Blount County Defenders
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For Muiticandidate Committees (PACs)
1. DATE OF REPORT f 2. NAME OF COMMITTEE
-7- 2 -I I
2.A. SHORT NAME OF COMMITTEE (IF APPLICABLE)
3. ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
33/ ( /,.Azu_: crff+Pcz Rt, /1'l4~y~,; 37ev3 60 65= I,~t- o ro ~a
4. TYPE OF CANDIDATES SUPPORTED
STATE PUBLIC OFFICV. 15§, LOCAL PUBLIC OFFICE ® BOTH
5.A. NAME OF POLITICAL TR URER T.6. DATE APPOINTED
A) b,4 i') Cr
6. CATEGORY OR REPORT (Check one
IR SECOND THIRD FOURTH ~ O OAR ~ D
QUARTER QUARTER QUARTER QUARTER 9%0& SUPPLEMENTAL SUPPLEMENTAL
7.A.BEGINNING DATE OF REPORTING PERIOD 77.B.ENDING DATE OF REPORTING PERIOD
8. (Check one)
A. This committee is exempt from detailed disclosures because contributions (including in4dnd) received total $1.000 or less AND
expenditures total $1,000 or less for this reporting period. I do soiemly swear or affirm that the information contained in this statement
is true and that the committee has complied with all applicable provisions of the Campaign Financial Disclosure Act. (items 10d., 10e.
and 1Df must also be completed.)
B. This committee 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. I do solemy swear or affirm that the information contained
In this statement is true and that the following page(s) are a complete and accurate accounting of all contributions and expenditures
required to be reported by political campaign committees by the Campaign Financial Disclosure Act.
4-1
signature of political treasurer date
9. WITNESS SIGNATURE
wd u,~
signature of wi es date
10. SUMMARY ` L F~ 1-
LoCA4 'n
a. BALANCE ON HAND LAST REPORT S Y('C J~
-
b. TOTAL RECEIPrsTHtSPERIOD / 3 rf
c. TOTAL DISBURSEMENTS THIS PERIOD $ a
o
d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) $
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1122(Rev. 2/06) RDA Pending
APPOINTMENT OF POLITICAL TREASURER
For Multi-Candidate Committees (PACs)
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 multi-candidate committees (PACs). 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.
Committees that make contributions only to candidates for state public office must file this forth and a $100 annual fee with the
Registry of Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360. Committees that make v
contributions only to candidates for local public office must file with the local county election commission in the county where the
contributions are made. Committees giving to both state and local candidates should file the original with the Registry and a copy
with the county election commission in any county the committee is making contributions.
1. Date 2. Name of Cortuniltee
C0 C,(N-7-
3. Address and Phone Street or Rural Route city state Zip Code Phone
93(I Aws- 09flPe-L fib, MogR Vf~--C ll✓ Y M10-3 (X65) &U-061~.,2
4. Committee Name as it Appears on Checks 5. Type of Candidate Supported (Check One or Both)
f L C L, /C' C. e+ Lc iV 7Y C F,5- JJN G-R S Ej State Candidate Local Candidate
6. Treasurer Name 7. E-mail Address
8. Treasurer Address and Phone street or Rural Route City State Zip Code Phone
9. Is your committee controlled by a political party on the national, state of local level or by a caucus of a political party established by the
members of either house of the general assembly?
❑ Yes S No
Name of Party (Democrat or Republican)
10. Is your committee affiliated with any other multi-candidate committee? If yes, please list name and address of committee(s) below.
❑ Yes 0 No
11.--7~Committee Officers (Name, Position and Address) (Must list at least one officer in addition to the treasurer listed above)
JortNiltA.Z~ C'wcK. 3C>07 eLD 41 iK1~L Rr~ fv(firrYvr~Cc
G ~~0 t; f~ E' F4 t t_ L. 9 9 3 mZ. t-'-r4 i C A K_< b k. t l 1:1
' `06,_ 7- Ve G EL. 3015 Col'(N;rzX AI E DCCL.s /i~j,q,~y✓, ~c
J_, otoRt i LL ocKS T D. 13oX l 4L c<7,4
~OSkPi-i ~ rU~ 331 ~ ~,,4u.'S ~11Af£"L ~/Q~\~(J/LLE
12. Appointing Authority and Treasurer lure (Both signatures must be witnessed. Treasurer can not witness signature.)
tt/ ~111~
Signature of Appointind&diertly Signature of Treasurer(-/
Signature of witness Signature of witness
ELECTRONIC FILING
If you are interested in filing your campaign financial disclosure statements with the Registry electronically then you will need an ID
and password. You may go to https://apps.tn.govAncamp to see a demonstration of the electronic tiling system. If you check the
box below and sign, the Registry will send you an ID and password along with instructions on how to get started on the electronic
filing system. If you have any questions, please feel free to conta dfioe at (615) 741-7959.
❑ I would like to receive an ID and Password I mpai fins isdosure statements electronically.
