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Simon, Steve
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 .J z/Lt_ 25~ O ~ ~ S~ 2.b. IF COM TTEE, NA E 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 .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. CATEGORY OR REPORT heckone) ❑ ❑ aRr' ❑ ❑ ❑ ❑ ❑ 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. his 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, Uwe swear or affirm that no campaign contributions have been exp ded for the personal financial b eft of the candida o or any other nonpolitical purpose as defined by the fed ral inter rev en a e. _*4z signature of candidate dot ignature of p litical treasurer ate 11. WITNESS SIGNATURE yy ' i r J sig ure of witness , dat signature of witness date 12. SUMMARY C) 10 11 12 44 00 a. BALANCE ON HAND LAST REPORT .......................IN ° $ G `O RECEIVED b. TOTAL RECEIPTS THIS PERIOD '1 r G ) w c. TOTAL DISBURSEMENTS THIS PERIOD ! tyt •t: .........c v................. $ U( ELEC7'!nnr °j d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ l Ll e. TOTAL LOANS OUTSTANDING $ - f. TOTAL OBLIGATIONS OUTSTANDING $ ~d SS-1109 (Rev. 2/06) Page 1 of RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD S 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) $ c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ ® J 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.) $ v ® ✓ 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) J 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 $ PI 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) $ d b. Itemized in-kind contributions (over $100 from each source this period) $ d 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) $ a c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $ 0 SS-1133 (Rev. 4102) Page - of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: 7 l TO: Zc~/ Amoun 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 ry ❑ 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 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 rgan¢a on ame ❑ 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.) (K this is the last page of contributions, this amount must be shown in item 15b. of summary.) AM% SS-1131(Rev. 2/06) Page-3 of RDA 1159 l~ ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT C VERING THE PERIOD . s/ FROM: TO: Amount[ 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) -0- 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any contributor during the period) First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Descriptonofln-KGndContribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Loral Elections Only) Address Date of In-KOnd Contribution Aggregate this Election City State Zip Code Description of InAnd Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Loral Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election [:1 General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-IGnd Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) / I i ll (If this is the last page of in-kind contributions, this amount must be shown in item 22b. of summary.) QP SS-1128 (Rev. 2/06) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE [4. . NAME OF CANDIDATE OR COMMITTEE sZ 2. REPORT C VERING THE RIO FROM: TO: TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) t- U( 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 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 City 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 NameBBusiness Name Address Qty State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NameBusiness 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.) (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) Age& SS-1129 (Rev. 4/02) Page ~ of~ RDA 1159 ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD S ~ -f/ 1Lkt) T0: 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 ✓ 3 / Q~ Q s / Ir- V - Address Loan Received For: Date of Loan 1 AL IT Primary Election ❑ General Election City Slate Zip Code 42 [3 Runoff (Local Elections Only) List All Endorsers or Guarantor` for Above Loan (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 State Zip Code city state Zip Code Amount Guaranteed Outstanding mount Guaranteed Outstanding 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 Cade 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 Payments 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.) Alffl& SS-1132 (Rev. 4102) Page of RDA 11159 r ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1. NAME OF CANDIDATE OR CO MITT 2. REPORT COVERING THE PERIO FROM: T0: 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Incurred Payments Outstan ing B lance 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 NameBusiness 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 city State Zip Code Description of Obligation Flrst 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 Rem 23b. on summary page.) SS-1127 (Rev. 4/02) Page of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates ForSing le-Candidate Committees 1. DATEOFREPORT 2.a. NAME OF CANDIDATE OR COMMITTEE 2.b. IF COyMM EE, NAME OF CANDIDATE 3. ELECTION DATE 19061 2 6)(4 CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 7-(t cx~'aqnZ7 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) n f) C, A ❑ ❑ ❑ ❑ ❑ 7. CATEGORY OR REPORT LQheck one) FIRST SECOND THIRD FOURTH PRE PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENT 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 co , mittee by the Campaign FinanciaTisclosure Act. Additi ly, INve swear or affirm that no campaign contrib ns have been expe for the personal financial benefit the id aor f other nonpolitical purpose as defined by the fed r interna ;venue c sip ature of candidat , at gnature of poli ical treasurer ate 11. WITNESS SIGNATURE l 1 -4 a~ 7 "8' / gnature of witness date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ b. TOTALRECEIPTSTHIS PERIOD l~ g ~t~. Dd c. TOTAL DISBURSEMENTSTHIS PERIOD /c~Dr~J d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c. $ e. TOTAL LOANS OUTSTANDING $ f. TOTALOBLIGATIONS OUTSTANDING $ r © ..i SS-1109 (Rev. 2106) Page 1 of~ RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT C VERING THE PE =1510D j ✓l~ V// -S /A/1~ FKU 27 j TO • t 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 $ r of c,>, 00 17. INTEREST RECEIVED THIS REPORTING PERIOD $__C 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ l ' d 0. dG 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) Cz 7; $ $ $ $ $ Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ 73 c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD $ O 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ .S dr 22.1WKIND 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.) $ 23.013LIGATIONS 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 121) $ Q SS1133 (Rev. 4W) Pie ~ d 7 ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF C DI ATE OR COMMITTEE 2. REPORT CO ERING THE PERIOD FROM//l TOE:: 3 ` unt 0 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 Address ❑ Runoff (Local Elections Only) City Sate ZipCode Date of Contribution Aggregate This Election Occupation Empoyer First Name Middle Name Contribution Received For: Amount of Contribution Last Name/OrganizationName ❑ Primary Election ❑ General Election Address ❑Runoff (Local Elections Only) City JState Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name iddle Name Contribution Received For: Amount of Contribution s Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) city State Zip Code Date of Contribution Aggregate This Election Occupation hmployer First Name Middle Name Contnbution Received 1-or: 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 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 15b. of summary.) y' SS-1131(Rev. 2/06) Page Z of RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CA DIDATE OR COMMITTEE 2. REPORT OV RING THE P RIOD ' 5 C7 40 /V FROM: 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 contributor during the period) First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last NamelOrganization Name ❑ Runoff (Local Elections Only) Address Data of In-KindCo&bution Aggregate this Election City State ZipCode Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Onty) Address Date of In-Kind Contribution Aggregate this Election City State ZipCode Description ofln-KindContribution Occupation Employer First Name Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organ ization Name ❑ Runoff (Local Elections Onty) Address Date of In-Kind Contribution Aggregate this Election city state Zip Code Descriptionofln-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Name0ganization Name ❑ Runoff (Local Elections Only) Address Date of I"indContribrtion Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution E] Primary Election E] General Election Last Name/Organization Name ❑ Runoff (Local Elections Onty) Address Date of In-Kind Contribubon Aggregate