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Carter, Sr., Shawn CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. NAME FFANDIDATE OR COMMITT E si it 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECT ON DATE /O 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 721/ 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) 7. C EGORY 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. 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. 1/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 ernal r venu code t benefit of the candidate or fo any other nonpolitical purpose as defined by th2: J" e" ~ ~ q- 23 -1K signature of candidate date signature of political treasurer date WITNESS SIGNATURE LV--, I -)3-~~ 1 - signature of witness date signature of witness date 12. SUMMARY J eil a. BALANCE ON HAND LAST REPORT $ oy b. TOTAL RECEIPTS THIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD $ `a • 7& d. BALANCE ON HAND 12.a. plus 12.b. minus 12.c. $ Lao. Z4. e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING ~18 ~110N SS-1109 (Rev. 2106) Page 1 of RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR CQMMITTEE In Full) / 14. REPORT COVERING THE PERIOD I~ FROM: T0: RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) $ ZOC2 c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 16. LOANS RECEIVED THIS REPORTING PERIOD $ 17. INTEREST RECEIVED THIS REPORTING PERIOD $ 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ / aC7 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) ~fEjlqe/inNyi4 m&i lei-I $ 3 , 00 L4 4 lef $ l/ "AW Std ,D $ 30-00 SA 04 a~ SS4~4~yy $ 33~r. S-0 1 $ 3y,~ $ 7s do $ $ Total of Expenditures ($100 or less each payee) $ roa 5 1, b. Itemized Expenditures (Over $100 each payee this period) $ fP c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 1O(f. 20. LOAN REPAYMENTS MADE THIS PERIOD $ 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ y~~•? 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 121.) $ SS-1133 (Rev. 4102) Page of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CAN IDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD S FROM: TO: 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 First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election S J /000, c~ Address ❑ Runoff (Local Elections Only) 5-121 City St~(e Zip Code Date of Contribution Aggregate This Election 1,,4/ 7`/.i Occupation Employer First Name Middle Name Contribution Received For: Amount 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 First Name iddle Name Contribution Received For: Amount of Contribution as ame rganiza on Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name Middle Name Contribution Received or: 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 (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 item 151b. of summary.) SS-1131(Rev. 2/06) Page of RDA 1159 . L DISCLOSURE STA For State TEMENT ~ CAMPAIGN FINANC and Local Candidates For Single-Candidate Committees 2.a. NAME OF CDATE OR C OMMITT S DATE OF REPORT I !77 w„ r P/ r / ~ 3. ELECTION DATE 2.b. IF COMMITTEE, NAME OF CANDIDATE State Zip Code Phone ! 4.a. CAMPAIGN ADDRESS AND PHONE City 37/) l Street or Rural Route/ ~ ~j ~1 /k 6 ~ V U ~l Zip Code Phone State 4.b. CANDIDATE'S HOME ADDRESS (if different tC ty 4.a. Street or Rural Route be candidate) licable 6. NAME OF POLITICAL TREASURER (may 5. OFFICE SOUGHT (include district number, if apse ~ j V l P~ ([n (;O'BI' • o+* / h Il ❑ . CA EGORY OR REPORT (Check one) 13 ❑ C3 MID-V AR YEAR-END 7 E- PRE F PL EMENTAL THIRD FOURTH PR SUPPLEMENTAL SUP El SECOND UARTER QUARTER PRIMARY GENERAL FART UARTER QUARTER 8.b. ENDING DATE OiREPRTING PERIO 8.a. BEGINNING DATE OF REEPORTING PERIOD 3 !lIJJJ (Check one) contributions including in-kind) received total $1,000 or less AND expendi osure because g. a. This campaign is exempt from detailed discleriod (Complete tems12d. (12e. and 12f.) period. lures total $1,000 or less for this reporting ai n is required to file a detailed financial di ree oause contributions (including in-kind) received total more than $1,00 b. ❑ This camp g and/or expenditures total more than $1,000 for this reporting this campaign financial disclosure report is true and that this repo is an the Campaign committe by contained in s required to be reported by the candidate ended for the personal financial 10. Ilwe do solemnly swear or affirm that the information C accurate accounting of campaign contributions and p Ac Aor dlany other/nonpoliticalrpuaffirm rposehas defined by the federate ntemal revenue code. o campaign Financial benefit of the cad o Disclosu a i y l 0 2,1, Y date date signature of political treasurer signature of candidate G It. WITNESS SIGN TURE 6'1 jo-LF