~
First Name N Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address
GAY State Zip Code
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 Name/Business Name
Address
City state Zip Code
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address
Gty State Zip Code
5. TOTAL ITEMIZED EXPENDITURES /
(Carry forward to Item 3. of next page If additional pages of this form are used.)
(If this is the last page of expenditures, this amount must be shown in item 19b, of summary.)
AWL
SS-1129 (Rev. 4/02) Page of RDA 1159
1
~ . i
ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE
1. NAME OF I+TR C TTEE 2. REPORT COVERING THE PERIOD
T
~`C/V~ YYV FROM: `Z I T0: --&J
3. COMPLETE THE APPROPRIATE ITEMS FOR EACH 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 Name/Business Name
1 1A Z16
Address tj U I -
e Zip Code
City
Description of Obligation
First Name ddle Same
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
city State Zip Code
Description of Obligation
First Name Middle Name
Last NamelBusiness 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.)
AWL
SS-1127 (Rev. 4102) Page of RDA 1159
1
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 12.a. NAME OF CANDIDATE OR COMMA EE C
_41 eve -
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
/
4.a. CAMPAIGN ADDRESS AND PHONE State Zip Code (p Phone
Street or ural Route City
!2~ ax 71v ~784~ G 0
4.b. CANDIDATE'S HOME ADDRESS (if different tha 4.a.) State Zip Code Phone
Street or Rural Route City
5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
7. CATEGOR OR REP RT (Check one) ❑ ❑
FIRST SECOND THIRD FOURTH PRE-
GENERAL SUPPLEMENTAL SUPPLEMENTAL
QUARTER QUARTER UARTER QUARTER PRIMARY
ENDING DATE NE REPORTING PERIOD
8.a. BEGINNING 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. 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 isclosure Act. Additionally, I/we swear or affirm that no campaign contributio ve been expended for the personal financial
benefit th or for any other nonpolitical purpose as defined by the federal i ern I e code. 40m date signature of litical signature o candidate treasurer date 11.r WITNESS GNATURE
• y ~ u C412.16
da
signature of witness date signature of witness
12. SUMMARY L\
a. BALANCE ON HAND LAST REPORT E C E I V t..................................... $ ~'~3,
b. TOTAL RECEIPTSTHIS PERIOD $
c. TOTAL DISBURSEMENTSTHIS PERIOD
3l
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)
ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
S+-ev e, " IVl (66 FROM: • .l (y TO: 4-;gk yif
nt ~r
3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 K first itemized page) l~
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION con6rbulions totaling more than $100 from a contritw6or
Ftat Name Kiddie Name Corvbb Aori Received For. Amount of Contribution
,eve-
Last NameKkgw iz0w Name I!7 Primary Election ❑ General Election
Address .r ❑ Runoff (Local Elections Only)
y v Stale zw311s3 Date of Contribution Aggregate This Election
t !S4
Ooapabon 21 /y
En,pfoyu
FAName rR~/~ WdSeNam C,onnttdbbuUon Received For. Amount of Conlrbution
Less Nana/Oryantmtion Name primary Election ❑ General Election
14 futmo
❑ Runoff (Local Elections Only)
_.a 1 T (f ~1T2~
Cky vIClg stare ,Ll Immi Date of Contrb" Aggregate This Election
Fast Name Name Conbibutiori Received For. Amount of Coatrbubon
LxdKsMwjwanMww ~m ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Eledions Orly)
Cxy Staia ap Code Date of Contnbution Aggregate This Election
First Name fiddle Name or Amount 0 Contribbulion
L sM Nam 0garizabw Name ❑ Primary Election ❑ General Election
Address ❑ Runoff (Local Elections Only)
City Stale Zip Code Date of Contribution Aggregate This Election
Ocarpation
Enpbyer
5. TOTAL ITEMIZED CONTRIBUTIONS
(Cony brwerd b Nam 3. of next page Nsd&UwW pages of form are used.)
(Y this is ft last pope d wftubom. ft enwu t must be dmn in Nom 15b. of summary.)
SS-1131(Rev. 2106) Page 2 of 3 RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE
1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD
it--T FROM4 / TO: -2
Amount
3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) , -G
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expeodibues baling more than $100 b any payee durinG the period)
First Name Mddte N Purpose of Expenditure Amount of Expenditure
Lost NamelB Name )91L V
Adl-
19z R v" E s v 7 Ord 1
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Las, R X /0#IL S6cil/
Address
N le~c,r, d.