this Election City State Zip Code Description of In-Kind Contri bution OocuW*n Employer 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 in4dnd contributions, this amount must be shown in item 22b. of summary.) SS-1128 (Rev. 2108) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. N4NEOFC*DD4TE OR OCNMTTEE 2 NG PERIOD FFUM / To 3. TOTAL fT MZED AWAIGN E)MURI ES FROM PFECBDING PAGE (enter $0 d first iter is page) 4. COW= TFE APPROPRIATE ITEMS FCR EACH ffEMZE0 EXPEN Ti RE (aperxitues totaiirg more #m $100 to any payee drirg are period) First Nome Mdde Name Repose d Bpniitue Ama.rt d Bp ndhre Last NwroBjaress~ Narre re 66 First Nana Mdde Nara Repose of E)pffdtue A mtrt of 6pt3ttre LastNervWD"imNarm City/Q- G ~ 3zipcode 7 7~' First Name Mdse Name Repose of PVrtdtue A Twt d 6gxndtue ~7` Nam 7K, Attses /99p c- (Sty She ZIp0011e First t~rre Mdrie Name Repose of E ue Anotet of 5pendtue Addesa 4 ytllz- 4-e-- w CSty Swe apC ode , td e trQ First Name Mdde Name Repose of EVndhee A Turt Of 6pu)citLm Last Na o9joress Nana Adders City State DpOode First Name MdseNine Repose of EVndtue A mart d BpmJtLre Last Narndaainms Nave Adriess City State apCode 5. TOTAL ITEMS E(PBUTURES (Caryfavmdtoitemadredpageifadltwelpagesddisformereused.) (ffftisftlastpagedegerdtam,ttisarrm tmathedwninihemf9b.daimery.) SS-1129 (Rev. W02) P2ge `S~ of RD41159 ITEMIZED STATEMENT OF LOANS -CANDIDATE 1. hAW OF CMDIDATE OR~O^ONAIATTEE 2 REPORT ODARW., THE PM0D TQ iA,6Q/S/ FROM lZ7 / l0 3~ 3. OOMUTE TFEAPPROPRIATE ME FOR EACH ITEWM LOAN Pori tdalirg morethm 3101)trom any sarwd mrg the peiad) O mplete the FolbMng for the Same of the Loan RrstNwe MddeNve QisiardrgLoan Batanoe Loam Loan QlstardrgLaanWerm c ro ~ i Fbceived par-ft (End of Raiod) Last t~merQga lst3rre " S(DO . ®v `ot 410( Dz. !9 ~5 0 DLL Address L,a_arlleomed FQ: [kbedL~ S Ly V Aw, E n:, ry Beatim 0 General EWcbm 0 & -CIbL, I L~~/ l'< l `cD~ rk~ or(►„Aeeo~~ List All Bxbrses or Qiarartas for Above Low (If more space is needed please altat a page) First Mms Mdde Urns First Norm MdcleNwm Last t hrrrerQ~flbm Last Nv engmatim urns Address Addem CRY Rye Lpomb CRY State LpQode ArtnutQaarteedQtstarcirg Grerarteed0Jmw iirg First N3 m Mdde Nm First Nwm Mdde Nv e Last hhrnaVVnzatim tine Last t~hntelQga ®tion ttarm Address Address CnY State ZpOode C8y Rabe ZpCode AnartQmwteed0LbW rg Arrourt GmrarteedQAAardrg First Lorne Mdie Nw a First Nm Mdde tarre Last MrterCrga u2 iw hkm Last M mWQgsn®tim tome Address A,dym City Rate zpcode aty State ApGode AmartGnaarteedQtAadnj knout GnerartsedQtstard g First rome Mdrletome F:Last M Mddetone Last MrWOga asbon Lome merQgai®tim Lorne Addess atY State ZpCod e CRY State bp Code Arnart Gueateed Qtstadn8 Gnararteed Qfarcirg 4. Totalsfor41Loats(mnlAeteonlast pageofitarizedloans) QtstadrgLomBalance Loam Los, (raWa snsmoa%edduWalsobsdvwini1em1fimaumnaypega) (BqjrTirvdPsr~ f WW Loaneelarce (tWiampaymBrft oddelaobeshominiten2amamnaypVe.) (kWaAs rdngloenbalarceshxidaisobeswminiteml2aonfi rim.) ~ ~Q.d® B~Q~00 - d ~DDrd SS-11M (Rev. 4102) Pie _ of FUA 1159 ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1. NAME OF CANDIDATEOR COMMIT EE 2. REPORT COVERING THE PERIOD S /)~I D/7` FROM: Z7 TO: ae / 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 oPeriod) persontvendor at the end of the reporting period) - Cl First Name Middle Name Last Name/Business Name Address city State Tip Code cnpuon of Obligation First Name Middle Name Last NamotBusiness Name Address city State Zip Code Description of Obligation Flrst 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 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.) M4 w SS-1127 (Rev. 4102) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE f~ ,.rte S , / 2. REPORT COVERING THE PERIOD NA FROM: T 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) mo G 7 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period) First Middle Name Purpose of Expenditure Amount of Expenditure Last Nameftsi Name 7T -V v Address C! G - (/~i C/ C~' ` O cl Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business mess Nam Address r Q/ J (/1 ~i j (J c✓~°~ city State Zip Code Fast Name Waddle Name Purpose at Expenditure Amount of Expenditure Last Name4 6usiness Name ress City _ St % ZIP Code ` First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name 7 /C ~y I`t K~fei S,Lt~eTL• Y pCode L - First Name M ddle Name Purpose of Expenditure Amount of Expenditure Last usiness Name Address/ CRY/-) Code am' v / )J7 First Name