signatu witness date ~ date signature of ness 12. SUMMARY rhl~ ^ a. BALANCE ON HAND MST REPORT .......v.i. b. TOTAL RECEIPTSTHISPERIOD c, TOTAL DISBURSEMENTS THIS PERIOD Gaffs; lT~ 1 $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.0 . e. TOTAL LOANS OUTSTANDING AdI f. TOTAL OBLIGATIONS OUTSTANDING Page 1 of RDA 1159 SS-1109 (Rev. JO6) r SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD n k w; i 1 / FROM: TO: RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ Is-19 b. Itemized Contributions (over $100 from each source this period) $ 75-V S ©U c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 16. LOANS RECEIVED THIS REPORTING PERIOD 17. INTEREST RECEIVED THIS REPORTING PERIOD $ 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) &L4 OFIJPr ,4 Vn4, f $ ;?C7y $ ~ $ $ $ $ $ $ Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures Over $100 each payee this period) ° C70 c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 7 20. LOAN REPAYMENTS MADE THIS PERIOD $ 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.) $ SS-1133 (Rev. 4102) Page of _ . _ . . _....~.w... - mss: ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDI ATE OR COMMITTEE 2. REPORT COVERING THE PERIOD s S FROM: TO: 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 First Na a Middle Name Contribution Received For: Amount of Contribution Last Name ganization Name ❑ Primary Election ❑ General Election L f ~c~~D Address ❑ Runoff (Local Elections Only) 'ev / lJ LP Ja City staff ZQCode 1 Date of Contribution Aggregate This Election MA-~4-,f Ile 7, Occupation 3 S Employer First Name Middle Name Contribution Received For: Amount of Contribution Last Name r anization ame/ ❑ Primary Election ❑ General Election ? 5-0, K Lt S Address t/P fL;e ❑ Runoff (Local Elections Only) 3 3 City f 4 j / stat„ TCode, Date o f Contribution Aggregate This Election / ~ Occupation -I Employer First Name Su iddle Name Contribution Received For: Amount of Contribution ' ft ✓t > r Last ame rganiza ion ame ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation 3 y Employer First Name Middle Name Contribution Received For: mount o 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 (Carty 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 item 15b. of summary.) SS-1131 (Rev. 2106) Page of RDA 1159 IAL DISCLOSURE STATEMENT CAMPAIGN FINANCIAL For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 12.a. NAME OF CANDIDATE OR COMMI E n / 3. ELECTION DATE 2.b. IF COMMITTEE, NAME OF CANDIDATE State Zip Code Phone 4.a. CAMPAIGN ADDRESS AND PHONE City Street or Rural Route S r / ~6SGS 4.b. CANDIDATE'S HOME ADDRESS (if different than 4•a•) 1 State Zip Code Phone Street or Rural Route Ile SU R (maXhe candidate) 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME F POLITICAL T ` r i G.~ v► u ✓1 - 7. CATEGORY OR W 01 , T (Check one) MID YaEAR YEAREND SECOND THIRD FOURTH PRE- PRE FIRST ER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL ARTER g.b. ENDINGDATEOFREPORTINGPERIOD UpRTER D DART S.a. BEGINNING DATE OF REPORTING PERIO J y r 2 7o 9. (Check one I J period (Comple e e mscontributions (inclu and in-kind) received total $1,000 or less AND expendi- a. This campaign is exempt fofrom r this etailed reporting disclosure because tures total $1,000 or less b. This campaign is required to file na detailed for this disc) sure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more information rt is true and rep disclosure financial aign cam contained tha 10. Uwe do solemnly swear affirm thontribut ons and expenditurreesl equ red opbe reported by the candida eocommittee by thetCthis report ampaign is an t. Addg c accurate accounting of a as defined by the federat'iltemal ebveeene expend red for the personal financial Financial Disclosure Act. Additional) I/we swear ~OSethat benefit of a candid or f an Oct. Oct signs ure of political treasurer d e ` dat signature f candidate 11. WITNESS SIGNATURE tO t'~S' I date signature of witness date signature of witness 12. SUMMARY a. BALANCE ON HAND LAST REPORT b. TOTALRECEIPTSTHIS PERIOD .................................C a...t..:..................................... $ c. TOTALDISBURSEMENTSTHISPERIOD ~rjFv}~ 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 Alak SS-1109 (Rev. 2106) CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REP'RT~ 12.a. NAME OF CANDIDATE OR COMMITTEE K 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 r~ Phone / 412 L l•4 /C ,3, ~ 7 S ' G J ~ / 5. OFFICE SOUGHT (include district number, if ap licable) 6. NAME OF POLITICAL TREASURER (may be candidate) t' ! / S 1.4 7. CATEGORY OR REPORT (Check one) 13 FIRST SEND THIRD FOURTH PRE- PPRE- 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 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 the c did a or r any ther nonpolitical purpose as defined by the federal in al revenu de. signature of candidate date signature of political treasurer d Ate 11. WI NESS SIGNATURE signatu of witness date signature of witness date E/ ~E~ 12. SUMMARY v a. BALANCE ON HAND LAST REPORT ! w..... $ ~S 6V wtj1 b. TOTAL RECEIPTS THIS PERIOD ..........