State zip Code
46ulsv! l! IV X7777
First Name Mddle Name Purpose of Expendhn Amount of Expenditure
Las, NarneBusiness Name
Address
ay State zip code
Fast Name MiMe Name Purpose of Expenditure Amount of Expendture
Lost NarnalBusiness Name
Address
ay Stale z'p Code
First Name IRddle Name Purpose of Expenditure Amount of Exper ddure
last NameBusiness Name
Address
ay State zip Code
First Name kiddie Name Purpose of Expenditure Amount of Expenditure
Last Na nelBusiness Name
Address
ay Sure zip Code
=TOTAL MIZED EXPENDITURES t /y
'~J D
ilam 3. d next page d additional pages at Ws,omr are used.I
pap of axWd e. this amount ffW be shown ir,Nam,9t.of ,m,.)
88-1129 (Rev. 4102) Page of RDA 1159
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT / 12.a. NAME OF CANDIDATE OR COMMITTEE
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
!2 / 7 t'(AV10.4, at'd e. MA v 7A) Vfo `f i?gg42t~g-
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.)
Street or Rural Route City State Zip Code Phone
5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
RUI.4sSl 36- .~~Gli`2 sdo»
7. CAT G9RY OR REPORT (Check one) ❑ El ❑ 1:1 El
FIRST SECOND THIRD FOURTH PRE PRE- MID-YEAR YEAR-END
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. 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
benefi f the candidate or for any other nonpolitical purpose as defined by the fed I &a ue code.
h&- (04
signature of ndidate date signature o political treasurer date
11. WITNESS SIGNATURE r
L-4- N 7 l~~ 4- 7 - I
signature of witness date signature of witness date
12. SUMMARY , 01
a. BALANCE ON HAND LAST REPORT $ (D
b. TOTAL RECEIPTSTHIS PERIOD q5h 60
(O y I A S
c. TOTAL DISBURSEMENTS THIS PERIOD $
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ 143t t 65-
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $
l4b SSA109 (Rev. 2/06) Page 1 of RDA 1159
J
--~EiVEp
APR U 7 701
FINANCIAL DISCLOSURE STATEMENT EXEMPTION
Pursuant to TCA 5 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:
~a m ~ s
L
Candidates Name: U
Candidates Position 1 .r
Residential Address: '2- 1 '7 I V1 nn
City: hrVA uL 1 It - State: TN Zip: V
I hereby state that I meet the above qualifications for exemption and am
therefore exe t from filing financial disclosure statements.
Ca idate s Signature Date
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.
CAMPAIGN FINANCIAL DISCLOSURE ST4TEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE
in. 3t, 201 + S n~ I~es
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route city state Zip Code Phone
12(7 16rtna Ctrde- Ma uille -rK 37#6q,
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.)
Street or Rural Route City State Zip Code Phone
5. OFFICE SOUGHT (include district number, If applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
lk ~'f c9i~e S ~4
ba Co 194w a s#*
7. CATEGORY OR REPORT (Check one)❑ ❑ ❑ ❑ ❑
FIRST SECOND THEM FOURTH PRE- PRE- MID-YEAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL. SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
Tune 3020 3 Ta r► . 31) 201
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. Uwe 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 candidate committee by the Campaign
Fina Disclosure AcL Additionally, Vwe swear or affirm that no campaign contributionsiftake been expended for the personal financial
benefi f to or for any other nonpolitical purpose as defined by the federal int ma
.1/31//4' hr(N
signature of ndidate date signature of pol' ' 1 treasurer date
11. WITNESS ;S NATURE
~ , Ta (lip
signature of witness date signature of witness date
12. SUMMARY 'r
`t~y
a. BALANCE ON HAND LAST REPORT $
b. TOTALRECEIPTSTHISPERIOD ................................................................................................3
c. TOTAL DISBURSEMENTS THIS PERIOD ...................................................................................3
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) 3 3% e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2/06) Pape 1 of / RDA 1159
I
r..
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:
4. Campaign Address and Phone: City State Zip Code Phone
/9,/7 ffak7lm Ov- ally J-Mv~ 11V " ~
Y
5. Home Address and Phone (if different than item 4 above): City State Zip Code Phone
64 M
6. Office Sought (include district number, if applicable) 7. Party Affliation 8. Election Year
~~v+wv~rr~ ~ ti
9. Treasur r Name: 10. Treasurer e-mail address:
v~ Shc~'~ fz°S LOs Q~ j
11. Treasurer Address and Phone: City State Zip Code Phone
r ~ ~rl rti gay 7
12. Candidat a d Treasurer Signature (both signatures must be witnessed. Treasure n not witness candidate's signature):
*Signatureloo Candidate Signature of Treasurer
Signature of Witness Signature of Witness
f VE, Registry of Election Finance l
SS-1120 (rev 10/2010) a ~'~T 3 ~Ojj v
f~01 5`;~
D\~~O
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT ti
For State and Local Candidates f~a
For Single-Candidate Committees
I
1. DA L RE I T 16 1.3 2.8. NAME OF CANDIDATE OR COMM(I I EE
2.b. IF COMMITTEE.-NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Ru 1 oute State Zip Code Phone
I NA CW_(j1a6 Q
4.b. CANDIDATE'S HOME ADDRESS (if different than .a.)