Wddle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code 5. TOTAL ITEMIZED EXPENDITURES (Carty forward to item 3. of next page d 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.) Z, ~t% ~J < O v/J SS-1129 (Rev. 4102) Page ~ of ~ RDA 1159 MONOMER ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD TO1 O 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (bans totaling more than $100 from any source during the period) 7 Complete the Following for the Source of the Loan First Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Bdance (Beginning of Period) Received Payments (End of Period) Last Name/Organization Name Address Loan Received For: Date of Loan ❑ Primary Election ❑ Generai Election Gty state Zip Code ❑ Runoff (Lail Elections Only) List All Endorsers or Guarantors for Above Loan of more space is needed please attach a page) First Nam Middle Name First Name Middle Name Last NamelOrganization Name Last NamelOrganization Name Address Address City Sialo Zip Code cfty 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 Slate Zip Code City State Pip Code Amount Guaranteed Outstanding nt Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Nane/Organizalion Name Last Name/Organization Name Address Address city State Zip Code City Stole Zip Code Amount Guaranteed Outstanding kinount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organizadon Name Last Name/Organlzation Name Address Address aty State Lp Cate City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed 6u tarading 4. Totals for all Loans (complete on last page of Itemized loans) outstanding Loci Balance Loans Loan Outstanding Loan Balance (Total loans received should also be shown in item 16. on summary page.) (Beginning of Period Received Payments 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.) (5~7 - e, - - SS-1132 (Rev. 4102) Page ol RDA 1159 ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD C7 FROM: TO: 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 v Last Name/Business Name Address Qly State Zip Code ption of igation First Name Muddle Name ast Name/Business Name Address city state Zip Code Description of Obligation First Name Middle Name Last NainelBusiness Name Address city state Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address Gty state Zip Code Dewriplim 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.) - SS-1127 (Rev. 4/02) Page ~ of ~ RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. D TE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE lefz- IL _q V, 12 d, / 41- s~. 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE ~_41r_- 51,1141111,W - 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) 91W14*1_e041 wY 00-&Jme~ S yr- - t57tlx® 7. CATEGORY OR REPORT (2heck one) FIRST SECOND THIRD FOURTH PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER ARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD 4 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 A neft of the candidate for any other nonpolitical purpose as defined by the federal internal revenue cod . j ~ 9 signature of c ndidate dat nature of ical treasurer date 11. WITNESS SIGNATURE ildnature of witness date signature of witness date 12. SUMMARY T a. BALANCE ON HAND LAST REPORT $ t 2 2 b. TOTAL RECEIPTSTHIS PERIOD ...................................:.'......C W u $ z 7~ a, TOTAL DISBURSEMENTS THIS PERIOD ~.:.:........e......i.:................................... $ . d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ a. TOTAL LOANS OUTSTANDING f. TOTAL OBLIGATIONS OUTSTANDING $ _ © v SS-1109 (Rev. 2/06) Page 1 of RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CA , (rDAATTE OR COMMITTEE (In Full)) 14. REP T COVERING T PERT D / FROM: / T0: All 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 =Q 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) $ 2 7f t c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.15.) $ I vc 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 ~1 a. Unitemized in-kind contributions ($100 or less from each source this period) $ - t% 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) $ C b. Itemized Obligations Outstanding (Over $100 each) $ a TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $ 1./ SS-1133 (Rev. 4/02) Page of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT C VERING THE PERIOD y L ~r~-~ /Y!! • C~/f'/~ FROM: TO: Amo t ' 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first Itemized page) 15b-; ( Q 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than $100 