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Blount Lifestyle CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For Multicandidate Committees (PACs) 1. DATE OF REPORT 2. NAME OF COMMITTEE Oy a of 2.A. SHORT NAME OF COMMITTEE (IF APPLICABLE) 3. ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 3aoti ei A I< e Alcor, S7721 G~ M-/sacs 4. TYPE OF CANDI ES SUPPORTED STATE PUBLIC OFFICE E] LOCAL PUBLIC OFFICE BOTH 5.A. NAME OF POLITICAL TREASURER 5.B. DATE APPOINTED AkSle 07--~~ -ors Ea ) ❑ ❑ 6. CATEGORY OR RE (Check o FIRST 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 0/ G G 8. (Che k on 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. 1L~~~~`d sig ure of political treasurer dot 9. WITNESS SIGNATURE signature of witness date 10. SUMMARY a. BALANCE ON HAND LAST REPORT $ 7 . l b. TOTAL RECEIPTS THIS PERIOD $ 3y/, al'SO, o c. TOTAL DISBURSEMENTS THIS PERIOD oG GG d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) ...~.fr,. ' $ j? 71, /1 e. TOTAL LOANS OUTSTANDING 0 'VW f. TOTAL OBLIGATIONS OUTSTANDING i... R , SS-1122(Rev. 2/06) C ` RDA Pending F E ~ I SUMMARY PAGE - PAC 11. NAME OF COMMITTEE (In Full) 12. REPORT COVERING THE PERIOD ,U((lGl i ~PS7 FROMD/ 0 T0: RECEIPTS 13. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ 0,00 b. Itemized Contributions (over $100 from each source this period) $ ;1_so, 0'0 c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 13.a. and 13.b.) $ 3G, o~SO, OU 14. LOANS RECEIVED THIS REPORTING PERIOD $ Ol o u 15. INTEREST RECEIVED THIS REPORTING PERIOD 0,()O 16. TOTAL RECEIPTS (add 13.c., 14., and 15.) (must be shown in item 10.b.) $ 3G, DSO, GU 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) $ /OG.IJU b. Itemized Expenditures (Over $100 each payee this period) $ 6wle I c. Independent Expenditures ( 0 d. TOTAL EXPENDITURES (other than loan repayments)(add 17.a., 17.b. and 17.c.) $ 00, Ole 18. LOAN REPAYMENTS MADE THIS PERIOD $ D'. DO l ~Gc OU 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) $ Qc00 b. Itemized in-kind contributions (over $100 from each source this period) $ DU c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 20.a. and 20.b.) $ D GYr 21. LOANS LOANS OUTSTANDING (must be shown in item 10.e.) ~I GU 22. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ a, UG b. Itemized Obligations Outstanding (Over $100 each) $ '0,00 c. TOTAL OBLIGATIONS OUTSTANDING (add 22.a. and 22.b.) (must be shown i item 10.f.)-0-0-44 $ U, CJl~ ` SS-1136 (Rev. 11/04) Page oZ of ~o ITEMIZED STATEMENT OF CONTRIBUTIONS - PAC 1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD Z ` e FROM:6FI114 TO: 3 ,?vl Amour 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) ,pp 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION (contributions totaling more than $100 from an contributor during the period) First Name M.I. Last NamelOrganizalionIN e i r` ( AmountofContribution ~s b Address City State Zip Code Date of Contribution Occupation Employer First Name M.I. Last Name/Organization Name AmountofContributon Address City State Zip Code Date of Contribution Occupation Employer First Name M.I. Last Name/Organization Name AmountofContnbution Address City State Zip Code Date of Contribution Occupation Employer First Name M.I. Last Name/Organization Name AmountofContribiulion Address City State Zip Code Date of Contribution Occupation Employer First Name M.I. Last Name/Organization Name AmountofContnbution Address City State Zip Code Date of Contribution Occupation Employer First Name M.I. Last Name/OrganizationName Amount of Contribution 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 J of t° RDA 1159 L, 00 00 00 00 00 00 00 O O O O O O O 4.. N N N N N N N O > ~ oo 'v i ^ aL+ N N N M N M M C :d O C U F. °O o °o °o °o °O °o 0 0 0 0 0 0 0 0 0 0 C) O r C, O C> N d U U C C T t U L C y ~ y O Q N Q ¢ 'cd coz UZza o ~ V L.. u C4 LQ C z ^ r N v v r c 00 ~ rn 00 N r r r r r N r M M M M M M M U F-FZ-zzz~z a c_ 1 T cC y x T O ~n cn c Q 3 2 cz O ~ ~ a ~ ro L 3 t~ U U v 4-0 x > = C Q O U •N C .N t U 0 3¢~ z T ~ o N O r M O 4,y M v1 ^ ^ O N N W M r o) O ~ M M M M O~ N ~a ~ vo y e y C/1 ° v M ra O T C sN. .