~ aECEIV
Registry of Election Finance ED °
Hmlv~m SS-1112 (Rev. 11/17) RDA Pending
7 AL 5 20,18
BLOCJN7'COUNTy N)
s ELECTION1
lee 9 S ~ c Z t'~ ~~A
SUMMARY PAGE - PAC
11. NAME OF COMMITTEE (In Full) 12- REPORT COVERING THE PERIOD
FROM TO:
RECEIPTS
13. 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 13.a. and 13.b.) $
14. LOANS RECEIVED THIS REPORTING PERIOD $
15. INTEREST RECEIVED THIS REPORTING PERIOD $
16. TOTAL RECEIPTS (add 13.c., 14., and 15.) (must be shown in item 10.b.) $ 0
DISBURSEMENTS
17. EXPENDITURES (other than loan payments)
a. Unitemized Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage,
gasoline)
,X , A, or CTl+I e S $ I ty' • &0 - j t= om
"Tv S u P100 AT- C Aiu D I $
F-0 k STS E? F F i e c $
$
$
Total of Expenditures ($100 or less each payee) $
b. Itemized Expenditures (Over $100 each payee this period) $
c. Independent Expenditures $ / a q--7
d. TOTAL EXPENDITURES (other than loan repaymentsxadd 17.a., 17.b. and 17.c.) $ ~7
/
18. LOAN REPAYMENTS MADE THIS PERIOD $
19. TOTAL DISBURSEMENTS (add 17.d. and 18.) (must be shown in item 10.c.) $ 3 / Y
20.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 20.a. and 20.b.) $
21. LOANS
LOANS OUTSTANDING (must be shown in item 10.e.)........
22. OBLIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $
b. Itemized Obligations Outstanding (Over $100 each)
c. TOTAL OBLIGATIONS OUTSTANDING (add 22.a. and 22.b.) (must be shown i item 10.0 $
SS-1136 (Rev. 11/04) Page of
ITEMIZED STATEMENT OF INDEPENDENT EXPENDITURES - PAC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
ti Lo CA-/U (20 i'c ,L) >~~E NItsE25 FROM: TO:
Amount
3. TOTAL ITEMIZED INDEPENDENT EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) /a 79 =
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED INDEPENDENT EXPENDITURE (expendkm totaling more than $100 to any payee during the
period). Please remember to include the purpose of the expendibue (e.g. postage, printing) and the name of the candidate supported or opposed.
First Name We Name rpose of Expenditure taunt of Expenditure
S~e( T fiddl n !l ~7p
Last Named N. WILL ` H "Y\ R 7
t ttMS
Address Candidate Supporw or opposed & oft Sough We of Expe dWm
r1`4 L/9 C' I v t T rl apposed ❑
City Coda i N 5,~, vR `J-- lbw
;Wkle 37 FO(
First Name Name of FterMpure wM of ExperWlu"
last NameGusirm Name
Address Canddate Supported or Opposed & Office Sought Opposed ❑ Date of Expenditure
CRY Code Suppoded ❑
First Name fiddle Name Pu pose of Expenditure A "aunt of Expenditure
Last NamwBusiness Name
Address CWKM to Supported or opposed & Office Sought oPDaed ❑ Date of Expendture
city Code Supported ❑
First Name Name of Expenditure t of Expenditure
Last Namegue6bse Name
Address Cerddete Supported or Opposed d Oflics Sought Dare of ExperrdWre
Opposed ❑
city a Code Supposed ❑
First Name ikkk Name of EVoubaae M of Expenditure
Last NamelBusrtbss Name
Mdress Carxkk to Supported or Opposed & Office Sought opposed 13 Date of Expendihxe
city to Code Supper ❑
First Name fiddle Name
rpoae of Expenditure aunt of Expenditure
Last NarnSusiness Name
Address
Candidate Supported or Opposed & Moe Sought Opposed C3 Date of Expenddure
Qtlf to Zip code Supported ❑
5 (a) Itemized Independent Expenditures $
(b) Unitemized Independent Expenditures $
c Total Independent Expenditures ff this is the last page of ind. expenditures, this amount must be shovvin in item 17c, of summa a 471
D SS-1139 Page of RDA 1159
Rev. 1 l00
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For Muiticandidate Committees (PACs)
1. DATE OF REPORT 2. NAME OF COMMITTEE
T cFEti ~ Cis
2.A. SHORT NAME OF COMMITTEE (IF APPLICABLE)
3. ADDRESS AND PHONE
Street or Rural Route d City State Zip Code Phone
3f i ( L A-ws L1 r~P~ M~R~ 7'~J 379o3 &f~-~
4. TYPE OF CANDIDATES SUPPORTED
STATE PUBLIC OFFICE ❑ LOCAL PUBLIC OFFICE BOTH
5.A. NAME OF POLITICAL TREASURER 5.13. DATE APPOINTED
6. CATEGOR ❑ YO E he on H E] 1:1 EPRE- l MID-YEAR YEAR-END
FIRST
PRE FOURTH QUARTER QUARTER QUARTER R PRIMARY.. GENERAL SUPPLEbfff& PP
7.A.BEGINNING DATE OF REPORTING PERIOD 7.B. ENDING DATE OF REPORTING PERIOD
r, /3 S,
8. (Check one)
A. This committee is exempt from detailed disclosures because contributions (including in-kind) received total $1,000 or less AND
expenditures total $1,000 or less for this reporting period. I do solemly swear or affirm that the information contained in this statement
is true and that the committee has complied with all applicable provisions of the Campaign Financial Disclosure Act. (Items 10d., 10e.
and 10f must also be completed.)
