Henry, Larry
( ~yCAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAMEOFCANDIDAT ORCOMMITTEE
-r ~ 3 I • I ~ ~v~v- d v-
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
AV 5;~ 7 '-o I LI
4.a. CAMPAIGN ADDRESS AND PHONE
Street or ur ute City State Zip Code Phone
4.b. CANDIDATE'S HOME ADDRESS (if dill ent than 4.a.)
Street or Rural Route city State Zip Code Phone
5. OFFICE OUGHT (include district number, if applicable 6. NAME OF POLITICAL TREA URER (may be candidate)
rC_ Ib Spa r 1~ L
7. CATEGO Y OR REPORT (Check one)
❑ ❑ ❑ ❑ ❑ ❑
FIRST SECOND THIRD FOURTH PRE- PRE- 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
--7. a, 3 0 I
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. UFf 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.
n ~.3 Iq cal -,.3~,
signatur of candidate date signat of political trea firer date
It. WITNESS SIGNATURE
(Y\, 14A144, 7-31-
signature of witness date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT :.y......... $
b. - TOTAL RECEIPTS THIS PERIOD u: ..1: $
1
C. TOTAL DISBURSEMENTS THIS PERIOD ......................................................'.4,.............. $ S
p- Y.I ~ li
d. BALANCE ON HAND (12.a -Rlus 12.b. minus 12.c.) ' ' . $
e. TOTAL LOANS OUTSTANDING n
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2/06) Z 0_~ O - ~q ~A C Page 1 of RDA 1159
I • a-o L~ /v
L
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDAT OR COMMITTEE
-l • -31 • I LI ~vv- o! v-
2.b. IF COMMITTEE, NAME OF CANDIDATE %
I (A 3. ELECTION DATE
LI
4.a. CAMPAIGN ADDRESS AND PHONE
S at or Rur ute City State Zip Code Phone
y 0~ \ v CM `a C., 1^ VI 1-n Co o?• 3 L( I I"
4.b. CANDIDATE'S HOME ADDRESS (if dill ent than 4.a.)
Street or Rural Route City State Zip Code Phone
5. OFFICE OUGHT (include district number, if applicable 6. NAME OF POLITICAL TREA URER (may be candidate)
Ib S~ i3
7. CATEGORY OR REPORT (Check one) / El Q 0 E3
FIRST SEND THIRD FOURTH PRE- PRE- MY-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
-7 . @,i. 30
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. [Ef 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. 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, 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.
4 L_' -I
signatur of candidate date signat of political trea rr date
11. WITNESS SIGNATURE
signature of witness date signature of witness date
12. SUMMARY 9 10
a. BALANCE ON HAND LAST REPORT \ $
.
~ s
b. TOTAL RECEIPTSTHIS PERIOD y $ 65% +
c. TOTAL DISBURSEMENTS THIS PERIOD i................ $ I
y b fir, f
o-
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $
ll pt 6~
e. TOTAL LOANS OUTSTANDING $ r)
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2106) Page 1 of ROAMS
SUMMARY PAGE - CANDIDATE
13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD
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) $ --K-4 -7 /
c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $
16. LOANS RECEIVED THIS REPORTING PERIOD $ Q
17. INTEREST RECEIVED THIS REPORTING PERIOD C)
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)
Cod 1 $ 36 Lk
Ajs n cowK $ 3 L
L._ $ y o 0
$
$
$
$
$
$
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 19.b.) $
20. LOAN REPAYMENTS MADE THIS PERIOD $ C)
-~S
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) $ f)
b. Itemized in-kind contributions (over $100 from each source this period) $ 0
c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $
23.013LIGATIONS
a. Unitemized Obligations Outstanding ($100 or less each) $ C)
b. Itemized Obligations Outstanding (Over $100 each) $ 6
c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 12.f.) $
SS-1133 (Rev. 4102) Page of
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDATE O COMMITTEE
. 3 1 • 1 Lt QJA L v-v- - y-
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural ute City State Zip Code Phone
4.b. CANDIDATE'S HOME ADDRESS (if dill ent than 4.a.)
Street or Rural Route Cit State Zip Code Phone
i s G 1 V f~V v' V►
5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICA171 TREASURER (may be ndidate)
7. CATEGORY OR REPO heck one)
❑ ❑ ❑ ❑ ❑ ❑ ❑
FIRST SECOND THIRD FOURTH PRE- PRE- 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
Q. r7 • ILA -7 ~ C)
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. 11we 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.
