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Stinnett, Tom CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates 'For Single-Candidate Committees 1. DATE OF REPORT 2.a. DIDATE OR COMMITTEE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS ANO PHONE Street or Rural Route city dstate` Zip Code Phone 7317 4.b. CANDIDATE'S HOME ADDRESS (rf different than 4.a.)7 Street or Rural Route City State Zip Code Phone 5. OFFICE SOU HT (include district number, If applicable) 6. NAME 6~CL. TREASURER (may be candidate)/ 7. CATEGORY OR 1 RT(Chedk one) ❑ ❑ ❑ ❑ FIRST SECOND THIRD FOURTH P1:1 1:1 RE- MI YEAR QUARTER QUARTER QUARTER QUARTER YEAf2❑END 8.8. BEGINNING DATE OF REPORTING PERIOD MARY GENERAL SUPPLEMENTAL SUPPLEMENTAL ~ ~ 8.b. ENOING DATE OF REPORTING 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• is campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 d/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 bee expend for the benefit of the candidate or r any other nonpolitical purpose as defined by the federal intern ue personal financial p signature o candidate date signs a of I treasurer date 11. WITNESS SIGNATURE 0-A A sign re of witness date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT S2 b. TOTAL RECEIPTS THIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD Q ` " d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) 7 ~tn e. TOTAL LOANS OUTSTANDING QOM P I. TOTAL OBLIGATIONS OUTSTANDING ..O p . $ 00 AML r1_ SS 1109 (Rev. 2R01i) ~~p 20~~ 24 cD IK" :;C. CO Page I of RDA 1159 1t tv~~ ~G1~Ot~ O SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD FROM: T0: RECEIPTS ~Z' 15. CONTRIBUTIONS (other than bans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) $ c. TOTAL CONTRIBUTIONS (other than loans 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 12.b.) $ 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) $ $ $ $ $ $ Z% Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 1 g.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD $ 21. TOTAL DISBURSEMENTS (add 1g.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.s. and 22.b.) $ 23.013LIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ G TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 121) $ AML SS-1133 (Rev. 4(02) Page of ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDAT ITTEE ' 2. REPORT COVERING THE PERIOD FROM: O:- ? It!_ i . 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 If first itemized page) moue 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (exper4ftw btar more than $100 to an ~ Y payee during Ore period) First Name k4ddle Name Purpose of Expenditure Amount of Expenditure, Last Nan&Susiness XV I ? v 3 ~ AAX eelG~ Address ~ G~1" C~' tA,1 ty, ` State Cade 6- First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Nameftsiness Name Address CtY Slate Zip Code Frsl Name Middle Name Purpose of Expenditure Amount of Expanddure Las, Narnenivskless Nome Address Cry Stale Zip Code First Name Middle Narne Purpose of Eltperldiplre Amount of Expenditure Last NamelBusiness Name Address City Stale Tip Code First Name lddle Nan* Purpose of Expenditure Amount of Expenditure Last NarneBusiness Name Address city stale hp Code First Name Wddle Name Purpose of Expenditure Amount of Expenditure Last NameBusiness New Address City stale rrp code 5. TOTAL ITEMIZED EXPENDITURES (Carty bnvard to ilem 3. of nerd page d additional pages of ft torn are used.) (N this k the last page of eapendNures. this a Taint must be shown in item 19b. of unmory.) ® SS-1129 (Rev. 4/02) Pape of RDA 1159 t -T4'f / / ~r •~l/ r 2- 2S 3 S 3 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. NAME OF~IDATE OR COMMITTEE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route ~Ci State Zip Code Phone L 2als , el 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) 7• GO OR REPORT (Check one) QUARTER 1:3 0 1:1 SECOND QYT~EJR THM FOURTH PRE PRE- MI YEAR YEAR❑-END QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 6.a. BEGINNING DATE OF REPORTING PERT , J 8.b. ENDING DATE OF REPORTING PERIOD %0--/ 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~ThQis campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 / d/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 for any other nonpolitical purpose as defined by the federal inter~l rtGenue code. signs ure of candidate date signs re of political treasurer date 41 11. WITNESS SIGNATURE - date signature f witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT b. TOTAL RECEIPTS THIS PERIOD $ (p c. TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) O e. TOTAL LOANS OUTSTANDING A~ 3 Pe>,t f. TOTAL OBLIGATIONS OUTSTANDING ~ 7.. ..RQE.I,~E~............ . AOL 1109 (Rev. 2=) rWR 2 4 2018 SS Page 1 of RDA t159 . ~ COUNT { MT Cb t4 - cn ELE CTION ro h'b Wd Z~ SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD s-~- FROM: 3-16 T0: ?/s? i✓ all RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ 5- b. Itemized Contributions (over $100 from each source this period) $ S~Q 0 c. TOTAL CONTRIBUTIONS (other than loans 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 12.b.) $ 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) Sr,P,r ~ J;' -19 $ / 71 $ $ $ $ $ $ 71 Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ 5 < ~o ~ c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD $ Q 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) ~v 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.OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ o. 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 •~~'pg FROM: TO: , r 0 17 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) Amount 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than $100 from an contributor Fkai Name Wddle Name Contribution Received For. Amount of Conbbjbon Last Nam CoVan¢riion Name } - LI f- r ry Election ❑ General Election /3L/vvA.0 'T- nma Address 3 2 17L ❑ Runoff (Local Elections Only) CRY ) ^ „ Lp Cod, O Dale of Contribution Aggregate Ttds Election Empbyor First Name WW&Name Contribution Received For. Amount of Cor*bX!on Leaf NamelOrganizaGon Name ❑ Primary Ekx6on ❑ General Election Address ❑ Runoff (Local Elections Only) City Stare Zip Code Date of Contrbubon Aggregate Ttus Election Oa:upa6M FrslName [Iliddle Name Contribution Received For. Amount of Contribution ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City Stare Zip Code Date of Contribution Aggregate This Election Oca"bon Employ- Fret Name Riddle Name or Amount of Contri Last NamarOntion Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) GA' State Zip code Date of Contribution Aggregate This Election Occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS (Carty lorward to kern 3. o(nesi page K addiGonal pages of this torte are used.) (If ft is t* test page of contnbuGons, this amount must be shown in item 15b. of anvnary.) SS-1131(Rev. 2106) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD / 't& S r0 n~ n/ FROM: TO: _ / g - rnoun 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enterSO'tf first itemized page) 4. COMPLETE THE APPROPRIATE WEMS FOR EACH ITEMIZED EXPENDITURE (expenditures btalwQ more Man $100 b any payee during Me period) First Name Mddle Name Purpose of Expenditure Arnount of Expenditure Last NamelBusiness Name r?~4r ' i • ° ,:a 3 Z.') 41 ~LYT/1Af 2e:r / O Address -40 37 Fist Name Middle Name Purpose of Expenditure Amount of Expendfture LLD ylJ last Name/Bush ss Name 0617 Address City y r v Zip Code Fast Name ►iddle Name Purpose of Expenditure Amount of Expenditure Last NamelBushm Name Address City Slab Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Bus#*ss Name Address City Stale Zp Code Fast Name Middle Narre Purpose of Expenditure Amount of Expenditure Last Narra%ines ; Name Address City State Zip Code Fast Name Middle Name Purpose of Expenditure Amount of Expenditure Last NartteBusiness Name Address CRY State zip code 5. TOTAL ITEMIZED EXPENDITURES ~p (Carty forward b item 3. of nexi pope N additional pages of ft form are used.) (K this Is tie last page of expenditures. Mrs amount must be shown In Nam 19b. of nxmary.) ® SSA 129 (Rev. 4102) Page of RDA 1159 L DISCLOSURE STATEME> T CAMPAIGN FINANCIAL For State and Local Candidates For Single-Candidate Committees NAME OF CANE OR COMMITTEE DATE OF REPORT 91 .r ~ ~ 3. ELECTION DATE 2.b. IF CO ITTEE, NAME OF CANDIDATE Zip Code Phone 3~~J - r 8~o~w 4.a. CAMPAIGN ADDRESS AND PHONE City State At" ~7 R I Street or Rural Route / ~6F- C t L 1'L/l / Zip Code Phone State 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a. Street or Rural Route be candidate) S applicable) 6. NAME OF POLITICAL TREASURER (may L OFFICE SOUGHT (include district number, if E3 ❑ Y OR REPORT (Check one) ❑ ❑ ❑ MID-YEAR YEAR END 7. CAE 13 _ PRE SUPPLEMENTAL 13 ITH FOURTH PRE GENERAL SUPPLEMENTAL PRIMARY IRS SECOND QUARTER F UARTER QUARTER QUARTER 8.b. ENDING DATE q REPORTING PE 8.a. BEGINNING DATE OF REPORTING PERIOD r kind received total $1,000 or less AND expendi- 9. (Check one) F] This campaign is exempt from detailed disclosure because tcontributions a. period. (complete tures total $1,000 or less for this reporting n is required