Benton, Douglas
FINANCIAL DISCLOSURE STATEMENT EXEMPTION
Pursuant to TCA 9 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.
Candidate's Name: S N~Q
Candidate's Position: CAA \ 0C9j\&&A S\00
Residential Address:
City: _ L CC*- State: TN Zip:
I hereby state that meet the above alif ications for exemption and am
t for exempt ro filin inancia isclosure statements.
Candi ates Signature Date
--nnA of\ ~JA . L
1__ Q_ 1~
I
itness'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.
jUN 12 LU W
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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. Dat : 2. Name of Candidate or Committee: 3. Candidate e-mail address:
1
4. Campaign Address and Phone: city
J~ State Zip Code Phone
T 2~ ~
~ (~1TN~ ~ItRCL~\LCc>A \ 1 D
-z
5. Home Address an Phone (if different th n item 4 above):
ty State Zip Code Phone
6. Office Sought (include districLumber, if applicable) 7. Party Affliation 8.Election Year
I L G O A Cw ~ L t C(a rJ 7-cD I
9. Treasurer Name:
n ~tpS> e N 1o ~ p vti t
10. Treasurer a-mail address:
11. Treasuredress and Phone: City State Zip Code Phone
S A L2
12. Candidate and Tr er Signature ( th signatures must be witnessed. rer can not wi ess ndi te's sig ture):
Signature of didate Si ature of Treasure
Signature of Witness Signature of Witness
Registry of Election Finance
SS-1120 (rev 10/2010)
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."
~nr
CANDIDATE'S INFORM TION:
Candidate !s Name: ~ ok 1v
"'D
Candidate's Position: _
Residential Address:
City: State: TN Zip: I
---r
I hereby state that I meet the above qual fi tions for exemption and am
t ref or a empt fr ng fi cial dis los restatements.
LU I~
Candidate's Signature D to 20
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.