B. This committee 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. I do solemly swear or affirm that the information contained
in this statement is true and that the following page(s) are a complete and accurate accounting of all contributions and expenditures
required to be reported by political campaign committees by the Campaign Financial Disclosure Act.
signature of political treasurer date
9. WITNESS SIGNATURE
-7-1 -1P
signature of itn date
10. SUMMARY
a. BALANCE ON HAND LAST REPORT $
-0-
b. TOTAL RECEIPTS THIS PERIOD $
c. TOTAL DISBURSEMENTSTHIS PERIOD $ 17
d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) $
y,,x
e. TOTAL LOANS OUTSTANDING .............................................D+ X.0
f. TOTAL OBLIGATIONS OUTSTANDING .ea $
'1 4
All
O
'A
3'Q V /
SS-1122(Rev.2/06) 4a A.' RDA Pending
11. NAME OF COMMITTEE (In Full) SUMMARY PAGE - PAC 12. REPORT COVERING THE PERIOD
FROM TO:
RECEIPTS
13. 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 13.a. and 13.b.) $
14. LOANS RECEIVED THIS REPORTING PERIOD $
15. INTEREST RECEIVED THIS REPORTING PERIOD $
16. TOTAL RECEIPTS (add 13.c., 14., and 15.) (must be shown in item 10.b.) $
DISBURSEMENTS
17. EXPENDITURES (other than loan payments)
a. Unitemized Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage,
gasoline)
$
Total of Expenditures ($100 or less each payee) $ O
b. Itemized Expenditures (Over $100 each payee this period)
c. Independent Expenditures $
d. TOTAL EXPENDITURES (other than loan repayments)(add 17.a., 17.b. and 17.c.) $
18. LOAN REPAYMENTS MADE THIS PERIOD $
19. TOTAL DISBURSEMENTS (add 17.d. and 18.) (must be shown in item 10.c.)
20.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 20.a. and 20.b.) $
21. LOANS
LOANS OUTSTANDING (must be shown in item 10.e.)
22.013LIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $
b. Itemized Obligations Outstanding Over $100 each $
c. TOTAL OBLIGATIONS OUTSTANDING (add 22.a. and 22.b.) (must be shown i item 10.f.) $
SS-1136 (Rev. 11/04) Page of
ITEMIZED STATEMENT OF EXPENDITURES - PAC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
7-3 l c U /t) i t ' i -D C-f E ND f-- fC-5 FROM: TO: (p 3 7
Amount
3. TOTAL ITEMIZED EXPENDITURES FROM PRECEDING PAGE (enter $0 iffirst itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED EXPENDITURE (expenditures totaling more than $100 to any payee during the period). If the ex
penditure is an in-kind contribution to a candidate, please remember to include the purpose of the expenditure (e.g. postage, printing) along with the candidate's name in
the purpose of expenditure section.
First Name iddie Name urpose of Expenditure ount of Expenditure
Last N usiness Name
LtIL B P/ej O 7.
Address Date of Expenditure
//42
Oily State Zip Code
First N. iddle Name Purpose of Expenditure ount of Expenditure
Last Nemai9usmess Name I r A
A( L -iT LNe, / -Y- S
ate of Expenditure
Address
x -71
city <1 State 'code ~{~a6 /f
-TI) 37P
First Name Middle Name Purpose of Expenditure mount of Expenditure
Last Name/Business Name
ate of Expenditure
Address
city state Zip Code
laaa"aaaaa
First Name iddle Name Purpose of Expenditure cunt of Expenditure
Last Narra&wiess Name
ate af Expenditure
Address
City State Zip Code
First Name Middle Name urpose Expenditure cunt of Expenditure
Last NanwBusiness Name
Date of Expenditure
Address
City State Zip Code
First Name Iddle Name urpose of Expenditure ount of Expenditure
Last NameGusiness Name
Date of Expenditure
Address
City State Zip Code
5. TOTAL ITEMIZED EXPENDITURES
(Cant' forward to item 3. of next page if additional pages of this form are used.) a/
If this is the last pace of campaign expenditures, this amount must be shown in item 17b. of summary.)
SS-1119-E (Rev. 1/00) Page of RDA 1159
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For Multicandidate Committees (PACs)
1. DATE OF REPORT 2. NAME OF COMMITTEE
G
2.A. SHORT NAME OF COMMITTEE (IF APPLICABLE)
3. ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
3~ll Ads htfl~~c~
4. TYPE OF CANDIDATES SUPPORTED
STATE PUBLIC OFFICE LOCAL PUBLIC OFFICE BOTH
5.A. NAME OF POLITICAL TREASURER
5.B. DATE APPOINTED
4- ( A) D li J< f A)
L~r -7
6. CATEGORY OR REPORT (Check one E] 11
FIRST SECOND THIRD FOURTH PRE- O- MID-YEAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
7.A. BEGINNING DATE OF REPORTING PERIOD 7.B.ENDING DATE OF REPORTING PERIOD
8. (Check one)
A. M This committee is exempt from detailed disclosures because contributions (including in-kind) received total $1,000 or less AND
expenditures total $1,000 or less for this reporting period. I do solemly swear or affirm that the information contained in this statement
is true and that the committee has complied with all applicable provisions of the Campaign Financial Disclosure Act. (Items 10d., 10e.
and 10f must also be completed.)