~M W U N CO U p..~ •o o x U Y a~ cc o u v ~ Ca 3 ~ cn Q v~ W G~ I~ O C60 v a~ ~ C z o 0 Dada 2, W n U U U F- Q y O ITEMIZED STATEMENT OF EXPENDITURES - PAC 1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD t FROM: TO:,9 t Amour 3. TOTAL ITEMIZED EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) G,GU 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 u oseofexpenditure section. First Name Middle Name urpose of Expenditure mount of Expenditure Last Name/Business Name r 'e eh ~ S Address Date of Expenditure City State Zip Code First Name Middle Name Purpose 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 Name/Business Name Address Date of Expenditure City State Zip Code First Name Middle Name Purpose 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 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 Date 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.) SS-1119-E (Rev. 1/00) Page of RDA 1159 y 00 00 00 w 00 00 w w w 00 w 00 00 00 00 w w L 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ~ N N N N N N N N N N N N N N N N N O \ \ V) \ \ \ V) \ \ \ \ \ \ \ \ \ i~.+ C Vl V) V) V) V1 V) In V) kn-i Vl Ln V) Vl V7 Ln V'1 to o Q ¢ M M M M M M M M M M M M M M M M M ~ W O F" O O O C O O O O O O O O O O O O O O 4, y_ Cl O O O O O O O O O O O O O O O O O O C O O O O O O O O O O O O O O O O O O V) O V O O O to O O O Ln V') V O O O O O C C l~ V1 I- Ln vl Ln I- Vn V') Vl l- r- Ln V) Vn Ln O O ~ .r E R. Q W L L L L L L L L L L L L L L L L 4. O O O O O O O O O O O O O O O O O C1. C1 O L C1., C1, C1. C1. CL C1. C1. C1 C1. Q. Cl. 0. C2. C1. C. O C C C C C C G p C ~ C G C C C C ~ C bn cn cn on on ~n cn on ~ rn on to on cn on rn cn p., W C~. a a C1. C1. a a C1. CL C1 Cs. C1. C1. a. n. a C1. E E E E E E E E E E E E E E E E E v U U U U U U U U U U U U U U U U U "t ct• ^ ^ ~ ~ M ^ ~ r- ~ Vr M ~ r- v m ¢ O O O O O O C O M M 00 w Vn ~ r- C O 00 00 00 ~ 00 oc oc 00 ~ 00 00 00 ~ r'- 00 00 M M M M M M M M M M M M M M M M M 1 ~ i • ^I ^ U U U U O m C,3 . U cd cC U° O 00 "M ct Q" :;2 22 w33c~~~~~ 7~ O U 4-o ct O U U U U cz C U ,U cd v cx Q Ll U o o o v~ o a) ct =u oo O N N ~O O •--d• N I~ Nol~ ~O C) N O O N N V M N M O Vr M M N M Vr d m C}' --d' N V) ^ M l~ N N M M N M N ~ 4~ 3 ~ • ~ E G~ I-a 0 on U E g u r~l . r•l y U U ,x C: y Z E on rn U rn U E c° CC L C~ co) c v E in. E : E ° r- 0. w oa ~ O x um o o U a U U o o E.E ~F" on L- o3 °U- U x c E Y E U C4 U L E _ M~ o o E E E Y E °c E U U EO- F°- cn p U Q H W W M CL~ C40 UC/) CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For Multicandidate Committees (PACs) 1. DATE OF REPORT 2. NAME OF COMMIE -3 S- g)0 ~e 2.A. SHORT NAME OF COMMITTEE (IF APPLICABLE) 3. ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone .o LJ 3>201 CFCs- 3'S-/-^ob 4. TYPE OF CANDIDATES SUPPORTED STATE PUBLIC OFFICE LOCAL PUBLIC OFFICE BOTH 5.A. NAME OF POLITICAL TREASURER 5.B. DATE APPOINTED 6. CATE❑GO OR REPORT (Check o ❑ ❑ a FIRST 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 -7 - I - I1) / s--- i 9- 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 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. signatur f political tr asurer d to 9. WITNESS SIGNATURE signature of witness date 10. SUMMARY /J a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTSTHIS PERIOD 4j $ c JA~...