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Miller, Karen CAMPAIGN FINANCIAL DISCLOSURE STATEMENT, For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 12.a. NAME OF CANDIDATE OR COMMITTEE r 3. ELECTION DATE 2.b. IF COMMITTEE, NAME OF CANDIDATE 4.a. CAMPAIGN ADDRESS AND PHONE State Zip Code Phone Street or Rural Route City 4.b. CANDIDATE'S HOME ADDRESS (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) L i a , {r' 7. CATEGO OR REPORT (Check one) ❑ ❑ ❑ ❑ ❑ MID YEAR YEAR-END FIRST SECOND THIRD FOURTH PRE- PRE DARTER QUARTER QUARTER UARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDINGDATEOFREPORTING 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 committee by the Campaign internal revenue codeded for the personal financial puaffirm that no rpose as defined campaign by theedebal ntriutions have Financial of the Disclosure e sanddate or fotlany other Ilwe swear nonpolitical or benefit i nature of political treasurer rdate si signature na yy of candidate date g 11. WITNESS SIGNATURE (or Ll t~ q•I signature of witness date signature of witness date 12. SUMMARY $ a. BALANCE ON HAND LAST REPORT b. TOTALRECEIPTSTHIS PERIOD (o c. TOTALDISBURSEMENTSTHIS PERIOD $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) e. TOTAL LOANS OUTSTANDING $ f. TOTALOBLIGATIONS OUTSTANDING Page 1 of RDA 1159 SS-1109 (Rev. 2106) A i ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 2. REPORT 4COVERI, HE PE RIOD 1. COMMITTEE FROM: un 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling mote than $100 to any payee during the period) Purpose of Expenditure Amount of Expenditure First Name Middle Name Las amel8usinessName jg" n Address i 1111 r) city state Zip Code Pu ose of Ex nditure Amount of Expenditure Frst Name Middle Name rP fre Last Name/Business Name Address CRY State Zip Code Purpose of Expenditure Amount of Expenditure Firs! Name Middle Name Last Name/Business Name Address City gtale Zip Code Purpose of Expenditure Amount of Expenditure First Name Middle Name Last Name/Business Name Address city Stale ZiP Code Purpose of Expenditure Amount of Expenditure First Name Middle Name Last Name/Business Name Address City Stale Zip Coda Purpose of Expenditure Amount of Expenditure First Name Middle Name Last Name/Business Name Address CRY State L'p Colo 5. TOTAL ITEMIZED EXPENDITURES Fag (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.) Page of RDA 1159 SS-1129 (Rev. 4/02) L CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT _ 12.a. NAME OF CANDIDATE OR COMMITTEE - n 3. ELECTION DATE 2.b. IF COMMITTEE, NA AF~~E 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route city State Zip Code Phone hone 4.b. CANDIDATE'S HOME ADDRESS (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) ~ RY r rn r L 7. CATEGO Y OR REPORT (Check on ❑ p MID-YEAR YEAR-END FIRST SECOND THIRD FOURTH PRE- MI SUPPLEMENTAL SUPPLEMENTAL QUARTER QUARTER QUARTER QUARTER PRIMARY DING DATE OF REPORTING PERIOD 8.a. BEGINNING DATE OF REPORTING PERIOD U, F?ECEIVED 9. (Check one) v ived to $1,000 or less NL~ expendi a. This campaign is exempt from detailed disclosure (because Complete ftemstio12d., 12e. ns (including in-kind) tures total $1,000 or less for this reporting period. b. [3 This campaign is required to file a detailed financial disclosure because contributions (inclu 'ngb -klrfd~ p6ivsd total than $1,000 and/or expenditures total more than $1,000 for this reporting period. ~ ' L L OL ~ 10. I/we do accounting of campaign conttributions and expenditures f required opbe reported by thelcandidate ocommittee by thetCthis ampaign is an accurate Addi expen benefit of the candidate or for any olther/no politicalrpu pose as de ed by thefederal1inte nal beenenue codeded for the personal financial Financial Disclosure s nature of political treasurer date gnature of candidate date 11. W NESS SIGNATURE signature of witness date signature of witness date 12. SUMMARY 7 a. BALANCE ON HAND LAST REPORT $ 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 Page 1 of RDA 1159 SS-1109 (Rev. 2106) CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 12.a. NAME OF CANDIDATE OR COMMITTEE of) - 09 - 19 1. 1 ( e. r 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE - r? 