Vananda, Karen
FINANCIAL DISCLOSURE STATEMENT EXEMPTION
Pursuant To TCA § 2-10-201(b) a candidate is exempt from filing financial disclosure
statements:
"If a candidate Is seeking an office'foi• which service is part-time, compensation is less
than $500 a month and the candidates 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 Name: ti Yrf
• ,
Candidate Position: ' .ie
Residence Address: / i 3 ; Imo,,., ,
City: State: TN Zip:
I. hereby state. that I meet the above qualifications for exemption and am therefore exempt
from filing financial disclosure statements.
- art f Yl r~ r~~ D /2-
Candidate Signature Date
Witness 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.
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~'rint Form
Appointment of Political Treasurer
For State and Local Candidates and Single-Candidate Committees
INSTRUCTIONS
[exempt ppointment of Political Treasurer statement must be used to appoint mpaign Financial Disclosure Act (T.C.A. § 2-10-105) for state and local candidat is and single- cand date
al campaign committees. A state candidate may not receive or expend funds for an election until a
al treasurer has been appointed for that election. A local candidate pursuant to T.C.A 2-10-101, maybe
from completing this form, please check with county election commission for more information. A
ate may appoint himself or herself as political treasurer. A new form must be filed if the treasurer is changed.
ates for state public office must file their original Appointment of Political Treasurer statement ONLY with
istry of Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360.
ates for local public office must file their original Appointment of Political Treasurer statement ONLY with
unty election commission.
1. Date: 2. Name of Candidate or committee:
3. Candidate e-mail address:
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4. Campaign Address and Phone:
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Cit 0 r U S Jr ~ PV
j
City State Zip Code Phone
L5.HomeAA ~
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ddress and Phone (if different than item 4 above : f1 n 78~ /
Y State Zip Code Phone
6. Office Sought (include district number, if applicable) 7. Party Affliction
8. Election Year
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9. Treasurer me: 10. Treasurer e-mail address:
11. Treasurer Address nclPhone:
City State e Zip Code Phone
r12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurercan not witness candidate's signature):
Sign ture of Candidate U
Signature of Treasurer
Signa ure of Witness Sig ature of Witness
Registry of Election Finance
SS-1120 (rev 10/2010)