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Holley, Angie J. FINANCIAL DISCLOSURE STATEMENT EXEMPTION Pursuant to TCA 9 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: o Candidate's Position: w.,a, t,11 ( e olito Residential Address: 80 t ✓i o AAAi, t . V.-Var. - City: State: TAI Zip: 37777 I hereby state that I meet the above qualifications for exemption and am therefore exempt from filing financial disclosure statements. andidate's Si ature Date Witness s Signature Date If my plans change and I realize I will spend more than $1 PM 12 ai n I will immediately make a financial disclosure report. g ~G a 1* Lo J 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"iA24 L C 4. Cagn Address and Pho Zip Co e hone 0 50 4.t5 v~ c-5-1177 9"387-fit, _AW 2!o& 5. Home Address and Phone (if different than item 4 aboIII! ve . City State Zip Code Phone 6. Office Sought (include district numb r, if applic le) 7. Pa Affliat n nY 8. Election n Year C.rMo ` 'e,., , W:ryl (4- ]PQ c / of O l 9. Treasurer ame: 10. Treasurer e-mail address: ryc7r2 w. w--lv CGS ,d e.~ C In rk ~c.~ G to . ~'1e. 11. Treasurer A dress and Phone: City State Zip Code Phone a/ V ,L o u is u J l~ f'1-(, n s-t /oti is v ~l l e l I d 3177 7 R 8'3 -.2 s3 12. Candidate and Treasurer signature (both signatures must be witnessed. Treasurer can not witness candidate's signature): Signat a of Candidate PM 1 Signature of Treasurer .~4\ 1 { s ) Signature of Witness 00 Signature of Witness via Registry of Election Finance SS-1120 (rev 10/2010)