"40 C_~ C,, ILI r- L -1. 31 • J q
signatur of candidate date gnature Apolitical treasurer date
11. WITNESS SIGNATURE
signature of witness date signature of witness date
12. SUMMARY ~Q 11
Co
a. BALANCE ON HAND LAST REPORT
b. TOTAL RECEIPTS THIS PERIOD
N
~S?i8....
c. TOTAL DISBURSEMENTS THIS PERIOD .........r........U3^i
d. BALANCE ON HAND (12.a. plus 12.b. minus 1 c. $
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $
SS-1109 (Rev. 2/06) Page 1 of RDA 1159
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 Cam ai n
Financial Disclosure Reports." p 9
CANDIDATE'S INFORMATION:
Candidate's Name: L, ~1 -.AA if
Candidate's Position: L 00
cJ
Residential Address: IL $ O a
City: ~ C4~~ S V 1 t/
State: TN Zip:
I hereby state that I meet the above qualifications for exemption and am
therefore exempt from filing financial disclosure statements.
I
ndidate's Signa re
Date
itness's i a re
S bate
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.
a 4r F4 ~
C w
~0l68~~
Appointment of Political Treasurer
For State and Local Candidates and Single-Candidate Committees
INSTRUCTIONS
The Appointment of Political Treasurer statement must be used to appoint a political treasurer as required by
the Campaign Financial Disclosure Act (T.C.A. § 2-10-105) for state and local candidates and single- candidate
political campaign committees. A state candidate may not receive or expend funds for an election until a
political treasurer has been appointed for that election. A local candidate pursuant to T.C.A 2-10-101, maybe
exempt from completing this form, please check with county election commission for more information. A
candidate may appoint himself or herself as political treasurer. A new form must be filed if the treasurer is changed.
Candidates for state public office must file their original Appointment of Political Treasurer statement ONLY with
the Registry of Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360.
Candidates for local public office must file their original Appointment of Political Treasurer statement ONLY with
their county election commission.
1. Date: 2. Name of Candidate or Co mittee: 3. Candidate e-mail address: 1
6 ' 12. • I.._ `M `A d S ~
4. Campaign Address and Phone: City State Zip Coe Phone
0 c. L LW I S V Ill C- I 31n-n 6 o -I
5. Home Address and Phone (if different than ite 4 above): City State Zip Code Phone
S v
6. Office Sought (include district number, if applicable) 7. Party Affliation 8. Election Year
9. Treasurer Name: 10. Treasurer e-mail address:
Ate- S cJ
11. Treasurer Address d Phone: City State Zip Code Phone
C.J
-S ;A NNA 12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
Signature Candidate Sign re of Treasurer
Si nature of Witne ignature of Wi ess
Registry of Election Finanoe
SS-1120 (rev 10/2010)
016 8b9
MAR
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:
Candidate's Name: L ;ZJ V\ \r
Candidate's Position: C O"VA k _N~N low c-
Residential Address: L v 0\ C_
City: -ray y 1\ y State: TN Zip: 3 -1-7 ~7 -7
I hereby state that I meet the above qualifications for exemption and am
therefore exempt from filing financial disclosure statements.
3 o
Ca idate's Signature Date
Witness's Signature Date
If my plans change and I realize I will spend more than $1,000 on my campaign, I
will immediately make a financial disclosure report.
A~17 12 ~4
,a~+r
~ s
Appointment of Political Treasurer
For State and Local Candidates and Single-Candidate Committees
INSTRUCTIONS
The Appointment of Political Treasurer statement must be used to appoint a political treasurer as required by
the Campaign Financial Disclosure Act (T.C.A. § 2-10-105) for state and local candidates and single- candidate
political campaign committees. A state candidate may not receive or expend funds for an election until a
political treasurer has been appointed for that election. A local candidate pursuant to T.C.A 2-10-101, maybe
exempt from completing this form, please check with county election commission for more information. A
candidate may appoint himself or herself as political treasurer. A new form must be filed if the treasurer is changed.
Candidates for state public office must file their original Appointment of Political Treasurer statement ONLY with
the Registry of Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360.
Candidates for local public office must file their original Appointment of Political Treasurer statement ONLY with
their county election commission.
1. Date: 2. Name of Candidate orCo mittee: 3. Candid to e-mail address:
3 ►o • a-v y L ~-r e~hv
4. Campaign Address and Phone: City State Zip Code Phone
y
~ISad K\V ~s~~ L~~Sv I I` i 6o-7.3
5. Home Address and Phone (if different than Item 4 above): City State Zip Code Phone
37777
6. Office Sought (include district umber, a able) 7. Party Affliation 8. Election Year
C o~V-J~W11 S J 10 V1\ ~ Z ~VXD\
o
9. Treasurer Name: 10.1 reasurer a-mail address:
n ~,_)VW- V\ I ;t~ ~V- VUk *st .%\A
11. Treasurer Address and Phone: City State Zip Code Phone
SA\.A&~, ;kS j;\0 0 -NJ C-1-;
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurercan not witness candidate's signature):
0
Q_j Signature f Candidate Signore of Treasurer
11 A
v
Signature of Witness Signature of Witness
Registry of Election Finance
SS-1120 (rev 1012010)