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone '7 03 :519/ 'q 9 1,5 R'l 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) 1 e, r 'l 1 Pk ('e :K f l 7. CATEGORY OR REP ; (Check one) FIRST SECOND THIREl El 0 D FOURTH PRE- PR - 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 Q4: In (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. _rioAft~ Q gnature of candidate date Ygnature of political treasurer date 11. WITNESS SIGNATURE 7~ cf-J signature of witness date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ sS~ . b. TOTAL RECEIPTSTHIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c. $7, e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ 4) SS-1109 (Rev. 2/06) Page 1 of RDA 1159 ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM -:a+~_ TO:~ .j -I " Amount 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 any contributor) Middle Name Contribution Received For: Amount of Contribution First Name LastNamelOrganizationName ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) state zip code Date of Contribution Aggregate This Election City 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 iddleName Contribution Received For: Amount of Contribution s am amzation ame ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) CRY state LpC~e Date of Contribution Aggregate This Election Occupation oyer 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 5. TOTAL ITEMIZED CONTRIBUTIONS (Carry forward to item 3. of next page N 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.) 0 SS-1131 (Rev. 2/06) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FRO y. _ TO; G Amount 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) , 4. 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 Name/Business Name I' 11 1 L C 7 r O-Ir Address 0 n~ `S r K City State Zip Code )L V-1 c, 9 6 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 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 Name/Business 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.) 1 (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) SS-1129 (Rev. 4/02) Page of RDA 1159 J ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD 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 Last Name/Business Name Address city State Zip Code Description of Obligation First Name Middle Name Last Name /Business Name Address -Fly- State Zip Code Description of Obligation Flrst Name Middle Name Last NameBusiness Name Address CGty State Zip Code Description of Obligation First Name 7 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 4.TOTALS (Total from Outstanding Balance - (End of Period) column must also be shown in item 23b. on summary page.) Afikk SS-1127 (Rev. 4102) Page of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates Tor Single-Candidate Committees 1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE 2.b. IF COMMITTEE. NAME OF CANDIDATE 3. ELECTION DATE rb' J 4.8. CAMPAIGN ADDRESS AND PHONE Street or Rural Route city state Zip Code Phone 4.b. CANDIDATE'S HOME ADDRESS (d 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) c t" 7. CATEGORY JDR R(Chock one) ❑ ❑ ❑ i] C3 FIRST SE TH&ID FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QkIARTER QUARTER QUARTER MARY GENERAL SUPPLEIvVENfA1. AL 8.a. BEGINNING DATE OF REPORTING PERIOD 8b. ENDING DATE OF REPORTING PERIOD J ' 9. (Chock one) a. This campaign Is exempt from detailed disclosure because conrbutions (including in- nil) received total $1,000 or less AND expendi- tures total $1.000 or less for this reporting period. (Complete Hems 12d., 12e. and 12f.) b. ® This campaign is required to file a detailed financial disclosure because contributions (including in4dnd) recelved total more than $1.000 and/or expenditures total more than $1.000 for this reporting period. 10. Uwe 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 expended for the personal financial benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. 4,A-0 An-vi _ ply AA /Y sig ature of candidate date s ' tore of political treasurer . date 11. WITNESS SIGNATURE signature of witneesss~ date signatureof witne date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ b. TOTALRECEIPTSTHIS PERIOD $ c. TOTALDISBURSEMENTSTHIS PERIOD $ 11 b j 72 d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) I v~ e. TOTAL LOANS OUTSTANDING $ f. TOTALOBUGATIONS OUTSTANDING $ SS-1109 (Rev. 2106) Page 1 of RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD FROM Tp: - RECEIPTS 15. CONTRIBUTIONS (other than bans and interest) a. Unhemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period)........, c. TOTAL CONTRIBUTIONS (other than bans and interest)(add 15.a. and 15.b.) 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 121.) 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) sJ $ . S $ a s $ $ Total of Expenditures ($100 or less each payee) b. Itemized Expenditures (Over $100 each payee this period) c. TOTAL EXPENDITURES (other than ban repayments)(add 19.a. and 19.b.) 