B. This committee 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. I do solemly swear or affirm that the information contained
in this statement is true and that the following page(s) are a complete and accurate accounting of all contributions and expenditures
required to be reported by political campaign committees by the Campaign Financial Disclosure Act.
..S
signature of political treasurer date
9. WITNESS SIGNATURE
signature of ' date
10. SUMMARY -~yy v
S, rfy2l
a. BALANCE ON HAND LAST REPORT $ / c A;
b. TOTAL RECEIPTS THIS PERIOD 7 /9 /C/ru
c. TOTAL DISBURSEMENTS THIS PERIOD $ I 7~
d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) b 5 U
e. TOTAL LOANS OUTSTANDING $
r$a
f. TOTAL OBLIGATIONS OUTSTANDING .....................................I~InCe.~kF~...................................................... $ - C~
APR 2 0 2018
SS-1122(Rev. 2/06) 13LOUNT COUW RDA Pending
ELECTION
SUMMARY PAGE - PAC
11. NAME OF COMMITTEE (In Full) 12. REPORT COVERING THE PERIOD
C
FROM T0:
RECEIPTS
13. CONTRIBUTIONS (other than loans and interest)
i F
a. Unitemized Contributions ($100 or less from each source this period) $
b. Itemized Contributions (over $100 from each source this period) $ b D i
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 13.a. and 13.b.)
14. LOANS RECEIVED THIS REPORTING PERIOD $
15. INTEREST RECEIVED THIS REPORTING PERIOD
16. TOTAL RECEIPTS (add 13.c., 14., and 15.) (must be shown in item 10.b.) l 3 l cz
DISBURSEMENTS
17. EXPENDITURES (other than loan payments)
a. Unitemized Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage,
gasoline)
i $
$
$
$
$
Total of Expenditures ($100 or less each payee) $ O -
b. Itemized Expenditures (Over $100 each payee this period) $ C~
c. Independent Expenditures $ /
d. TOTAL EXPENDITURES (other than loan repayments)(add 17.a., 17.b. and 17.c.) $
O 7~- 7
18. LOAN REPAYMENTS MADE THIS PERIOD $
19. TOTAL DISBURSEMENTS (add 17.d. and 18.) (must be shown in item 10.c.) $
20.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 20.a. and 20.b.) $
21. LOANS
LOANS OUTSTANDING (must be shown in item 10.e.)
22. OBLIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $
b. Itemized Obligations Outstanding (Over $100 each) $
c. TOTAL OBLIGATIONS OUTSTANDING (add 22.a. and 22.b.) (must be shown i item 10.f.) $
SS-1136 (Rev. 11/04) Page of
ITEMIZED STATEMENT OF CONTRIBUTIONS - PAC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
c
~C'
FROM: T0: _Zf_ 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 an contributor during the period
First Name / M.I. n Last Name/ anization Name AmountofContributon
I 'j
Address
city State Zip Code
~ Dale of Contribution
Occupation Employer
l~ ~ T/ v2
First Name M.I. Last Name/Organization Name AmountofConlriMon
,4• JL( o C LS
Address
City State Zip Code Date of Contribution
L ~ 7-rJ 3 ' 'J r✓ l
Occupation li\ Employer
FirstNa M.I. Last NameOrganizationName AmountofContribufion
j~ DNAC-~ f~ ~t>SEL L-
Address _
i
City State Zip Code Date of Contribution
L 4 -7 -7 f
Occupation Employer C ( v
~j - ~F Fc sir ' ( ( CAD i 7 0
First Name M.I. Last Name/Organization Name AmountofContribution
Address
City State Zip Code Date of Contribution
OccupationJ 3 Employer
ET f L 21et, t -
First Name b M.I. Last a elOrlgganization Name AmountofConbbAon
Address
city State Zip Code Date of Contribution
VILL,C I N
Occu ation -5L Employer
-7~'j F fz,- - I Cyv 4- t I = l-t
First Name M.I. Last Name/Organization Name AmountofContnbuticn
Address
City State Zip Code Date of Contribution
Occupation Employer
57OTAL 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 13b. of summary.) 0
SS-1119-C (Rev. 2/06) Page of RDA 1159
ITEMIZED STATEMENT OF EXPENDITURES - PAC
1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD
t o~~N r` ~0 L'_ FROM: TO: L{-Z(--Q
Amount
3. TOTAL ITEMIZED 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). If the ex-
penditure is an in-kind contribution to a candidate, please rememberto include the purpose of the expenditure (e.g. postage, printing) along with the candidate's name in
the u ose of expenditure section.