~1..;.....' /S . TOTAL DISBURSEMENTS THIS PERIOD $ _ t ~0 d. BALANCE ON HAND (10.a. plus 10.b. minus ltto l.t. lwC)t~ $ ~r r- I n e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ SS-1122(Rev. 2/06) RDA Pending CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For Muiticandidate Committ ' s (PACs) 1. DATE OF 2. NAME OF COMMITTEE t~ E C E (IF APPLICABLE)! AND PHONE Skrset or Rural Route City Ststs Zip Code Phone 3.?G~ to ? - 71- .rG~ TYPE OF CANIMATE3 SUPPORTED STATE PUBLIC OFFICE LC CAL PUBLIC OFFICE [ BOTH S.A. NAME OF POLITICAL 1 REASU R S.B. DATE APPOI ,ors one 4 WIM" T.A. OFREPORTNGPERIOD 7.f3.ENDNG d ,r, .y y o~ a 09 8. (t,edc one) A. This committee Is exempt from detailed disdosuros because contributions (i uding in4dnd) received total $1,000 or less AND expenditures total $1,000 or less for this reporft perlod. I do ademly or affirm that the information contained in this statement Is guar and ft oommittee has compiled with all applicable provisions of Campaign Financial Disclosure Ad. (items 10d., 10e. and 10f must also be completed.) & Q This committee Is required to the a detalled flnandel disclosure because ooM bud" Ondudkv in-kind) received total more than $1,000 "or expend" total mom ftn $1.000 for this reporting period. do soleney swear or *Mrm OW the Inkrmadon contained In ft statement Is he and that the following page(s) are a complete and s rate accounting of all contributions and experrdNt m mqukW to be reported by politloal campaign committees by the Campaign ndai DWcWw a Act signs of g. WITNESS SIGNATURE 0-1 It- signature of witless 1_..-- ti. Q 7 a. BALANCE ON HAND LAST REPORT $ b. TOTALRECEPTSTHISPERIOD » RECEIVED 44A Q12 JUL - 8 201 cr; c. TOTAL--11~tJ f ATM PERIOD cta ° Y10 y T3wu d. BALANCE ON HAND (10.8. plus 10.b. minus 10.c.) s, S •~,.c•~'" ~Z1 d e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBUGATIONS OUTSTANDING . 88-1122(Rev. 2/W) RDAPe xft CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For Multicandidate Committees (PACs) 1. DATE OF REPORT 2. NAME OF COMMITTEE 7 - ~R-15' _61a, , L 2.A. SHORT NAME OF COMMITTEE (IF APPLICABLE) 3. ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 3avti e, l A9iW 06 /1) 3926 1 4. TYPE OF CANDIDA S SUPPORTED STATE PUBLIC OFFICE LOCAL PUBLIC OFFICE BOTH Q~ S.A. NAME OF POLITICAL TREASURER S.B. DATE APPOINTED jefr i-C, P -/S - 6. CATEGORY OR REPORT (Check one ❑ ❑ FIRST 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 16 906 -:3 - - CJ Ul~- 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 1 Of 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. ignature of political treasurer date 9. WITNESS SIGNATURE signature of witness date 10. SUMMARY r~ a. BALANCE ON HAND LAST REPORT Ov b. TOTAL RECEIPTS THIS PERIOD $ 3 o S S7 c. TOTAL DISBURSEMENTS THIS PERIOD ~d 3 ^ d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) $ 3, e. TOTAL LOANS OUTSTANDING $ _j f. TOTAL OBLIGATIONS OUTSTANDING $ C . . . A JUL 15 2015 SS-1122(Rev. 2106) 4 Blp(j RDA Pending SUMMARY PAGE - PAC 11. NAME OF COMMITTEE (inn Full) 12. REPORT COVERING THE PERIOD ~ I OLVI i / S" 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~ c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 13.a. and 13.b.) 3o& 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.) $ 3 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) $ " 37 b. Itemized Expenditures (Over $100 each payee this period) $ 00 c. Independent Expenditures $ -0- d. TOTAL EXPENDITURES (other than loan repayments)(add 17.a., 17.b. and 17.c.) $ 263 18. LOAN REPAYMENTS MADE THIS PERIOD $ v do3 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) -u- b. Itemized Obligations Outstanding (Over $100 each) $ - v 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 Bwt ~ ~f S lc FROM:1 f6-I) T0: 4e -/A- Amount 3. TOTAL ITEMIZED EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) - 0 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 u ose of expenditure section. mount of Expenditure FirstName Middle Name urpose of Expenditure Last NameBusinessName C lie, P03 Address Date of Expenditure crd~,~d onlrne d City State Zip Code First Name Middle Name Purpose of Expenditure ount of Expenditure Last NameBusiness Name Address ate of Expenditure City State Zip Code First Name Middle Name Purpose of Expenditure %mount