Higdon, J. Nathan
Print Form
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:
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4. Campaign Address and Phone: City State Zip Code Phone
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5. Home Address and Phone (if different than item 4 above): City State Zip Code Phone
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6. Office Sought (include district number, if applicable) 7. Party Affliation 8. Election Year
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9. Treasurer Name: 10. Treasurer e-mail address:
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11. Treasurer Address and Phone: City State Zip Code Phone
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12. Candidate and Treasure Signature (both signatures ust be witnessed. Treasurer can not witness candidate's signature):
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Si nature of Candi t a<0 Signature of Treasurer
Signatur ltness ~19 ~a Signature of Witness
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Registry of Election Finance
SS-1120 (rev 100010)