First Name Middle Name urpose of Expenditure mount of Expenditure
Last Nam 1B iness Name
t f~ LLE 7p,I ti k5 TNC J I J=
Address Date of Expenditure
City
State Zip Code
6
S U.)
car y .A r i N 7
FirstName Middle Name Purpose of Expenditure mount of Expenditure
Last Name/Busi ss Name
Address Date of Expenditure ID '7 City State t Zip 3 Cod e '7 f
First Name t T ' Mid/d`leeName l/L Purpose of Expenditure mount of Expenditure
Last Name/Business Name
Address n ate of Expenditure
City ij 3 j{
First Name Middle Name Purpose of Expenditure mount of Expenditure
Last NameBusiness Name
Address Date of Expenditure
City State Zip Code
First Name Middle Name Purpose of Expenditure ount of Expenditure
Last Name/Business Name
Address Date of Expenditure
City State Zip Code
First Name Middle Name urpose of Expenditure mount of Expenditure
Last Name/Business Name
Address ate of Expenditure
City State Zip Code
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to item 3. of next page if additional pages of this form are used.) / p ~7~ LI
If this is the last page of campaign expenditures, this amount must be shown in item 17b. of summary.)
SS-1119-E (Rev. 1/00) Page _ of -I RDA 1159
APPOINTMENT OF POLITICAL TREASURER
For Multi-Candidate Committees (PACs)
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 multi-candidate committees (PACs). 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.
Committees that make contributions only to candidates for state public office must file this form and a $100 annual fee with the
Registry of Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360. Committees that make
contributions only to candidates for local public office must file with the local county election commission in the county where the
contributions are made. Committees giving to both state and local candidates should file the original with the Registry and a copy
with the county election commission in any county the committee is making contributions.
1. Date 2. Name of Committee
Lb~Fcr~~crs
3. Address and Phone Street or Rural Route city State Zip Code Phone
4. Committee Name as it Appears on Checks 5. Type of Candidate Supported (Check One or Both)
c• nl ; p c t ,+J ; L Fc ~J r S ❑ State Candidate Local Candidate
6. Treasurer Name
Ljx)DA
7. Treasurer Address and Phone Street or Rural Route city State Zip Code Phone
Sri M~
8. Is your committee controlled by a political party on the national, state of local level or by a caucus of a political party established by the
embers of either house of the general assembly?
❑ Yes ® No
Name of Party (Democrat or Republican)
9. Is your committee affiliated with any other multi-candidate committee? If yes, please list name and address of committee(s) below.
❑Yes [D No
10. Committee OfficersJ (Name, Position and Address) (Attach additional page if necessary)
r 3a ~ftl2 0AK-5 M,g kvt «E
~D fj c /Z V L ~L D I S pw ( i~~jT2 M E c a S ( fl i2~~ t/ 1 LL E
~'l)It `cc`-iL5 0• 0 I s T1 L
y5 r F i, C C H fkP~'r , lei" r cc
11. Appointing Authority and Treasurer Signature (Both signatures must be witnessed. Treasurer can not witness signature.)
Signature of Appointing Aut Signature of Trea rer
Signature of Witness Signature of Witness
ELECTRONIC FILING
If you are interested in filing your campaign financial disclosure statements with the Registry electronically then you will need an ID
and password. You may go to www.tennesseeanytime.org/tncamp/ to see a demonstration of the electronic filing system. If you
check the box below and sign, the Registry will send you an ID and password along with instructions on how to get started on the
electronic filing system. If you have any questions, please feel free to contact the R'eglstry office at '(615) 741-7959.
❑ I would like to receive and ID and Password to file campaigro6bricial disclosure stgtefrients electronically.
r, EN
x EG.~
" Registry of Election Finance r~Y ,
SS-1112 (Rev. 8/08) cf ' ~m .l O p1~ RDA Pending
6LOG C11101A Cb
~ O~
~
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For Multicandidate Committees (PACs)
1. DATE OF REPORT 2. NAME OF COMMITTEE
(P-
2.A.'1910RT ME O MMITTEE (IF APPLICABLE d
~b
3. ADDRESS AND PHONE
Street or Rural Route Ci State Zip Code Phone
1_1 4. TYPE OF CANDIDAT~u t ES SUPPORTED- r
STATE PUBLIC OFFICE LOC PUBLIC OFFICE BOTH
5.A. NAME OF POLITICAL TREASURER S.B. DATE APPOINTED
1
6. CATEGORXJNR REPORT❑ (Check one ❑ ❑
AC, Q
SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
7.A.BEGINNING DATE OF REPORTING PERIOD 7.B.ENDING DATE OF REPORTING PERIOD
8.(Che`ck/one)
Ak This committee is exempt from detailed disclosures because contributions (including in-kind) received total $1,000 or less AND
fff "'TTT expenditures total $1,000 or less for this reporting period. I do solemly swear or affirm that the information contained in this statement
is true and that the committee has complied with all applicable provisions of the Campaign Financial Disclosure Act. (Items 10d., 10e.
and 1Of must also be completed.)
B. ❑ This committee 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. I do solemly swear or affirm that the information contained
in this statement is true and that the following page(s) are a complete and accurate accounting of all contributions and expenditures
required to be reported by political campaign committees by the Campaign Financial Disclosure Act.