Street or Rural Route City State Zip Code Phone
5 OFFICES LIGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
A r bN~~ `JQ
MW 0
7. CATS RY OR REPORT (Check one)
IV 1:1 FIRST SECOND ~ Fin.{ PRE. P❑RE. MI ❑YEAR YEAR-END
QUARTER QUARTER PRIMARY GENFJZAI_ SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
j2 /(0 W3 = 3' 0 J
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 fide 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. Uwe 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 Dis ure Act Additionally, Uwe swear or affirm that no campaign contributions have been expended for the personal financial
benefi a to or for any other nonpolitical purpose as defined by the federal internal venue code.
1.13 ~-«_44?
signature of candidate date signature of political treasurer date
11. SS TURE
signature of witness date signature of witness date
12. SUMMARY ~e 6a
a. BALANCE ON HAND LAST REPORT $
b. TOTALRECEIPTS THIS PERIOD ................................................................................................3
c. TOTAL DISBURSEMENTS THIS PERIOD ...................................................................................3
d. BALANCE ON HAND (12.8. plus 12.b. minus 12.c.)
e. TOTAL LOANS OUTSTANDING $
Lt. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2106) Page 1 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
TA 2 3 2D t S Sc~ ~~S
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route city state Zip Code Phone
1 `,2 /.7 14 lr`~' 11t k fft,~ 179,J y W_~ ~
41. CANDIDATE'S HOME ADDRESS (if different than 4.8.)
Street or Rural Route City State Zip Code Phone
5. OFFICE SOUGHT (indude district number. If applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
7. CATEGORY OR REPORT (Check one) ❑ ❑ ❑ ❑
FIRST SECOND (THIRD' FOURTH PRE PRE- MID-YEAR YEAR-END
QUARTER WARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
B.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
-2L
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. Uwe 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, Uwe swear or affirn that no campaign contributions he expended for the personal financial
bene of the candidate or for any other nonpolitical purpose as defined by the federal Inte code.
i.2 V z ~ J ,3
signatur candidate date signature o dice treasurer date
11. WITNESS IGNAIURE
W11__ 23 N;bj 13
signature of witness date signature of witness
date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $ b. TOTALRECEIPTS THIS PERIOD ................................................................................................3
-6
c. TOTAL DISBURSEMENTS THIS PERIOD ...................................................................................3
d. BALANCE ON HAND 12.a. plus 12.b. minus 12.c. w
e. TOTAL LOANS OUTSTANDING $ G/
I. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2/06) Page 1 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
UU L 1., z O l 2 5 tee -so m LS
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
17-1-1 K01M Cir- MaND) I If, 71U 37f~64 965-V -6238
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.)
Street or Rural Route city state Zip Code Phone
5. OFFICE SOUGHT (include district number. If applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
U l bi5-T 30 Seat 14 Ste~reSaMP~s
7. CATEGORY OR REPORT (Check one)
FIRST SECOND THFID FOURTH PRE- P❑RE- MI YEAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
j"a h I6 01 Zane 3,0 ab 1 a
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. Itwe 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
Fnnancia Disclosure Act. Additionally, Uwe swear or affirm that no campaign contributions ve been expended for the personal financial
benefit a
as defined by the federal int I revenue code. +
A 6 1 ~t to or for any other nonpolitical purpose
Fl 1~Iw 14-12,
signature of caate date signature o treasurer date
11. WITNES IGNATURE
)J) to
signature of witness date signature of witness date
~ti t ,A
12. SUMMARY
a. BALANCE ON HAND LAST REPORT
b. TOTALRECEIPTSTHISPERIOD ...............................................r........... Jl.)L..L.I~.
c. TOTAL DISBURSEMENTS THIS PERIOD .~•:"~I yl'...
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $
a. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $ r Q
AfflMik
SS-1109 (Rev. 2106) Page 1 of RDA 1159
'OOV
r '
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE
r;W 23, P16 5 E tv
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.)