to file a detailed 0 for this financial disclonuree 'od use contributions (including in-kind) received total more than $1,00 b. This campai9 nd/or expenditures total more than $1,00 report 9 P for and that this report is an reported nancial by the disclosure candid port is true swear or affirm that the information containedditures in this required to be campaign financial 10. I/we do solemnly committee Campaign financial contributions and exp accurate accounting of campaign code. Financial Disclosure Act. Additionally, Ilwe swear or affirm that no campaign contributions have ee benefitt 01 1 candi to o or any other nonpolitical purpose as defined by the federal inte I revenue ` 4 " t { date signat a of political treasurer L signatur of candidate 11. WITNESS SIGNATURE i signat a of witness date I date signature of witness i 12. SUMMARY a. BALANCE ON HAND LAST REPORT b. TOTAL RECEIPTS THIS PERIOD 3 c. TOTAL DISBURSEMENTS THIS PERIOD `J d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c. $ e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING pEGFJVFO•......... i r 9 ~~8 Page 1 of RDA 1159 fto(ft COO - S'5-1109 (Rev. 2106) ON SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR CO I EE (In Full) 14. REPORT COVERING THE PERIOD rLVIZ4 ~V1 FROM:,3 -~,v TO: RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) 00 a. Unitemized Contributions $100 or less from each source this period) b. Itemized Contributions (over $100 from each source this period) $ c. TOTAL CONTRIBUTIONS (other than loans 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 12.b.) $ 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) 3 I --18 S%c~, $ $ $ 2_7 7 $ $ Total of Expenditures ($100 or less each payee) $ J b. Itemized Expenditures (Over $100 each payee this period) $ 39 c. TOTAL EXPENDITURES (other than loan 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.) $ YJ 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. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $ SS-1133 (Rev. 4102) Page of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CAND DATE OR COMMITTEE 2. REPORT COVERING THE PERIOD L FROM: . / T0: Amoun 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) ~O 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totalin more than $100 from an contributor First Name Middle Name Contribution Received For: Amount of Contribution Las g )Zatio e XPrimary Election ❑ General Election Addres L ❑ Runoff (Local Elections Only) City S Zip Code Date of Contribution Aggregate This Election j^-1 37a4 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 iddle Name Contribution Received For: Amount of Contribution as 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 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 if 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.) SS-1131(Rev. 2106) Page of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees F1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 7-~ 7 ~F~S 3i a~ 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural City State Zip Code Phone 5. O FFICE SOUGH include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) ice`-sS~ - .s✓ 7,+ 5!~=l 7. CATEGORY OR REPORT (Check one) ❑ ❑ ❑ ❑ ❑ FIRST SECOND THIRD FOURTH PRE- PRE- MIl-Y AR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD 9. (Check o ) 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. 1/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 an other nonpolitical purpose as defined by the federal inter venue code ` - !i signatu of candidate date signatur f politica yeasurer date 11. ITNESS SIGN AT E (T signatu 1 ness date sign f witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ RECEIVED b. TOTAL RECEIPTS THIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD JAN 2 9 2018 . , $ TJLOUNT COUpJT'~ ELECTION 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 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates_ For Single-Candidate Committees 1. DATE OF REPORT 1 2.a. NAME OF CANDIDATE OR COMMI EE n R 'n ' Y ~ - 2 2 I ~ ~YY~ Ili ~C. 