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.) SS-1133 (Rev. 4/02) Page of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: TO: n 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter 40 if fast itemized page) d 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH RUIZED CONTRIBUTION oatbbNioru WYOV more than $100 horn a Filt Name hcdae Naive C nb u6on* For. Amour t of Contribution t,at yam, Eatwory Bacbm ❑ General Election Address -nn ❑ Runoff (Local Eiectkm Only) '16 C)) Q e 1 ~T CRY Skle Zip Code Date of Contribution Aggregate This Election a - tiSd . a HrstName W"eName ContrUllon Received For. Amount of Contribution NNU [gPrinwty Election ❑ General Election j"~1 O®, tl Addmss ❑ Runoff (Local Eledi m Only) qry Ste-~}e-y ` LpOoda Dale of Contribution Aggregate TMs Election 1 N Q 4 ,s r li*Nsft Name Contribution Received For. Amount of Cowbition RrPw~ Becton ❑ General Election. ` o Re-s) rA C- Runoff (Local Elections Only) ~a 3 P. 8, en~ (ky. Stare Lp Gods Data of Conn button Aggregate This Election y-~_,w ~~eoa Fist ANN Wddle Name a of ConbbA*n Last Name ` IRPrirnary Election ❑ General Election e A r 0 e© d Ad&M CD hTry ❑ Rune(( (Local Elections Only) a pry . 1 LpOoda -S Date of Conbbulion Aggregate TMs Election MAC~ temp q- 5. TOTAL ITEMIZED. CONTRIBUTIONS rArvyb wdiokemlafmA warod"orW »9«arftt mweweaj (Q t is k fro last pope of oonebvoons. #is arnwt mwt be strewn h Mesm 15b. a swwmaa SS-101(Rev. 2106) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NA YE F CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: TO: 4 - ~ noun 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 )f first hemized page) -8 - 4. COMPLETE THE APPROPRIATE ITEW FOR EACH ITEMIZED EXPENDITURE (expene'mxes bW" more than $100 to any PWW during the period) Fbl Name fiddle Name Purpose 01 Expenditure Amount of Expenditure s ~ ' L~, • Gam- ry rte. ~ ~ ~ , G a P sy s J c Sale zp co* L U Fiat Name fiddle Name Purpose of Expen6kure Amount of Expenditure t,sl Namereusiness IS_ r stale Zip Code PkWd , 3 e Uiddle Name Purpose o(Experlddne Amount of Expeedmrre l ~ y LastNanWBU8kWssNarne ; r ~ ~ rr n Q ` c, n mo, 1c r c Y/N J ~C, C~ J Ad&"6 Gr c- o r N ' t `n as , . I r r'1 j j ~Gi,.~S c1 lie- -10 1")997 First Nine W* Name Purpose of Expo ,*n Amount of Expendtm fast NamdBusinass Nine C T C, a- V- CA zip com c- 4 ~ Fkat Name Diddle Name Purpose of Expendture Amount o(Expenddre Lag Na raAk rom Name T. ~o I i Tr c- ~ 2 ).3.32 Address c t - J Ciy St* Lp Code Fkst Name V*"e Name Purpose of Expenditure Amount of E*orx 4rre Wt Na wffluskxss Name Address ab lrw.. Trvow. 5. TOTAL ITEMIZED EXPENDITURES (Carry forwardbNam7.anextpageraddiftWpapasdMform areusedJ 9 ~ ,g (If ft k ft hat pope o(a>"dikres. this amours aW be shown In lem 19b. of summary.) SS-1129 (Rev. 4102) Pape of RDA 1159 i 5 ITEMIZED STATEMENT OF OBLIGATIONS • CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: TO: 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED OutsWing Balance Debi Incurred Payments Outstanding Balance OBLIGATION (obrlgations totaling more than $100 owed to any Beginning of Period) This Period This Period (End of Period) Personlyenclor at the end of the reporting period) Rat Nam, Idddte Name Lest NamaBusiness Name Address Gh Stela Zip Coda Flat Nine Wld& a Name Address Ck $ala *C0* D-0-aot,rpeso„ Fkst Name VpMe Name hash Nat mevsiness Name Address C' Slade Zp Code oem"m aob4a6m nW Name Iiddte Name Lsst NxndBusinas Name Address store Z+D Codo oescrip6on at tkspation Flat Nana widdb Name Lest NamelBuskbss Name A&%u Stela Zip Code Deserfpson a Abfipargr, 4.TOTALS (Total lrom Outsta *V Balance - (End of Period) wk mn must also be shown in Ilem 23b. on summary Pape.) ® SS-1127 (Rev. "2) Pape of RDA 1159 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 the candidate 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: Candidates Name: A(Ze~J 1`(1 l Candidate's Position: Coffin ► C, a M M ViSS Residential Address: Q I) 5 W► I K Sam 1~ t State: TN Zip: 5"M3 City: I hereby state that I meet the above qualifications for exemption and am therefore exempt from filing financial disclosure statements. 03L-acz - Iy Candidate's Signature bate -ao -l4 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. RECEIVE i 2 ~,.M., FEB 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: K A R0_ u rn : 4. Campaign Address and Phone: City State Zip Code Phone 6 a I~ J a9 15 lsL 1 Ki n 56 ~ti' I~~ m AC~f Ile I tii 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 C 9. Treasurer dame: 10. Treasurer e-mail address: c, Q „ L f1 K M I. ; i G~ C-r e 11. Treasurer Address and Phone: City State Zip Code Phone ~S _ 53 I ~S oh flf ~,II~ I 120 12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurercan not witness candidate's signature): v ,41 ~►ti L 51ature of Candidate Signature of Treasurer Signature of Witnes Signature of ess Registry of Election Finance SS-1120 (rev 10/2010)