of Expenditure Last Name/Business Name Address Date of Expenditure City State Zip Code First Name Middle Name Purpose of Expenditure ount of Expenditure Last NameBusiness Name Address ate 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 ount of Expenditure Last Name/Business Name Address ate of Expenditure City State Zip Code 5. TOTAL ITEMIZED EXPENDITURES J (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.) (1 Aflk SS-1119-E (Rev. 1 100) Page L~ of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For Multicandidate Committees (PACs) [2.A. . DATE OF REPORT =.NAME OF COMMITTEE - a6 r le SHORT NAME OF COMMITTEE (IF APPLICABLE) 3. ADDRESS AND PHONE Street or Rural Route nn City State Zip Code Phone Qd L/ ~C w V111~C II 4. TYPE OF CANDIDATES SUPPORTED STATE PUBLIC OFFICE LOCAL PUBLIC OFFICE BOTH t~ S.A. NAME OF POLITICAL TREASURER 5.B. DATE APPOINTED 6. CATEGORY OR REPORT (Check one ❑ FIRST SECOND THIRD FOURTH PRE- PRE- MI-Y AR YEAR-END UARTER UARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 7.A.BEGINNING DATE OF REPORTING PERIOD 7.B.ENDING DATE OF REPORTING PERIOD to a6 - 1-I S- l~ 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 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. - " / - signature of political treasurer date 9. WITNESS SIGNATURE 1- a6 signature of witness date 10. SUMMARY 9a a. BALANCE ON HAND LAST REPORT $ _3 I b. TOTAL RECEIPTS THIS PERIOD $ D - c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) $ e. TOTAL LOANS OUTSTANDING _Q - f. TOTAL OBLIGATIONS OUTSTANDING $ - U - SS-1122(Rev. 2/06) RDA Pending CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For Multicandidate Committees (PACs) 1. DATE OF REPORT 2. NAME OF COMMITTEE ~ 0 _ 31 t~_ - ) 9 7 .5 ) 0 v J 2.A. SHORT NAME OF COMMITTEE (IF APPLICABLE) 3. ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 3 0 L( 6 I P'10-c )cap 4. TYPE OF CANDIDATES SUPPORTED STATE PUBLIC OFFICI= ❑ LOCAL PUBLIC OFFICE BOTH 5.A. NAME OF POLITICAL TREASURER 5.13. DATE APPOINTED 6. CATEGORY OR REPORT (Check one) FIRST SECOND THIRD FOURTH PRE- PRE2r' 0 - MIDYEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 7.A. BEGINNING DATE OF REPORTING PERIOD 7. B.ENDING DATE OF REPORTING PERIOD l0 I_ ly I~ -d- 1~1 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 1 Of 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. gnature of political treasurer date 9. WITNESS SIGNATURE signature of witness date 10. SUMMARY 7 a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTS THIS PERIOD $ - L c. TOTAL DISBURSEMENTS THIS PERIOD d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING s SS-1122(Rev. 2/06) RDA Pending CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For Multicandidate Committees (PACs) 1. DATEOFREPORT 2. NAMEOFCOMMITTEE i / 3o - I LI 2.A. SHORT NAME OF COMMITTEE (IF APPLICABLE) 3. ADDRESS AND PHONE State Zip Code Phone Street or Rural oute city / 19 3)1vLl j,, N(o . ~1,V 4. TYPE OF CAND ATES SUPPORTED STATE PUBLIC OFFICE LOCAL PUBLIC OFFICE BOTH [L}~ 5.B. DATE APPOINTED 5.A. NAME OF POLITICAL TREASURER 7S efir /7 q 1 ~(4 'Y1 6. CATEGORY OR REPORT (Check one) FIRST SECOND THIRD FOURTH PR❑E- GENERAL SUPPLEMENTAL SUP AR-E NDTAL PLEME QUARTER QUARTER QUARTER QUARTER PRIMARY ENDING DATE OF REPORTING PERIOD 7.A. BEGINNING DATE OF REPORTING PERIOD E F a D-d8. (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 1 Of 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 arr. expenditures required to be reported by political campaign committees by the Campaign Financial Disclosure Act. 10-Io N s ature of political treasurer date 9. WITNESS SIGNATURE signature of witness date 10. SUMMARY a. BALANCE ON HAND LAST REPORT $ ID (p b. TOTAL RECEIPTSTHIS PERIOD c I c. TOTAL DISBURSEMENTS THIS PERIOD t7,) Ai I `i - d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) $ e. TOTAL LOANS OUTSTANDING f. TOTAL OBLIGATIONS OUTSTANDING $ - RDA Pending : SS-1122(Rev. 2/06) SUMMARY PAGE - PAC 11. NAME OF COMMITTEE (In Full 12. REPORT COVERING THE PERIOD 1G~,A S~ FROM I Y T0: ~D t 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) $ -'d 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) ( 1 y U 1 c~0 m c,I PxAen S ~rZ n }ln $ U . $ $ $ $ ~I Total of Expenditures ($100 or less each payee) $ 113 S b. Itemized Expenditures Over $100 each payee this period) c. Independent Expenditures $ d. TOTAL EXPENDITURES other than loan re a ments add 17.a., 17.b. and 17.c. ~`ld `I 18. LOAN REPAYMENTS MADE THIS PERIOD $ 19. TOTAL DISBURSEMENTS (add 17.d. and 18.) (must be shown in item 10.c.) $ 5 ~ya 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 3 4 a • a ITEMIZED STATEMENT OF EXPENDITURES - PAC 1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD C , PS ~L FROM: ) TO -3o r O~r1~ Amount - CO- 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 ur seofex ndituresection. Middle Name urpose of Expenditure mount of Expenditure First Name I I U q Last Name/Business Name/Yl m rl (I ! X ~ ! , ~'~r ~~1~7/l CQ, 111 Date of Expenditure Address tly 3 U Sr) e ~~n 5). r}7~ n ~~:r City Lvti o 3V; /Ie SI Zip Code / / > 1 First Name Middle Name Purpose of Expenditure mount of Expenditure Mr ~4t Last Name/BusinessNarm 6 CC. 10 r I Date of Expenditure Address /)av State Zip Code ')3 1 - / q T ti/ 3~ L y First Name Middle Name Purpose of Expenditure mount of Expenditure 00 Last Name/Business Name, 160 ate of Expenditure Address 307 c ,(-f `f - 111e. g- s-14 City State Zip Code L G, of l1 3)S ~ First Name Middle Name Purpose of Expenditure mount of Expenditure Last Name/Business Name t_4`3+ d 4 S~ 6 Vr ate of Expenditure Address 3L1o l .mss s e y City State ZipCode~/ JC 1 ~f'~S / 1'JI~t iv C !T i First Name Middle Name Purpose of Expenditure mount of Expenditure Last Name/Business Name Date of Expenditure Address city state Zip Code First Name Middle Name urpose of Expenditure mount of Expenditure Last Name/Business Name Date of Expenditure Address city State Zip Code 5. TOTAL ITEMIZED EXPENDITURES r~ (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 summa 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 r 2.A. SHORT NAME OF COMMITTEE (IF APPLICABLE) 3. ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone ~ d 4/ dnw e Aj~, 3~7ad ~8,ys~3~S-6SGo 4. TYPE OF CANDIDA S SUPPORTED STATE PUBLIC OFFICE ❑ LOCAL PUBLIC OFFICE ❑ BOTH E~J- 5.A. NAME OF POLITICAL TREASURER _ 5.13. DATE APPOINTED 6. CATEGORY OR REPORT (Check one) FIRST 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. (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 1Of must also be completed.) B. [EfThis 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 Dis a Act. ture of political treasurer date 9. WITNESS SIGNATURE .r nt re .of witness date f, 10. SUMMARY F;ECEIVE1) \ a. BALANCE ON HAND LAST REPORT . \ AU6..0.5...?-W $ i uv b. TOTAL RECEIPTS TH I S PER IOD $ ~S D7 / c. TOTAL DISBURSEMENTS THIS PERIOD $ ~ d. BALANCE ON HAND (10.a. plus 10.b. minus 10.c.) $ , to / e. TOTAL LOANS OUTSTANDING $ d f. TOTAL OBLIGATIONS OUTSTANDING $ _ d d SS-1122(Rev. 2/06) RDA Pending SUMMARY PAGE - PAC 11. NAME OF COMMITTEE (In Full) 12. REPORT COVERING THE PERIOD IIJUn~ CI 9~S o~ FROM Eo: / ~e- RECEIPTS 13. CONTRIBUTIONS (other than loans and interest) o~ a. Unitemized Contributions ($100 or less from each source this period) b. Itemized Contributions (over $100 from each source this period) $ l ~aCJ c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 13.a. and 13.b.) $ /S D y 4J 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.) $ /S, G y uu 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) $ b. Itemized Expenditures (Over $100 each payee this period) $ 5, 4!a a~ c. Independent Expenditures $ 7 7 d. TOTAL EXPENDITURES (other than loan repayments)(add 17.a., 17.b. and 17.c.) $ J, la 18. LOAN REPAYMENTS MADE THIS PERIOD $ ' 19. TOTAL