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE State Zip Code Phone Street or Rural Route City 4.b. CANDIDATE'S HOME 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~ TREA~ ER('m^ay be candidate) cc- -l 2~ 7. CATEGORY OR REPORT (Check oi1c ❑ ❑ FIRST SECOND FOURTH PRE- PRE- MI0 YEAR❑-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING 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 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 py~rpose_as_defined by the federal int enue code. zzca idate date signa re of olitical treas rer date W TNESS SIGNATURE 2 j > 11. date signature of witness date signature of witness 12. SUMMARY 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. $ ^ Fe. TOTAL LOANS OUTSTANDING f. TOTAL OBLIGATIONS OUTSTANDING $ Page 1 of RDA 1159 SS-1109 (Rev. 2106) w ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD FROM: T0: 3. COMPLETE THE PPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more than $100 from any source during the period) Complete the Following for the Source of the Loan First me Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance I l~ 1'x -1 / (Beginning of Period) Received Payments (End of Period) Last Name/Organization NanYe C_ Coll A Address Loan Received For: Date of Loan nlr 119 4(~ t .J~1J ❑ Primary Election ❑ General Election lx C X\51c erfh a City State Zip Code ❑ Runoff (Local Elections Only) List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page) First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding mount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Tip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding 4. Totals for all Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Total loans received should also be shown in item 16. on summary page.) (Beginning of Period Received Payments End of Period (Total loan payments should also be shown in item 20. on summary page.) (Total outstanding loan balance should also be shown in item 12.e. on front page.) SS-1132 (Rev. 4102) Page of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTIO DATE 1 7 E~tivyrY! L- - 4.a. CAMPAIGN ADDRESS ARID PHONE 6 Street or Rural Route City State Zip Code h ne o Z ibvl~Cd~ z_© 7 7 7 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or, to City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURE (may be candidate) 7. CATEGORY OR REPORT (Check one) FIRST SECOND THIRD FOURTH PRE- RE- MIDYEAR YEAR❑-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERT /J- 3 J r-/ 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. jhis cam paign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 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 ndidate or f r any other nonpolitical purpose as defined by the federal i it ue co e. signatur of can t signatur of political treasurer date id to da e -7 11. WITNESS SIGNATURE lk&Al\ (tlbf L L signature of witn' ess clue r signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT : $ b. TOTAL RECEIPTS THIS PERIOD ......,................;1,..... $ c. TOTAL DISBURSEMENTS THIS PERIOD .cf , a~. $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12. c.) .........a,`........... ,T $ e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ 0 SS-1109 (Rev. 2/06) Page 1 of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.8. NAME OF CANDIDATE OR COMMITTEE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 'W.-M r G 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route city state Zip Code Phone ! o Z ~~G•v ~211yic1~ (v v~7.~Z ~O~ Z© 4.b. CANDIDATE'S HOME ADDRESS ('d different than 4.a.) Street or Rural Route s State Zip Code Phone 5. OFFICE SOUGHT (include district number, If applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) Cov m 7. CATEGORY ORR POR Check one) 11 1:3 11 0 FIRST THIRD FOURTH PfiE PRE= MI YEAR YEAR-END QUARTER I;& QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DA OF REPORTING PERIOD 8.b. ENDING OF REPORTING 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.'KThis campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 ncVor 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. sig ure of candidate date signature f political treasurer date 11. WITNESS SIGNATURE signature of witness date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT -7 b. TOTALRECEPTSTHISPERIOD ................................................................................................5 c. TOTALDISBURSEMENTS THIS PERIOD $ O r r/ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) " 010 ~r e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING SS-1109 (Rev. 2/06) Pape 1 of RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDI R COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD L ~Y l,rv1..~ et FROM: TO: -7-.10-/ RECEIPTS 15. CONTRIBUTIONS (other than bans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ l> b. Itemized Contributions (over $100 from each source this period) $ c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 16. LOANS RECEIVED THIS REPORTING PERIOD $ t" ^'T 17. INTEREST RECEIVED THIS REPORTING PERIOD 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ 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) 4: Z/oz $ $ $ $ $ $ Total of Expenditures ($100 or less each payee) $ b. Itemized Expenditures (Over $100 each payee this period) $ yC~Zr 7~ 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.) 