from an contributor First Name Middle Name Contribution R ed For. Amount of Contribution e-7 ;r-f Last Nam anlzation Name Pnmary Election ❑ General Election Address ! ~°yJ , ❑ Runoff (Local Elections Only) CRY Date of Contribution Aggregate This Election Gmupat on E P- Ap'-*J, First Name MiddleNsme Contribution Received For: Amount of Contribution Last Name0ganization Name ❑ Primary Election ❑ General Election Address ❑Runoff (Local Elections Only) Ctty State zip Code Date of Contribution Aggregate This Election occupation Employer First Name IddieName Contribution Received For: Amount of Contribution Last ame a on Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election oeapatlon 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 Employer 5. TOTAL ITEMIZED CONTRIBUTIONS (Carty forward to item 3. of nerd page if add banal pages of this form are used.) Of this Is the last page of contrtlrutionz, this amount must be shown In item 15b. of summary) AWk SS-1131(Rev. 2/06) Page of J RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE 0 COMMIE 2. REPORT n NG THE PERIOD, FROM: TO: /ZF oAMOUlft 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0d first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (n-kind contributions totaing more than $100 from any contributor during the period) First Name M idle a In- n Contribution Received For: Value of In-Kind Contribution Primary Election ❑ General Election Last Name/Or idati Na~'` e ~ ~ / ® o ~f L , Z ~j ❑ Runoff (Local Elections Only) ~~4 r Address /Z (G ! / ~Y Date of lMGnd Con*tdron ? Aygate EI city t2 Desaip1"0f1 a`ur/bnd c« tria,~tioln~~✓~ Occupation Employer First Name Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution Lest Name/0rganizauon Name ❑ Primary Election ❑ General Election ❑ Runoff (Local Elections Only) Address Date of kWund Contribution Aggregate ft Election C4 State Zpcode Des n"oonofln WCorr*Wkin Occupation Empiyer First Name Middle Name In-Kind ContnbAion Received For: Value of In-Kind Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election ❑ Runoff (Local Elections Only) Address Date of In-Kind Contrilbulion Aggregate this Election City State 2'p code Description of In-Kind ConlrbAon Occupation tiniploym First Name Middle Name Intend Contribution Received For: Value of In Kind Contribution ❑ Primary Election ❑ General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address DabotIr WContrib" Aggregate lbisElection City state ZipCode DesaiplionofIn-Kind Ccrttrihutlon Occupation Employer FkatName Middle Nam In-Kind Contribution Received For: Value of In-Kind Contribution [3 Primary Election General Election Last NarrtelOrganizadat Name ❑ Runoff (Local FJectlons Only) Address Dateof hn4eid Cantrtbuhon Aggregate this Election City State Zp Code Description of In4Qnd CorgAbudon Occupation tirpoW 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Cary forward to Rem 3. of next page nadditional pages of this form are used.) (If this Is the last page of in-Idnd contributions, this amount must be shorn in item 22b. of summary.) SS-1128 (Rev. 2/06) Page of RDA 11,59 A CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates EIVT For Single-Candidate Committees 1. DATE OF REPORT I 2.a. NAMEOFCANATEORC06AMRTEE 2.b. IF COMMITTEE , NAME OF CANDIDATE ELECTION DATE 4.8. CAMPAIGN ADDRESS AND PHONE S treet or Rural Route L City f State Zip Code .c ll %:'12 1'/11f4 Phone 4.b. CANDIDATE'S HOME ADDRESS 01 different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, K applicable) 6, NAME OF POLITICAL TREASURER (may be candidate) 7. CATEGORY ORREPOR FIRST (Check one) SECOND ❑ _ 1:1 TFiAiD NTH ❑ Ql1AR MI YEAR YEAR❑-END 8.a. BEGINNING DATE REPORTING PERIOD JPRIMARY GENERAL SUPPLEMENTAL S(fppEM ALL ENOINGDATEOFRF_PORTINGPERIOD 9. (Check one) a. El This campaign is exempt from detailed disclosure because contributions (including in-Wnd) 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• D...This campaign is required to file a detailed financial disclosure because contributions (including in4dnd) received total more than $1,000 andtor expenditures total more than $1,000 for this reporting period. 