~fti~,tt......... .ay $ hd Zl 6 00 IV ~ t7 C7 c. TOTAL DISBURSEMENTS THIS PERIOD 4~•••~• $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) e. TOTAL LOANS OUTSTANDING $ IM f. TOTAL OBLIGATIONS OUTSTANDING $ ~JI SS-1109 (Rev. 2/06) Page 1 of RDA 1159 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 orCommittee: I Candidate a-mail address: 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 tI12 Z-4,vMt-11M M+yv`11e Teri 31-4-1) f y6~~5~//3 6. Office Sought (include district number, if applicable) 7. Party Affiliation 8. Election Year L411 0 72 9. Treasurer Name: ' 1 0: reasurer e-mail address: 11. Treasurer Address and Phone: N City State Zip Code Phone 11LUU I ~A 12. Candidate and Treasurer Signature (both s tures nuts / witnessed. Trea urer can n t witness candidate's signature): Signature of Candidate Signature of Treasurer Signature of Witness Signature of Witness Registry of Election Finance SS-1120 (rev 1012010) CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 12.a. NAME OF CANDI ATE OR COMMI E 57 C / Ss' 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE K 04 +e' 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone Q!L LAIVA 01kniv,ik, r(~ 3nol &(0~-4/0 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 TTREAS RER (may be candidate) C~. O Cv~~ k Se 1#s24 7. CATEGORY OR REPORT heck one) FIRST D THIRD FOURTH PRE- PRE- MID YEAR YEAR❑-END DARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD'' ff 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 of the candidate ofner nonpolitical purpose as defined by the federal internal revenue code. signature of candidate date signature of political treasurer date 11. WITNESS SIGNATURE :~L z- 941 -IL I date signature of witness date signature of wit s 12. SUMMARY 11 AM PAf ' \ a Dd.aO a. BALANCE ON HAND LAST REPORT ~...........(~Q........... QD b. TOTALRECEIPTS THIS PERIOD LID c. TOTALDISBURSEMENTS THIS PERIOD ~.........~U~ $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ e. TOTAL LOANS OUTSTANDING $ f. TOTALOBLIGATIONS OUTSTANDING $ - Aft, SS-1109 (Rev. 20) Page 1 of RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD FROM: TO: RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) $ c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 16. LOANS RECEIVED THIS REPORTING PERIOD $ 17. INTEREST RECEIVED THIS REPORTING PERIOD $ 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 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.) $ 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 121) $ 0 SS4133 (Rev. 4/02) Page of ITEMIZED STATEMENT OF CO 1. NAME OF CANDIDATE OR COMMITTEE NTRIBUTIONS . CANDIDATE 3. TOTAL ITEMIZED FROM: CAMPAIGN CONTRIBUTIONS FROM PRECEDI I- REPORT COVERING THE PERIOD TO: 4. COMPLETE THE gpp First Name RppRIATE ITEMS FOR EACH ITEMIZED Ca NG PAGE enter $0 if first itemized page) Amount J) on CONTRIBUTION Midd contributions totalin more than $100 from an leName contributor LastN OrganizafionName Contribution Received For Amount of Contdbu; Address ❑ Primary Election 2-General Election I D V a City ❑ Runoff (Local Elections Only) State ZIP Code Occupation Date of Contribution Aggregate This Election Employer RrstNamer _ Py Middle Name Last Name/O~an ,nName Contribution Received Fw: Amount of Contribution Address ❑ Primary Election Ld General Election 00, Lj City ❑Runoff (Local Elections Only) V~ State zip code Date of Contribution Pon Aggregate This Election First Nam iddle Name Contribution Received For. an a n ame Amount of Contribution Address El Primary Election ❑ General Election ❑Runoff (Local Elections Only) City State Zip Cow Date of Contribution Occupation Aggregate This Election er Fkst Name Middle Name on ubon ecelve or. moun o onto u ion LastName/Organization Name ❑ Primary Election ❑ General Election Ptldress ❑ Runoff (Local Elections Only) Chy State Zip Code Date of Contribution Aggregate This Election aoc„oa - Employer 5. TOTAL ITEMIZED CONTRIBUTIONS (Carty forward to item 3. of next page I additional pages of thisbn ate used (if this is the last page of contributions, this amount must be stom in Item 15b. of summary.) AM% SS-1131(Rev. 2/06) Page of RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD r SR. FROM: TO: w r Amount 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any oontributor during the period) Received For. Value of In-Kind Contribution Middle Name In- 11 Kind Primary