22AWKIND 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.) $ 23.013UGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ o TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $ SS-1133 (Rev. 4102) Page of s ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD T 11s ,w 2- FROM: 7w TO: -10 nt 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter SOH first eternized page) 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than $100 from an contribu6or Fist Name hurdle Name Coontribbulion'Recetved For. Amount of Contribution Last Name/Orpw"tim Name ~-y ~Ptirnary Election General Election q aL190.4 I;'- Addr? 01 ® /0A/ [3 Runoff (Local Elections Only) CRY Lpcode Date of Contribution Aggregate This Election oomwtion Empbyer First Name hfddleName Contribution Received For. Amount of Contribution teat Nams Orparirrabm Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City state zp Coae Date of ConMbutlon Aggregate This Election 0-*dtion Fast Name Name Contribution Received For. Amount of Contribution Last NsmW0fpmz@bm Nam ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) C4 stare 14COde Date of Contribution Aggregate This Election Occupation EwOW Fist Name iWdleName Contribution Received or Amount o Contribution Lest Narnelorparr m6w Name ❑ Prirtlary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City Stale Zip Code Date of Contribution Aggregate This Election occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS (Carty lorrrard b lern 3. of nett pays f additional pages of ft form are used.) (f free is fie 1W page or contib Aom, fas w=W must be show it item 15b. of armrary.) Amk SS-1131(Rev. 2/06) Page of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPOFA / 12.a. NAME OF CAND TE OR COMMITTEE o V -11 3. ELECTION DATE 2.b. IF COMMITTEE, NAME OF CANL7TE .rte 4.a. CAMPAIG ADDRESS AND PHONE Cit State Zip Code Phone Street or Rural Route y 3~ n Z S TAG 3 1111 4.b. CANDIDATE'S HOME ADDRESS (if different h Yn 4.a.) State Zip Code Phone Street or Rural Route y 02- 'off .+t ~vDfd~ ccr= 7N 3 973 2 F 67 A~ e7II r7. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) ~o,~,i ssio v s T 7 7715 PI Y S ry ti~~'7'' CATEGORY OR REPORT (Check one) El 0 FIRST SECOND THIRD FOURTH PRE- MI EAR YEAR❑-END ER RIMAR GENERAL SUPPLEMENTAL SUPPLEMENTAL QUARTER QUARTER QUARTER QUART 8.b. ENDING DATE OF REPORTING PERIOD 8.a. BEGINNING DATE OF REPO TINGPERIOD ~ I/- - 2 Z/_/_/ 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 nd/or expenditures total more than $1,000 for this reporting period. 10. I/we d_-o 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 Finan losure Act. Additionally, I/we swear or affirm that no campaign contributions have been expended for the personal financial cial Disc benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. 04 ~4 c l of signatu date signature of political treasu er date FWITNE'S SIGNATURE date signature of witness date ture of witn ess 12. SUMMARY ~ Z .i HAND LAST REPORT $ 1 a. BALANCE ON $'C b. TOTAL RECEIPTS THIS 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 SUMMARY PAGE - CANDIDATE 14. REPORT COVERING THE PERIOD 13. NAME OF CANDIDATE OR COMMITTEE (In Full) FROM: TO: RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.).....••••••••••••••••••••••...•'•""•'$ 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 12.b.) DISBURSEMENTS 19. EXPENDITURES (other than loan payments) must be listed by category - e.g~nting, postage, gasoline) a. Expenditures ($100 or less each payee this period) ZI.l.L DAL 60-1 Vj O-S $ s rna`'tv~vt~ $ =0'7- $~z /!o $ $ $ Total of Expenditures ($100 or less each payee) $ b payee this period) $ Itemized Expenditures (Over $100 each c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD I 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. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) Page of SS-1133 (Rev. 4102) A 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 Z- Ti f /J~•fr (o 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route city state Zip Code 3773' Phone 940r e o 2 SAGE G'4AC-_// Cam , .t= ; . 