Hunt, Tommy
Appointment of Political Treasurer
For State and Local Candidates and Single-Candidate Committees
INSTRUCTIONS
Fr tment of Political Treasurer statement must be used to appoint apolitical treasurer as required by
n Financial Disclosure Act (T.C.A. § 2-10-105) for state and local candidates and single- candidate
paign committees. A state candidate may not receive or expend funds for an election until a
surer has been appointed for that election. A local candidate pursuant to T.C.A 2-10-101, maybe
completing this form, please checkwith county election
new form must be filed if the treasurer is changed.
ay appoint himself o herself as political treasurer.
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.
3. Candidate e-mail address:
1. Date: 2. Name ofCandidajeorCo mittee:
2- I ~~fi I C) ~Q
2 )H I h city State rip Code Phone
. Campaign Address and Phone:
4
131 fn bar ~
5. Home Address-and Phone (if diffe nt than item 4 above): City State Zip Code Phone
5 4 1 I 8. Electio n Year
6. office Sought (include district number, if applicable) 7. Party Af lation
kt~CA 2~1y
'V (OVOL, J~11
9.Treasu r Name: 10. Treasu r e-mail address: ~G r
ipso 3
Ci ate Zip Code Phone
11.TreasurerAddress and Phone: ty 12. Candidate and Treas r Sl nature (bot signatures must be witnessed. Treasurer cannot witness candidate `s signature):
nature of Candidate Signature of Treasurer
Signature of Witness nature of Witness
Registry of Election Finanoe
SS-1120 (rev 1012010)
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."
SEP 2 2 l tts
UT,
CANDIDATE'S INFORMATION:
Candidate's Name:
~c l e cif
Candidates Position:
Residential Address: 6
State: TN Zip. 37cu
W Iel
City: I hereby state that I meet the above qualifications for exemption and am
they re exempt f m filin financial disclosure statements.
Candidates Si nature bate
_14 ~ A q,
c
Witness's Signature Date
If my plans change and I realize I will spend more than $1,000 on my campaign, I
will immediately make a financial disclosure report.
APPOINTMENT OF POLITICAL TREASURER
4 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. Astate candidate may not receive or expend funds for an`election
until a political treasurer has been appointed for that election. Alocal 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 Registryof Election Finance, 404 James Robeilson Parkway, Suite 104, Nashville, TN 37243-1360
Candidates for local public office must file their originalAppointmef t of. Political TreasurerstaternentONLY
With their county. election commission.
1. Date 2. Name of Candidate or Committee
6W & CL a I F
3. Campaign Address and Phone
Street or Rural Route city state Zip Code Phone
I Tv (p ~ e (r, Z~qw
r r IU j/ Vi fla, PJ (flJ?e3-L-5
4. Home Address and Phone (if dief an item 3 above) '
Street or Rural Route City State Zip Code Phone
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5. Office Sought (include district number, if applicable) 6. Party Aftiiation 7. Election Year
/limo V1,11 c, (;~Y (0urf I i~ 1u~ Z ~1 ~
8. Treasur Name
t 1 A
9. Treasurer Address and Phone
Street or Rural Route City State Zip Code Phone
z I h f~6~~R brae e IfE /k 37Fa3 fey-6~~Y
10. Candidate and Treasurer Signature (Both signatures must a witnessed. Treasurer can not witness candidate's signature)
-RX y
Signatur of Candidate Signature of Treasur
Signature of Witness i 1 P Signature M 7 g ature of VUkn s
X, A
o> RECEIVED
_ Registry of Election Finance m
SS-1120 (Rev. 8108) (
C' 0 6 101; i RDA Pending
8LOUNTCC0i1NTY
3 i L.ECTION 6
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