U) big-k i~~, ge,
signature of political treasurer date
9. WITNESS SIGNATURE
4 signature of witness date
10. SUMMARY
a. BALANCE ON HAND LAST REPORT $
b. TOTAL RECEIPTS THIS PERIOD $
c. TOTAL DISBURSEMENTS THIS PERIOD $ 0V
d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.)
e. TOTAL LOANS OUTSTANDING
f. TOTAL OBLIGATIONS OUTSTANDING
OD SS-1122(Rev. 2/06) RDA Pending
SUMMARY PAGE - PAC
11. NAME OF COMMITTEE (in Full) 12. REPORT COVERING THE PERIOD
FR ~f. T0:
RECEIPTS
13. 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 13.a. and 13.b.) $
14. LOANS RECEIVED THIS REPORTING PERIOD $
15. INTEREST RECEIVED THIS REPORTING PERIOD
16. TOTAL RECEIPTS (add 13.c., 14., and 15.) (must be shown in item 10.b.)
DISBURSEMENTS
17. EXPENDITURES (other than loan payments)
a. Unitemized Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage,
gasoline)
$
$ 75 e
Total of Expenditures ($100 or less each payee) $
b. Itemized Expenditures (Over $100 each payee this period) $
c. Independent Expenditures
d. TOTAL EXPENDITURES (other than loan repayments)(add 17.a., 17.b. and 17.c.) $
18. LOAN REPAYMENTS MADE THIS PERIOD
19. TOTAL DISBURSEMENTS (add 17.d. and 18.) (must be shown in item 10.c.) t„p............................. 20. IN-KIND CONTRIBUTIONS f
a. Unitemized in-kind contributions ($100 or less from each source this period) $ ~J
b. Itemized in-kind contributions (over $100 from each source this period) $
c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 20.a. and 20.b.) $
21. LOANS
LOANS OUTSTANDING (must be shown in item 10.e.)
22. OBLIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $ C-~
b. Itemized Obligations Outstanding (Over $100 each) $
c. TOTAL OBLIGATIONS OUTSTANDING (add 22.a. and 22.b.) (must be shown i item 10.f.)
0 SS-1136 (Rev. 11/04) Page of
ITEMIZED STATEMENT OF CONTRIBUTIONS - PAC
1. NAME OF COMMI EE 2. REPORT COVERING THE PERIOD
FR TO:
Amount
3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING AGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than $100 from an contributor Burin the eriod
First Name M.1.7 ast Name/Organization Name Amount ofContributon
Address
Gay State Zip Code Date of Contribution
Occupation Employer
First Name M.I. Last Name/Organization Name AmountofContribution
Address
City State Zip Code Dale of Contribution
Occupation Employer
First Name M.I. Last Name/Organization Name Amountol'ContflMon
Address
City State Zip Code DateofContribution
Occupation Employer
First Name M.I. Last Name0ganization Name AmountofContributin
Address
city State ZipCode Date of Contribution
Occupation Employer
First Name M.I. LastName/Organization Name hTwntofCortbtion
Address
city State Zip Code
Date of Contribution
Occupation Employer
First Name M.I. Last Name/Organization Name Amounto(Conlrbution
Address
City State Zip Code Date of Contribution
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 13b. of summary.)
SS-1119-C (Rev. 2106) Page of RDA 1159
ITEMIZED STATE ENT OF EXPENDITURES - PAC
1. NAME OF COM TE ~ 2. REP RT OVERING TH PERIOD
FR TO:
Amount
3. TOTAL ITEMIZED 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). If the ex-
penditure is an in-kind contribution to a candidate, please rememberto include the purpose of the expenditure (e.g. postage, printing) along with the candidate's name in
the u ose of expenditure section.
FirstName Middle Name urpose of Expenditure mount of Expenditure
Last Name/Business Name
Address Date of Expenditure
City State Zip Code
First Name Middle Name Purpose of Expenditure mount of Expenditure
Last NameBusiness Name
Address ate of Expenditure
City State Zip Code
First Name Middle Name Purpose of Expenditure mount of Expenditure
Last NameBuslness Name
Address Date of Expenditure
City State Zip Code
FirstName Middle Name Purpose of Expenditure ount of Expenditure
Last NameBusiness Name
Address ale of Expenditure
City State Zip Code
First Name Middle Name Purpose of Expenditure ount of Expenditure
Last NameBusiness Name
Address Date of Expenditure
city State Zip Code
First Name Middle Name urpose of Expenditure ount of Expenditure
Last Name/Business Name
Address ate of Expenditure
City State Zip Code
5. TOTAL ITEMIZED EXPENDITURES
(Carry forward to item 3. of next page if additional pages of this form are used.)
If this is the last page of campaign expenditures, this amount must be shown in item 17b. of summary.)
'Mk SS-1119-E (Rev. 1100) Page of RDA 1159
ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - PAC
1. NAME OF COMMITT 2. REP OVERINGPERT D
FROM: ING
Amount
3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE enter $0 if first itemized a e
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION (in-kind contributions totaling more than $100 from any contributor during the period)
First Name Middle Name Description of IrAnd Contribution Value of In-Kind Contribution
Last Name/Organization Name
Address (~A
Date In IGnd Contribution
City State Zip Code
Occupation
Employer
First Name Middle Name Descrlp n of In-Kind Contribution Value of In-Kind Contribution
-East Name/Organizaton-Wanie
Address
Date of In-IGnd Contribution
City State Zip Code
Occupation
Employer
First Name Middle Name Description of In-Kind Contribution Value of In-Knd Contribution
Last NamelOrganization Name
Address
Date of In4,5nd Contribution
City State Zip Code
Occupation
Employer
First Name Middle Name Description of In•Knd Contribution Value of In-Kind Contribution
Lest NamelOrganization Name
Address
Date of In-Kind Contribution
city Stale Zip Code
Occupation
-Employer
5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS
(Carryforward to item 3 of next page if additional pges of this form are used.)