4.b. CANDIDATE'S HOME ADDRESS (d different than 4.a.) 207 72A Street or Rural Route City State Zip Code Phone O 2 S 6E &-;Vbxvl a 27-732 r4r- o Abe irp 5. OFFICE SOUGHT (include district number, If applicable) 6. NAME OF POLITI TREASURER (may be candidate) Gott ~ S-&-;Pr-r `7 A L_ ,F- 7. TE Y OR REPORT (Check one) ❑ SECOND SEO T~ FOURTH PR P❑R& MID-YEAR YEAR-END QUARTER QUARTER QUARTER MARY GENERAL AL 91PPLEM AL 8.a. BEGINNING DATE OF REPORTING PERIOD 8b. ENDING DATE OF REPORTING PERIOD 1-1(0"2013- 9. (Check one) a. ❑ This campaign Is exempt from detailed disclosure because contributions (including "rid) received total $1,000 or less AND expendi- tures total 51,000 or less for this reporting period. (Complete Items 12d., 12e. and 12L) b.XThis campaign is required to file a detailed financial disclosure because contributions (including "rid) received total more than $1,000 ndlor 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 AcL Additionally, l/we swear or affirm that no campaign contributions have been expended for the personal fancial benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. L 3-, signs a of cand ate date signature of political treasurer dare 11. WITNESS SIGNATURE • ignature of witness date 4nature of witness at! 12. SUMMARY a. BALANCE ON HAND LAST REPORT S b. TOTALRECEIPTSTHIS PERIOD . $ c. TOTAL DISBURSEMENTS THIS PERIOD $ • d. BALANCE ON HAND (12.a. plus 12.b. minus 12.a) 'Z • e. TOTAL LOANS OUTSTANDING S ' f. TOTALOBLIGATIONS OUTSTANDING O SS-1109 (Rev. 2106) Page 1 of RDA 1169 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) I'll III L 14. REPORT COVERING THE PERIOD RECEIPTS FROM: ro: 3-Al 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 ri) $ 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., W. and 17.) (must be shown in item 12.b.) 5 310 DISBURSEMENTS 19. EXPENDITURES (other than loan payments) a. Expenditures ($100 or less each payee thjs p@riod) (must be listed by cat ~ e8°ry - e.9 Printing, postage, gasoline) S S 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 I9.b.) $ 93.9. 20. LOAN REPAYMENTS MADE THIS PERIOD 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) 3 22.IN-KIND CONTRIBUTIONS a. Unhemized in-kind contributions ($100 or less from each source this periog) $ 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! item 12J.) Page of ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD N FROM: TO: f _ l 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 9 first itemized page) moon 4. COMPt.ETE THE APPROPRIATE ITEMS FOR EACH ITEMQED EXPENDITURE (experiftm bt faq more Uwn $100 b any paym during t,e period) First Name L L d Y N hurdle Hama Purpose Of Expenditure Amount Of Expen dihxe Last Nameff3usirress Name , tt 2 5:S- &a 4'39• First Name h6ddle Name Purpose of Expenddure Amount d Expenditure Last Naveffl shie 3 Name Address ab stage zip code First Name Middle Name Purpose of Exp&Xk nC Amount of Expenft" Last NxnsDAtias Name Address a0 Stale zip code Fast Name Udde Name Purpose of B per>Q m Amount o(Experx4hxe Last NameSAinass Name Address civ stale zip cede First Name piddle Name Purpose of Expenftre Amount o(Fxpenditore Last Hamel&aYress Name Address Car swe rp Code First Name piddle Name Purpose of Expenditure Amount of Expenditure Last NamefBuskwu Now Address a4' Stale zip code 5. TOTAL ITEMIZED EXPENDITURES (Carty toward b Nam a. of nW papa raaditiorW pages of dies form are used.) (If tilt Is Vis lad pope of exWW x". tis amoral mitt be shown in Nam 19tk of summary.) Allk SS-1129 (Rev. 4102) Pape 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, 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: 4. Campaign Address and Phone: City State Zip Code Phone 102-4 577 &dOA4 -W 4.1v ~r 7;;l Zo Z Z zo 7 -4-117117 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 Affiiation 8. Election Year CovAlrY ~m,nisria~ ,QE'pv13~/~ zo 9. Treasurer Name: 10. Treasurer e-mail address: 11. Treasu rer Add ress and Phone: City State Zip Code Phone 12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature): Z_ Pro' Signature of Candidate Signature of Treasurer 1~ At; FtE 9nature of Witness Signature of Witness Si Registry of Election Finance SS-1120 (rev 1012010) wd Z~ ' I FINANIICIAL DISCLOSURE STATEIAEN'T EXEIAPTION RECEIVED Pursuant to TCA § 2-10-101(b) a candidate is exempt from filing financial JAN 29 2018 disclosure statements due to the following: 8LOUNT000NTY ELECTION 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 financial disclosure reports regardless of compensation or spending. CANDIDATE'S INFORMATION: Candidate's Name: S//GVr+i- Candidate's Position: i~/'/-~~ Residential Address: /0 L41- City: 71il t~'y~ fi~ C S State: TN Zip: 3 7 7?7 1 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. Candi ate's Signature Date Witness's Signa ure Date