DISBURSEMENTS (add 17.d. and 18.) (must be shown in item 10.c.) $ S l./ /a 20.IN-KIND CONTRIBUTIONS 00 a. Unitemized in-kind contributions ($100 or less from each source this period) $ Oo b. Itemized in-kind contributions (over $100 from each source this period) $ - W__ u~ c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 20.a. and 20.b.) $ JOD 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) ~~Mt ` Page j of ITEMIZED STATEMENT OF CONTRIBUTIONS - PAC 1. NAME OF COMMITTEE 5411 S 2. REPORT COVERING THE PERIOD ~ )e_ FROM: /Y TO: )-dg-IL Amount 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) -0- 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totalin more than $100 from an contributor Burin the eriod First Name M.I. Last Name/Organization Name + OG 6w 1` Amount ofCont bWon Address APS ou we Sc7CJ Ciry 4State ZipCode y I c d q T/L 3 1/ t? 0 Dale of Contribution Occupation n Employer r i &J l$ First Name M. 1. Last Name/Organization Name Q eo AmountafConMbutlon Address Inn /®z V d 3 `d SS der" )I Soo C) City state ZipCode ~ ",6 J,1W G'~ V Date ofConMbution Occupation KKK Employer O 04 First Name M.I. Last Name/Organization Name AmountofContnbutlon dress ~lS/roa.rn~ jr-e 0 Soo 00 city State Zip Code ~~/,I 1„ ( 3 Date ofContribution Occupation / V Employer o A)TA First Name M.I. Last Name/Organization Name AmountofContnb&n im lG .S Address Q0 City qppp state Zip Code 0 N ~ S Y~ ~3 ~ ~ ) Date of Contribution Occupation II~~ Employer (y c~ First Name - M.I. Last Name/Organization Name AmountofContnbuton Y4~'r~f Address ~J q041 ~0 6 L'e 3GG City State ZipCode ^ -p„ , -5 JZ e 7 / Date of Contribution 1-0 Occupation Employer First Name Last Name/Organization Name AmountofContritwtron pp rd~J `WN7'1 77-, } Address -?0-3 V r 6/~. +J ~Ow~ l~ ©e City 1 State ZipCode 7 v 4 ~ J s'o ~ Date of Contrbuton Occupation i Employer -d3- IV 53OTAL ITEMIZED CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) vv (If this is the last page of contributions, this amount must be shown in item 13b. of summary.) ~r Sao ";a! SS-1119-C (Rev. 2/06) Page of RDA 1159 ITEMIZED STATEMENT OF CONTRIBUTIONS - PAC 1. NAME OF COMMITTEE 2T COVERING THE PERIOD ~Ow► LAS -/y TO:-~ 3. TOT ro AL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) AI `1 n36v 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totalin more than $100 from an contributor during the period) First Name MI Last Name/Organization Name [IvV//q ~1 ( 1"~ ~ r le AmountofContributlon Address ago ~t~ ord. So 0 City State zip Code O Date of Contribution ( u n ~'v 3 )9 Occupation Employer ~g 3-l `d First Name M.I. Last Name/Organization Name AmountofContribution Address City State Zip Code Date of Contribution Occupation Employer First Name M.I. Last Name/Organization Name Amount ofContribution Address City State Zip Code Date of Contribution Occupation Employer First Name M.I. Last Name/Organization Name AmountofContribufion Address Ciry State Zip Code Date of Contribution Occupation Employer First Name M. 1. Last Name/Organization Name AmountoiContribufion Address City State Zip Code Date of Contribution Occupation Employer First Name V. 1. Last Name/Organization Name AmountofConfitwlion Address City State Zip Code Date of Contri bution Occupation Employer STOTAL ITEMIZED CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) B ~UO uo (If this is the last page of contributions, this amount must be shown in item 13b. of summary.) t U SS-1119-C (Rev. 2/06) Page ~ of _ ~ RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - PAC 1. NAME OF COMMITTEE NN 2. REPORT COVERING THE PERIOD FROM) TO )-fie /`f Amount 3. TOTAL ITEMIZED EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) - U_ 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 purpose of expenditure section. First Name _ Middle Name _ urpoos'e' of Expenditure Q mount of Expenditure Last Name/Business Name P' n d' r 3,/91" Address