Contribution Election _1 Fast Name ff General Election i, ( 0'1 ' LastNamelOrganlz ' n me ❑ Runoff (Local Elections Only) Aggregate this Election Dateofin4ndConin'bu6on Address - We City State Zip bode Description of InNGrd Contribution Occupation Employer Middle Name In-Kind Contribution Received or. Value of In-rind Contribution First Name Primary Election General Election 14~,0~ Last NamelOrganization Name ❑ Runoff (Local Elections Only) Date of In-Kid ContriWw j Aggregate this Election Address city Spate Zip Code Description of In4W Contrdwtbn \ Occupation Employer Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution First Name Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Daleofln4WGonMbuGon Aggregate this Election Address City State Zip Code Description of In4Qnd Contribution Occupation ployer Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution First Name Primary Election General Election Last NamelOrganization Name ❑ Runoff (Local Elections Only) Dateofln-10nd Contribution Aggregate this Election Address City State Zip Code Description of InNnd Contribution Occupation Errpbym Middle Name lr -Kmd Contribution Received For: Value of In-Kind Contribution First Name ~ Primary Election ❑ General Election Last NanielOrganiration Name ❑ Runoff (Local Elections Only) Date of In Kind Contribution Aggregate this Election Address City State zip Code Description of In-Kind Contr' 'on up n yer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carry forward to Item 3. of next page'rf 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 EXPEN 1 • NAME OF CANDIDATE OR COMMITTEE D 1 T U R ES -CAN D 1 DATE 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) oun iiiiiiiiiiiiiiiiiiiiiillillilllllllllllllllIIIIIIIIIIIIIIIIIiiiiiiilliiilliilliillillllllllllllllllllllliiiiiiiiiiiiiiilllIlI Firs t Name EACH ITEMIZED EXPENDITURE texPendiWres totaling more than $100 to an Q. Middle Name Y Payee during the period) Last Name/Business Name Purpose of Expenditure Ss Amount of Expenditure Address /~y► /7~~~ v,.~~ Al Siraty ~`~L Ley d ~'(~'t7e~ /.,-y l~~vv V i r / C Stale ZIP Code I ~ L I(Ji~a~-^ First Name O ti'f ~~~1' A~sl}4CC ,~'14"n ~ Middle me ftmon Last Narr"usiness Name l j k' 411, Purpose of Expenditure ( Amou t of Expenditure Address city State ZiP?Code First Name ' ✓ yot Middle Name Last NamelBusiness Name Purpose of Expenditure Amount of Expenditure Address Gty state Zip Code First Name Last Middle Name Purpose of Expenditure Amount of Expenditure Address city State Zip Code First Name Middle Name Purpose of Expenditure Last NamelBusiness Name Amount of Expenditure Address State Zp Code Fast Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address Stale ZIP Code 5. TOTAL ITEMIZED EXPENDITURES (Carry toward to item 3. of next page W additional pages si lhhW are used) IN this Is the test page of expenditures, this amount must be $tauln hem 19b. of summary.) SS-1129 (Rev. 4102) Page of RDA 1159 12 AM Cb7 Q i REC~: IV EO r'\ ~1'rtn't' .Form Cl) 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 _ Ae 507 S. 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 CON~~y (04 n+M~'f/"'1 O ~ / 9. Treasurer Name: 10. Treasurer a-mail address: 11. Treasurer Address and Phone: City State Zip Code Phone 12. Candidat and Treasurer S tore ( th signa ures must b witnessed. Treasurer cannot witness candidate's signature): Signature of Candidate Signature of Treasurer 5:X Sig ture of Witness Signature of Witness Registry of Election Finance SS-1120 (rev 1012010) FINANCIAL DISCLOSURE STATEMENT EXEMPTION 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 Ca Financial Disclosure Reports." mpaign CANDIDATE'S INFORMATIO. Candidate's Name: U.,„ k Candidate's Position: o Fe, Residential Address: City: State: TN Zip; I hereby state that I meet the above qualifications for exemption and am therefor exe t fr m filing financial disclosure statements. Y Candidate's ignature Date 1- 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. ~LLJ °O U Cu 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 apolitical 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 Z/ 1 2 4,41110,~tj )fie 7113 ? d'v / S. Home Address and Phone (if different than item 4 above): City State Zip Code Phone 6.0 ffice Sought (include district number, if applicable) 7. Party Affliation 8. Election Year cog4 k uo,,A/a,7 ] set . 9. Treasurer Name: 10. Treasur r e-mail address: cl Sic 0 I D 11. Treasurer Address and Phone: City State Zip Code Phone AQ _-2),4-f T OV7 12. Candidate and Treas re t both signatures must be witnessed. Treasurercan not witness candidate's sign Iture)- Main Signatwe Candidate Signature of Treasurer Signature of Witness Signature of Witness Registry of Election Finance SS-1120 (rev 10/2010)