(If this is the last page of in-kind contributions, this amount must be shown in item 20.b. of summary.)
SS- 1125 (Rev. 2/06) Page of RDA1159
ITEMIZED STATEMENT OF INDEPENDENT EXPENDITURES - PAC
1. NAME OF COMMITTEE 2. PORT COVERIN TH ERIOD
lj_e_~s
T
Amount
3. TOTAL ITEMIZED INDEPENDENT EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page)
4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED INDEPENDENT EXPENDITURE (expenditures totaling more than $100 to any payee during the
period). Please remember to include the purpose of the expenditure (e.g. postage, printing) and the name of the candidate supported or opposed.
First Name Middle Name urpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address Candidate Supported or Opposed & Office Sought Date of Expenditure
Opposed ❑
qty State Zip Code Supported ❑
First Name Middle Name
urpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address Candidate Supported pos Once Sought Dale of Expenditure
Opposed ❑
City State Zip Code A Supported ❑
First Name Middle Name
urpose i E pe lure Amount of Expenditure
Last Name/Business Name
Address Candi ate Supported or Opposed & Office Sought Opposed ❑ Date of Expenditure
City State Zip Code Supported ❑
First Name Middle Name urpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address Candidate Supported or Opposed & Office Sought Opposed ❑ Date of Expenditure
City State Zip Code Supported ❑
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address Candidate Supported or opposed & Office Sought Opposed ❑ Date of Expenditure
City State Zip Code Supported ❑
First Name Middle Name Purpose of Expenditure Amount of Expenditure
Last Name/Business Name
Address Candidate Supported or Opposed & Office Sought Opposed ❑ Date of Expenditure
City State Zip Code Supported ❑
5 (a) Itemized Independent Expenditures $
(b) Unitemized Independent Expenditures $
C Total Independent Expenditures If this is the last page of ind. expenditures, this amount must be showin in item 17c. of summa page.) $
Alk SS-1139 Page of RDA 1159
Rev. 1100
ITEMIZED STATEMENT OF LOANS - PAC 2 REPORTCOVERINGTHEPERIOD
1. NAME OF COMMITTEE FROM:
Outsta ng Balance Loans Loan Payments Outstanding Balance
3. COMPLETE THE T0:
APPROPRIATE ITEMS FOR EACH ITEMIZED Received This (End
Period Period of Period) LOAN (loans totaling more than $100 owed to any person/business at the end of Beginning of Period) This
the reporting period)
First Name Middle Name
Last Name/Business Name
Address
City State Zip Code Date of Loan
Middle Name
First Name
Last Name/Business Name
Address
State Zip Code Date of Loan
City First Name Middle Name
Last Name/Business Name
Address
City state Zip Code D of Loan
First Name Middle Name
Last Name/Business Name
Address
rate p e Date of Loan
CRY FirstName Middle Name
Last Name/Business Name
Address
City State Zip Code Date of Loan
4. TOTALS
(Total from "Outstanding Balance - (End of Period)" column must also be shown
in item 21 on summary page.) RDA 1159
91112116
SS 1135 (Rev. 1100) Page of
ITEMIZED STATEMENT OF OBLIGATIONS - PAC
1. NAME OF CO ITT E
_ 2. REPORT COVERING THE PERIOD
(~C) FROM: T0:
3. COMPLETE T APPROPRIATE ITEMS FOR EACH ITEMIZE Outstanding Balance Debt Payments Outstanding Balance
OBLIGATION (obligations totaling more than $100 owed to any pers /vendor at (Beginning Incurred This (End
the end of the reporting period) of Period) This Period Period
of Period)
First Name Middle Name
Last Name/Business Name
F State Zip Code
Firs t Name M
iddle 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
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
city State Zip Code
Description of Obligation
4. TOTALS
(Total from "Outstanding Balance - (End of Period)" column must also be shown
in ftem 22.b on summa page.)
Afflik
SS-1126 (Rev. 1/00)
Page of RDA 1159
I
i
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For Multicandidate Committees (PACs)
1. DATE OF REPORT 2. NAME 05 COMMITTEE 2.A. ORT NAME OF COMMITTEE (IF APPLICABLE)
3. ADDRESS AND PHONE State Zip Code P ne
Street or Rural Route City
i
4. E OF CANDIDA S UP OR
STATE PUBLIC OFFICE CAL PUBLIC OFFICL'J BOTH
5.B. DA E APPOINTED
5.A. NAME OF P ITICAL TREASURES _
6. CAIE90 R REPORT (Check oneL ❑ ❑
[~_-_JJ
SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END Q ARTER QUARTER QUARTER QUARTER PRI BAENDING DATE OF GENERAL REPORTING PE SUPPLEMENTAL SUPPLEMENTAL
7.A.BEGINNING DATE OF REPORTING PERIOD _
8. (Ch ck one)
A. his committee is exempt from detailed disclosures because contributions (including in-kind) received total $1,000 or less AND
xpenditures total $1,000 or less for this reporting period. I do solemly swear or affirm that the information contained in this statement
is true and that the committee has complied with all applicable provisions of the Campaign Financial Disclosure Act. (Items 10d., 10e.
and 1Of must also be completed.)