10. Uwe do solemnly swear or affirm that the information contained in this cam accurate accounting of campaign contributions and expenditures paign finned b disclosure report is true and that this reFina I Disclosure Act Add' ' My, Uwe swear or affirm that nor campaign contnb tut s haavve bee ate committee by the port l an be of the candidate for ny other non y Campaign I nonpolitical purpose as defined by the fade internal nue xPe for the personal financial nature of card' to dat nature of poll I treasurer 4ddtte 11. WITNESS SIGNATURE a / F sigma of witness dale s date 12. SUMMARY a. BALANCE ON HAND LAST REPORT b. TOTAL RECEIPTS THIS PERIOD Q Q c. TOTAL DISBURSEMENTS THIS PERIOD t d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) f j e. TOTAL LOANS OUTSTANDING f. TOTAL OBLIGATIONS OUTSTANDING $ d SS-1109 (Rev. 2/06) Payelof_)_ RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (in Full) 14. REPORT COVERING THE PERIOD / '511W% N FROM TO: 3l 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) $ i c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ C D 16. LOANS RECEIVED THIS REPORTING PERIOD $ C~ 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) $ $ s s $ $ Total of Expenditures ($100 or less each payee) b. Itemized Expenditures (Over $100 each payee this period) $ rrr y 7~ c. TOTAL EXPENDITURES (other than ban repayments)(add 19.a. and 19.b.) $ ~3 Q y 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.) $ 23.013LIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ a TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $ (9- SS-1133 (Rev. 4102) Page of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING TI1E PERIOD FROM TO: • I Amoupft 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 0 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION conNr ulions totaling more than $100 from an mbitxrtor F>st Na"1° ~C W4* Name CorrtnWon Received For. Amount of Conoilx bon Last Na son Name L~3'Prirrrary Election ❑ General Election 1 r /v (~i ~I ❑ Runoff (Local Elections Only G ~iC Sra~ Z,pCode7 Date of Contrbuton Aggregate This Election O=paWn Empbyer r~ IirslNarne lAddeName Contribution Received For. Amount of Contrbution Last Nam&Orpantration Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) Ck Stale Zip Code Date of Corift lion Aggregate This Election OOMP86M Fist Name Name Contribution Received For. Amount of Contibution ❑ PrimarY Election ❑ General Election Aft873 ❑ Runoff (Local Elections Only) Cky St* Zip Code Date of Contnbufion Aggregate This Election omupabm Hral Name die Name « Amount 0 Lag Nwr&VryantzafW Name ❑ Prknary Election ❑ General Election Address ❑ Runoff (Local Eons Only) M Sfale [-rode Date of Contrbution Aggregate This Election Errpbyer 5. TOTAL ITEMIZED. CONTRIBUTIONS (Carry br*wd b item 3. of nett pope k eddtdonai popes of ft form are wed.) (I ft istoe foal papa of cx*b Aom ft wmunt must be N kem 15b. of vxmrery.) j ~ of E ~G' Ash W+ SS-113i(Rev. 2106) Page ( of RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE P RIOD FROM: l TO: n AMOUFA 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 K first itemized page) Q 1 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION ("M m*bub= btarap more than $100 from any contributor during the period) (r Fret Name Md& Name - k ow Contribution Received For. Value of In KW Contribution Lest ❑ Primary Election ❑ General Election ❑ Runoff (Local Elections Only) r o - , Date ofh4W ow*bubon Aggregate M EWjm Fc / / CRY state Zip oode Dees "m cf IrAmd ombli uion tkcupebon Enpbyer Fret Name 7 txddle Name kNGrld Cork iMAion Received For Value of trrddrd Contribution ❑ Pmwry Election ❑ General Election ❑ Runoff (Local Elections Only) Address Oaleo(hKrdCantrbution Aggregatef %cbon CRY stale [Zip c.* Oesaipbonof MGM Conbbubar First N. WW& Name R>-IOrd Cwtbibu6on Received For Value of h4W Contribution Pmtaty Election ❑ General Election LsANamerOrjwkabon Name ❑ Runoff (Local Elections Only) Address Dateofkvowco*bufion Aggregale WsBodon ck SW Zip Code Dn*fiono(inaCadCoMbubon oca"bon B* Now Wddb Name In*M Conhtb ftn Received For. Value of In-Kind Contribution ❑ Primary Election ❑ Genewl Election Last NamMOrganiration Name ❑ Runoff (Local Elections Ong} Address D* of h4W Ca*bu6w Aogrepale tfris BecWn allf sme mpcoda Desor"onoflnoWC**tuion Ooagabon Enplger F4slName WAMName In-Kind Contribution Received For: Value of In4W = b,Wn ❑ Primary Election ❑ General Election last Wmm~antrabonName ❑ Runoff (Local Elections Only) Address Dale o(kv-*WCw*bubon Aggregate M Elecom City Stale zo oode Daa"m c f Cw*bAw 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carty forward b Rem 3. of ne)d page r sdff*nsl papa 91aria form are wed.) (If ft Is he last page of in*W cWAlxrbom, wts amount mat be shown in Rem 22b. of w wAq.) SS-1128 (Rev. 2106) Pape of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR