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Hitson, Sandra FINANCIAL DISCLOSURE STATEIVIEKIT EXEN APTION1 Pursuant to TCA § 2-10-101(b) a candidate is exempt from filing financial disclosure statements due to the following: 1. The service for the office which I seek is part-time and the compensation is less than $1,000 per month, AND 2. 1 do not plan to'spend more than $1,000 on my campaign. *Candidates running for Chief Administrative Officer (i.e. Mayor) of the county or ' city are NEVER exempt from filing and should file the required campaign fin 10 11 1 disclosure reports regardless of compensation or spending. .off RECEIVF~, A CANDIDATE'S INFORMATION: JAN 2 ` 2018 w g~ CONNTY 1+ Candidate's Name: S &Ad ro-- 0 ~ A co n^y' S15 117 h Candidate's Position: u ~hfi ra, ci Residential Address: g ~3 p-~p✓~ State: TN Zip: -3 7 City: I hereby state that I meet the above qualifications for exemption and am therefore exempt from filing financial disclosure statements. If any of the above change and I no longer qualify as an exemption, I will file the required campaign financial disclosure reports with my local election commission. Candidate's Signature Date J Witness's Signature Date 7 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 12.a. NAME OF CANDIDATE OR COMMITTEE I l 8 50- ' s~~ 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE S a, 1 S 9 4.a. CAMPAIGN ADDRESS AND PHONE State Zip Code Phone Street or Rural Route ~ City 3 % a >r -rIq . 3 ao 4.b. CANDIDATE'S HOME A DRESS (if different than 4.a.) State Zip Code Phone Street or Rural Route City 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) ` vne 1,~ G S 7. CATEGORY OR REPORT (Check one) ❑ MID YEAR YEA -END FIRST SECOND THIRD FOURTH ❑ PRE- PRE- QUARTER QUARTER QUARTER QUARTER PSRIIMAR DING DATE OF REPORTING PER EDSUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD S. (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 benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. J~Yl~r'► W!/alL/ + date signature of political treasurer date signature of candidate 11. WITNESS SIGNATURE ~ RECEIVED signature of witness date signature of witness V dat CV) JA ~ 9 BLOUNT COU 12. SUMMARY ~ EJECTION b a. BALANCE ON HAND LAST REPORT $ wd t l l t b. TOTAL RECEIPTSTHIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ e. TOTAL LOANS OUTSTANDING f. TOTAL OBLIGATIONS OUTSTANDING SS-1109 (Rev. 2/06) Page 1 of RDA 1159 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: he~ 1`3 -)`AC0.r Pti' COt - I J Kd r C~ 1 11 ~S on 4. Campaign Address and Phone: City State Zip Code Phone S. 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 bC l~(c~ ~L h1►y~ 1 SS i t)r)-e i l ~ (I +'1 I`f 9. Treasurer Name: 10. Tre surer e-mail address: V ASvr1 S CZ_v\CIt 2- net 11. Treasurer Address and Phone: City State Zip Code Phone 3 16 w ~a i1c rC+ N, IS53 12. Candidate and Treasurer Signature c(_ signatures must be Witnessed. Treasurer can not witness candidate's signature): Ir Signature of Candidate Signature of Treasurer A/vI 6__ A26a~ 1. Signature of Witness Signature of Witness Registry of Election Finance SS-1120 (rev 10/2010) i FINANCIAL DISCLOSURE STATEMENT EXEMPTION Pursuant to TCA § 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 thedoe's not have to file Campaign than $1,000 to get elected to office, the candidate Financial Disclosure Reports."woo - JAN 2~ 71114 CANDIDATE'S INFORMATION: Candidates Name: GZ V1N Candidates Position: 1 1 4-~Lh M t 5 S 1-I) Residential Address: 3 b S l~ I o Zip: 3 c K -t r d State: TN City: 1 I hereby state that I meet the above qualifications for exemption and am therefore exempt from filing financial disclosure statements. Candidates Signature Date Witness's 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.