Street or Rural Route City State Zip Code Phone
5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
COOK' GAIA0510) 0156_1J i SC~v'e . 1>° S
7. CATEGORY OR REPORT (Check one) Lyf~
MIDYEAR YEAR-END
FIRST SECOND THIRD FOURTH P❑REL PRE- ❑
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
3'uI 1 tl 3-aki I ~y Gr
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. 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
Fnan ial Disclosure Act. Additionally, Uwe swear or affirm that no campaign contributio have been expended for the personal financial
bene t f the candidate or for any other nonpolitical purpose as defined by the federal ' t mal revenue code.
I ~Z3 l2 1- Z3 )Z.
signature of ca idate date signature of political treasurer date
11. WITNESS SIGNATURE
t~-
signature of witness date signature of witness date
12. SUMMARY J
a. BALANCE ON HAND LAST REPORT $ J CSC
b. TOTALRECEIPTSTHIS PERIOD
L=~
c. TOTALDISBURSEMENTS THIS PERIOD
( )
d. BALANCE ON HAND 12.a. plus 12.b. minus 12.c.
e. TOTAL LOANS OUTSTANDING $ .
L
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2/06) Page I of RDA 1159
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Caindidate Committees
1. DATE OFRiPORT 2.a. NAMEOFCANDIDATEORCOMMITTEE
D 2,411
Sams
,Tul 2.b. IF COMMI E, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route city state Zip Code Phone
1'Q1-7 Agmy Ga.'L6
4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.
Street or Rural Route City State Zip Code Phone
5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
,Gkpt"3 S
7. CATEGORY OR REPORT(Check
one)
SECOND T HM FOURTH ~ ~ MID-YEAR YEAR-END
FIRST
QUARTER QUARTER TER QUARTER PPRIMARY GENERAL SLIPPLEMEM
8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATEOFREPORTINGPERIOD
,16INI( Sol 4Q6
9. (Check one)
a. (This campaign Is exempt from detailed disclosure because contributions (including in4drid) 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 in4dnd) 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
Fina I Disclosure AcL Additionally, uwe swear or affirm that no campaign contributions have been expended for the personal financial
fit ate or for any other nonpolitical purpose as defined by the federal internal revenue code.
sign fe ' to date signature of political treasurer date
11. WITH URE
signture of witness date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $ :3q • 00
b. TOTALRECEIPTSTHISPERIOD ...~ZA.... .,3...s......................$ D
c. TOTALDISBURSEMENTSTHISPERIOD fob................. $
R~G ~g . (
d. BALANCE ON HAND (12.a. plus 12.b. minus 12. $ 4• •
Q~ = O
e. TOTAL LOANS OUTSTANDING ........c; $
17
S
f. TOTALOBLIGAMONSOUTSTANDING .Z..1..Wd.............................................................$
SS 1109 (Rev. 2108) Page 1 of RDA 1159
4:
Z
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1 • DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE
2.b. IF COMMITTEE, NAME OF CANDIDATE j
3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City
~ KraK/N~4 U ~ State Zip Code Phone
f~ MR KY) WA) 37& 41- 64 9 S~GL'3
4.b. CANDIDATE'S HOME ADDRESS (if different than 4".a..)
Street or Rural Route City
State Zip Code Phone
5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate)
CUr~>v
1 T Cv~►scc u>J ~(s-~ -14 5'C-~„ ► l~ s
7. CATEGORY OR REPORT (Check one)
~
SECOND THIRD F ~TH PRE- ~ MID YEAR
FIRST ❑ YEAR-END
DARTER QUARTER QUARTER DARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a. BEGINNING DATE OFREPORTING PERIOD 8.b. ENDINGDATEOFREPORTINGPERIOD
3'u IV I .26 t l i-ah~ !~S_.
9. (Check one)?("(a
a. EN 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. Uwe 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
Finan ial Disclosure Act. Additionally, I/we swear or affirm that no campaign contnbutio have been expended for the personal financial
t f the candi
bene date or for any other nonpolitical purpose as defined by the federal ' t mal revenue code.
~ ~23 l2 j_ z3 ~Z
signature of ca idate date
signature of polifical treasurer date
11.'WIIT,N,ESS SIGNATURE
signature of witness
date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $ 3
~ ~+G!
b. TOTALRECEIPTSTHISPERIOD
c. TOTALDISBURSEMENTS THIS PERIOD L y
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.)
e. TOTAL LOANS OUTSTANDING t~
f. TOTAL OBLIGATIONS OUTSTANDING
AM,
EMI SS-1109 (Rev. 2106)
Page 1 of j RDA 1159