gOMMIE 2. REPORT COVERING THE PERIOD FROM: r ; TO: ~ '7727 mou 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 9 first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expendihees totaling rare ow $100 to any payee during ft period) First Name Addle Name Purpose of Expenditure Amount of Expenditre J Las, Narne C41 ~L Stale Fast Name Middle Name Purpose of Expendituve Amount of Expenditure Last Name/Business Name Address CRY State zip code FYst Name Middle Name Purpose of ExpendWre Amount of Expenftn Lad NamelBusiness Name Address pry State Zip code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Namel&niness Nave Address py Stale Zip Code First Name Liddle Name Purpose of Expenditure Amount of Expenditure Last NamdBusiness Name Address City Slate Zip Cade First Name Middle Name Purpose of ExpendiWre Amount of F.xperditre Last NamelBusiness Name Address City Stale zip code 5. TOTAL ITEMIZED EXPENDITURES (Carty forward to Ilan 3. of next page t additional pages of this form are used.) (UNs Is the last page oto diWres, this amount mutt be shown in hem 19b. of mninary.) 6 % ® 88-1129 (Rev. 4102) Page ~ of RDA 1159 ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD S/ f f ~r~ FR T0: d / 3. COMPLETE THE APPROPRIATE ITEM FOR EACH ITEMIZED LOAN (bans ataruq more toff $100 from my wurce during ere period) Complete the Folbwirg for the Sotm of the Loan First NameC y / lAddle N Wtstandirg Loan Balance toms loan Outsta~ng Loan Balance ,pme C , (fsinr+4 of PeriA JRecetved Pam-ts (End of Period) Last Na pan'ization Name 121W 6) Address,, 19161 Loan Received For. Dale of Loan z- W'r,,ny Election (3 Garad FJection r0 D ~ zip code _ o R"ltaod-tionuony) -~/y List Al Endorsers or Guarantors forAbove Loan (N more space is needed please attach a page) First Name VAd* Name Fast Name ATddle llama Last NanodOnganization Name Last Name0gar action Name Address Address C4 Stab Code G4 State Zp Code AmountCrraranlaed Oulsfandag Guaranteed Outstaft fist Name 66ddle Name First Name Middle Name 1. -.--7 Last NmWOWnization Name Lag NamerOnganaation Name Address Address a4' SteAe Lp Cade City State Iwo* Amount Guarantoed puktar rq Anoint Guaranteed Ondswe" Fiat Name tfiddle Name First Name WMIS Name Last NmwArganitation Name Last Name0ganization Name Address Address LO Cade aly tale zip code Amount Guaranteed Outstanding Mix" Guaranteed Ouistan ft First Name W& Name First Named Nano Midd Last NarnwOrgarrizabon Nano Lmst Nam ovanizatim Name Address Address CRY State Zip Code City State Zip Code Amount Guaranteed 01 mg kinwril Guaranteed Outstanding 4. Touts for ak Lo-am (mnpkk 011 fast pap of keirked bm) Fiftoy dig Loan Uw" Loans Loan outstanding Lem Balance (Total loans moeivad should also be shown to Nam 10. on summary tom.) of ' Received Psyrents (End oo(Pwi4 (Told ban paynra* ttould ahso be shorn in item 20. on turnery papa.) ~1~ n (TotalbmWarmshmildalsobeshownInbml2A.onhadpage.) cc? - ~ t / ~D ® SS-1132 (Rev. 4102) Page of RDA 1159 ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1 • NAME OF CANDIDAT OR COMMI EE f . C / 2. REPORT COVERING THE PERIOD 3COMPLETE THE A FROM: LPRL:AT PPRE IT MS FOR EACH ITEMIED Outstaring Balance Debi ricu OBLIGATION (obligationg more than 5100 owed to any inns p{ p Payments Outsing Balance P&W*endor at the enreporting pew ) This Period This Period (End of Period) nrm Name Riddle Name Last ' S. ness Name Address CRY state zip code no( Hfst Name Riddle Name t Address State zip code iv6ono( on AbipaiFkst Name Uddle Name Last Narna9winess Name Address O Sato Zip Code Desmom of Obka5m Flat Name piddle Name Last Namelg Name Address City Lxl~ ate Zip code n of Obipetion Flat Name piddle Name Last NanrelB k*u Name Address ckf Stab LP Code lNlscdpion o(Obipaion 4. TOTALS (Tote(Gom OuWan ft Balance - (End of Period) oolumn must also be Whom In Mom 23b. on tilxirttary page.) - - - Ank SS-1127 (Rtiv.1l02) Pape of ~ RDA 1159 ,.vi 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 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: 4. Campaign Address and Phone: City State Zip Code Phone /if61 Ah/~kOc~i~O(l~ 5. 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 zsw 9. Treasu Name: 10. Treasurer e-mail address: A //1 11. Treasurer Address and Phone: City State Zip Code Phone 12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature): Signature of Candidate Signature of Treasurer Signature of Witness Signature of Witness 1 Registry of Election Finance SS-1120 (rev 10/2010) ~/F/t1Ar oil it 01 6 -Z r - .u