B. F-1 This committee 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. I do solemly swear or affirm that the information contained
in this statement is true and that the following page(s) are a complete and accurate accounting of all contributions and expenditures
required to be reported by political campaign committees by the Campaign Financial Disclosure Act.
signature of political treasurer ate
9. WITNESS SIGNATURE /
date =
signature of witness
10. SUMMARY
a. BALANCE ON HAND LAST REPORT $
b. TOTAL RECEIPTSTHIS PERIOD $
c. TOTAL DISBURSEMENTS THIS PERIOD $ GC
d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) $7",-
a. FTOTAL LOANS OUTSTANDING
$
f. TOTAL OBLIGATIONS OUTSTANDING
RDA Pending
SS-1122(Rev. 2106)
1
i
SUMMARY PAGE - PAC
11.' NAME OF COMMITTEE (In Full) 12. REPORT COVERING THE PERIOD
FROM TO:
r-46 &-Qp
RECEIPTS
13. CONTRIBUTIONS (other than loans I 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 13.a. and 13.b.)
14. LOANS RECEIVED THIS REPORTING PERIOD
15. INTEREST RECEIVED THIS REPORTING PERIOD -
16. TOTAL RECEIPTS (add 13.c., 14., and 15.) (must be shown in item 10.b.)
DISBURSEMENTS
17. EXPENDITURES (other than loan payments)
a. Unitemized Expenditures ($100 or less each payee this period) (must be listed by category - e.g., printing, postage,
gasolin )
LOJ-A
$
$
$
$
$
Total of Expenditures ($100 or less each payee) $ ' l b~
b. Itemized Expenditures (Over $100 each payee this period) $
c. Independent Expenditures $
d. TOTAL EXPENDITURES (other than loan repayments)(add 17.a., 17.b. and 17.c.) $
18. LOAN REPAYMENTS MADE THIS PERIOD $
19. TOTAL DISBURSEMENTS (add 17.d. and 18.) (must be shown in item 10.c.) $
20.IN-KIND CONTRIBUTIONS _J
a. Unitemized in-kind contributions ($100 or less from each source this period) $ -v
b. Itemized in-kind contributions (over $100 from each source this period) $ `
c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 20.a. and 20.b.)
21. LOANS
LOANS OUTSTANDING (must be shown in item 10.e.)
22. OBLIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $
b. Itemized Obligations Outstanding (Over $100 each) $
c. TOTAL OBLIGATIONS OUTSTANDING (add 22.a. and 22.b.) (must be shown i item 10.f.)
SS-1136 (Rev. 11/04) Page of
t
ITEMIZED STATEMENT OF OBLIGATIONS - PAC
1. NA C tITTEE 2. REPORT COVERING THEPER(00
FRO T f
3. COMPLETE THE APPROPRIAT EMS FOR EACH ITE IZED Outstanding Balance Debt Payments 0 tstanding Balanc
OBLIGATION (obligations totaling more than $100 owed to an person/vendor at (Beginning Incurred This (End
the end of the reporting period) of Period) This Period Period of Period)
First Name Middle Name
Last Name/Business Name
Address
City State Zip Code
Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
City State Zip Code
Description of Obligation
First Name Middle Name
Last Name/Business Name
Address
City State Zip Code
Description of Obligation
First Name Middle Name
Last NameBusiness Name
Address
City State Zip Code
Description of Obligation
First Nam r Middle ~ c
Last Na sines N e
Addres
City S Zi Code
Description ligation
4. TOTALS
(Total from "Outstanding Balance - (End of Period)" column must also be shown
in item 22.15 on summa Page.)
Ask
SS-1126 (Rev. 1/00)
Page of RDA 1159
APPOINTMENT OF POLITICAL TREASURER
For Sin e
t Ca e, C
INSTRUCTIONS
This form must be used to appoint a political treasurer as required by the Campaign Financial Disclosure Act (T.C.A. §2-10-105)
for single-measure committees. No funds may be received or expended for a future election until a political treasurer has been
appointed. A new form must be filed if the treasurer is changed.
Single-Measure Committees supporting or opposing statewide referendums must file an original of this form with the Registry of
Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360. Single-Measure Committeess supporting
or opposing local referendums must file an original of this form with the local county election commission in the county where the
election is to be held.
1. ate 2. Name of Committee
3. Address and Phone Street or Rural Route city State Zip Code 37 ~'C, hone v
3 f ~2- o
4. Measure Supported or Opposed 5. Election Date
6. Treasurer Name ,
~G
7. Treasurer Address and P one Street or Rural Route City State Zip Code Phonee/
' d d Sz1dW,$
8. Appointing Authority and Treasurer Signature (Both signatures must be 1rvit essed. -treasurer can not witness signature.)
C .
A (4 D- '/0
Signature of Appointing Authority Si ature of Treasurer
n'4 '2 1 d tLl~ ~ (
i nature of Witness Signature of Witness
iiln
i
Registry of Election Finance
SS-1107 (Rev. 8/04) RDA Pending