Citizens for a new Alcoa High School
APPOINTMENT OF POLITICAL TREASURER
For Single-Measure Committees
INSTRUCTIONS
This form must be used to appoint a political treasurer as required by the Campaign Financial Disclosure Act (T.C.A. §2-10-105)
for single-measure committees. No funds may be received or expended for a future election until a political treasurer has been
appointed. A new form must be filed if the treasurer is changed.
Single-Measure Committees supporting or opposing statewide referendums must file an original of this form with the Registry of
Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360. Single-Measure Committeess supporting
or opposing local referendums must file an original of this form with the local county election commission in the county where the
election is to be held.
1. Date [2. Name of Committee
6/1/2012 Citizens for a new Alcoa High School
3. Address and Phone Street or Rural Route City State Zip Code Phone
6 Pasteur Place Alcoa TN 37701 q77-4517
4. Measure Supported or Opposed 5. Election Date
Su orted 8/2/2012
6. Treasurer Name
John Rochelle
7. Treasurer Address and Phone Street or Rural Route City State Zip Code Phone
567 Pasteur Place, Alcoa, TN 37701 6 977-4517
8. Appointing Authority and Treasurer Signature (Both signatures must be witnessed. Treasurer can not witness signature.)
Signatur of Appoi Authority Signature of Treas
J n lch lle n R the e
Signature Wit s Signature itnes
G. William Hammon, Jr. G. William Hammon, Jr.
Registry of Election Finance
SS-1107 (Rev. 8/04) RDA Pending