Date of Expenditure city Ly / /Q State Zip Code 3/7/ n n G cr First Name Middle Name Purpose of Expenditure mount of Expenditure LastName/Business Name ()o Address f ale of Expenditure City State Code _ / CI a r/1/Zip First Name Middle Name Purpose of Expenditure mount of Expenditure Last Name/Business Name Address 3 7d S IK P Date of Expenditure City ~40 X ale- St~ate~ Zip Code 3)9d o - l First Name Middle Name Purpose of Expenditure ~l 1 mount of Expenditure --~~BB''~~IILL ,t 1 u.,nT /1r1QV'~ uo Last Name/Business Name g CL C k , o Ud Address n 3 1fd ~ 0 ate of Expenditure LL City / State Zip Code First Name 1 J Middle Name Purpose of Expenditure mount of Expenditure /'p (~JJ IIII ~ rw- Last Name/Business Name 00 Address Date of Expenditure 3"Io ~ 6 d Ur i2 l 6 City pp State ZipCode 3 97 9 7 ~ ~ 3 y First Name Middle Name urpose of Expenditure %mount of Expenditure Last Name/Business Name Address ale 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.) J SS-1119-E (Rev. 1/00) Page of RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - PAC 1. NAME OF COMMITTEE 2. REPORT COVERING PERIOD I0 s,.4 FROM: 9 TO: > Amount 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE enter $0 if first itemized page) -C) - 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 Descnplion of In-Kind Contribution Value of In-Kind Contnbution Last Name/Organization Name Address Date of In-Kind Contribution City State Zip Code Occupation Employer First Name Middle Name Description of In-Kind Contribution Value of In-Kind Contribution Last Name/Organization Name Address Date of In-Kind Contribution City State Zip Code ccupaion Employer First Name Middle Name Description of In-Kind Contribution Value of In-Kind Contribution Last Name/Organization Name Address Date of In-Kind Contribution City State Zip Code Occupation Employer First Name Middle Name Description of In-Kind Contribution Value of In-Kind Contribution Last Name/Organization Name Address Date of In-Kind Contribution City State Zip Code Occupation Employer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carry forward 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 RDA 1159 ITEMIZED STATEMENT OF INDEPENDENT EXPENDITURES - PAC 1. NAME OF COMMITTEE 2. REPORT COVERING THE PERIOD Iv '/1 FROM: T0: Amount 3. TOTAL ITEMIZED INDEPENDENT EXPENDITURES FROM PRECEDING PAGE (enter $0 if first itemized page) - v- 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 Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address Candidate Supported or Opposed & Office Sought Date of- xpenditure Opposed ❑ City Stale ZipCode Supported ❑ First Name Middle Name urpose of Expenditure Amount of Expenditure Last Name/Business Name Address Candidate Supported or Opposed & Office Sought Datof Expenditure Opposed ❑ City State ZipCode Supported ❑ First Name Middle Name urpose of Expenditure Amount of Expenditure Last Name/Business Name Address Candidate Supported or Opposed & Office Sought Date of Fxpenditure Opposed ❑ City State Zip Code Supported ❑ d 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 ❑ 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 Date of Expenditure Opposed ❑ r' City State ZipCode Supported ❑ First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name i' Address Candidate Supported or Opposed & Office Sought Date of Expenditure Opposed ❑ City State Zip Code Supported ❑ L~ 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 summary pace.) $ SS-1139 Page _ _ of i_ RDA 1159 Rev. 1/00 ITEMIZED STATEMENT OF LOANS - PAC 1. NAME OF COMMITTEE 2 . REPORT COVERING THE PERIOD L~ °S L)(L FROM: ) -/-/y TO: ~•dk-/9 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMI D Outstanding Balance Loans Loan Payments Outstanding Balance LOAN (loans totaling more than $100 owed to any person/business at the end of (Beginning Received This (End the reporting period) of Period) This Period Period of Period) First Name Middle Name Last Name/Business Name Address City state zip Code Date of Loan First Name Middle Name Last Name/Business Name J L) ' / Address City State zip Code Date of Loan First Name Middle Name Last Name/Business Name Address City State Zip Code Date of Loan First Name Middle Name i Last Name/Business Name Address t' Mate ip o e Date of Loan First Name 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.) SS-1135 (Rev. 1/00) Page of RDA 1159 ITEMIZED STATEMENT OF OBLIGATIONS - PAC 1. NAME OF COMMITTEE, ~1 2. REPORT COVERING THE PERIOD pug V L, 4c, 6 L FROM: 7-I - I Y TO: i> --de- 11 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Payments Outstanding Balance OBLIGATION (obligations totaling more than $100 owed to any 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 Name/Business Name Address City State Zip Code Description of Obligation First Name Middle Name Last Name/Business Name Address City State Zip Code Description of Obligation 4. TOTALS (Total from "Outstanding Balance - (End of Period)" column must also be shown _ in item 22.b on summa page.) SS-1126 (Rev. 1/00) Page _ of ~ RDA 1159 1ti AM pM ~ ~ r APPOINTMENT OF POLITICAL TREASUR For Multi-Candidate Committees (PACs) NSTRUCTIOI Th[s Torn must be used to appolnt a political Teasu[er as iequlred by4the Campaign FiRanGal4DisclgsureAct (TC A, §2-10-105) fog multhcandidate committees {PACs) t lg fundsnay be received. jqr expended fior'a_iufure election ujitll a polltical;treasurer has been Appolnted Anew form must be lited 1f thelreasurer is changed r , Commltteedlha► make'_Gontrlbl,X66-; 661j7'0candidates for state Public offtce_'-bustflle this fomi'an'd a $$100 anodal-fee tvilli the. ` Registrya( ElectlonFine, 4Q4 James;Rghefson Pprkivsy Suite 1.04, Nashville fN`37243 1360 Gommittees that make cgtitrtbutipns only to candldatesfiorlocaCp~lbl(c offjce must file w1thtEt0 local aoun(y:elechph commit ion in the county.wberelhe corltrlbutlons-are and ~opithltrees g]VJngrioih statgnd focal';candidates should filer original month the f2egistry~nd a cgPy with" the county elecilon cornmisslon~n any eouh~y the gorrimittee ls. lnakirtg cQntrlbution5 s _ 1. Date 2. Name of Committee 07/01/14 Blount Lifestyle 3. Address and Phone Street or Rural Route City State Zip Code Phone 3204 Regal Drive Alcoa TN 37701 865 583-8160 4. Committee Name as it Appears on Checks 5. Type of Candidate Supported (Check One or Both) Blount Lifestyle ❑ Stale Candidate ® Local Candidate 6. Treasurer Name Jerry Cunningham 865-599-7135 7. Treasurer Address and Phone Street or Rural Route City State Z/p Code Phone 1616 McKenry Road Walland TN 37886 865 983-8578 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 ® No 10. Committee Officers (Name, Position and Address) (Attach additional page If necessary) C. Rand Masse 3817 River Vista Way, Louisville, TN 37777 Chairman Jerry Cunningham 1616 McKenry Road Walland, TN 37886 Treasurer Dave Bennett 1511 Valley Breeze Circle Maryville, TN 37803 Secretary 11. Appoin uthorlty and Treasurer Signature (Both signatures must be witnessed. easurer not witnes nature.) -7 Sig ur p I ling Author y Ign to a Trea er Ig ure of ess Signature of witness ELECTI2.O.W rII,II~TG If ou are interested In filing, Y yonr'campafgn financial dlsciostirestatenjenls wlthAhe Registry electronically.then you will need an ID and password'. You tnay gq to W tennesseegnyflme orgitncamp/ to see a demonstration:of the elecfronic:fling system. If yotl check the box be ow and sign, thq;.,eglstry w111 send you an; ID and password eiong tiylth In -tructlons on how io gel started on the electronic iiling, system It you haveany _q esttons;;=please Peel free. to soritaciahe Registry office at 645 7917959 I would like to receive and ID and Password to file campaign financial disclosure statements electronically. Registry of Election Finance SS-1112 (Rev. 8/08) RDA Pending