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DeBusk, Alan CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For Stale and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT I 2.a. NAME OF CANDIDATE OR COMMITTEE Committe to Elect Alan DeBusk 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE Alan C. DeBusk 8/4/2016 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 709 Columbus St. Maryville TN 37804 865-984-8277 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) Blount County Clerk Scott DeBusk - Primary Alan DeBusk - Alternate 7. CATEGORY OR REPO~IRT (Check one) 1:1 1:1 FIRST SECOND THIRD FOURTH PRE- PRE- MI EAR YEAR-END DARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD 4/1/2016 6/30/2016 9. (Check one) a. ❑ This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. This campaign is required to file a detailed financial disclosure because contributions (including in-kind) received total more than $1,000 and/or expenditures total more than $1,000 for this reporting period. 10. I/we do solemnly swear or affirm that the information contained in this campaign financial disclosure report is true and that this report is an accurate accounting of campaign contributions and expenditures required to be reported by the candidate committee by the Campaign Financial Disclosure Act. Additionally, I/we swear or affirm that no campaign contributions have been expended for the personal financial benefit of the candidate or for any other nonpolitical purpose as defined by the federal internal revenue code. t -76 (//4 signature of candidate date signature of political treasurer date 11. WITNESS SIGNATURE k)luo~6&_ 11 ""'U" - signature of witness date signature of witness date 12. SUMMARY 0 a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTSTHIS PERIOD 2,656 c. TOTAL DISBURSEMENTS THIS PERIOD $ 1,984.94 d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ 671.06 e. TOTAL LOANS OUTSTANDING , . $ 0 > f. TOTAL OBLIGATIONS OUTSTANDING .....................................................,I(J(,. 1... 140.65 1 X16 $ ELEC77ON SS-1109 (Rev. 2/06) Page 1 of RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING THE PERIOD Alan DeBusk FROM: 4/1/2016 TO: 6/30/2016 RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ 150 b. Itemized Contributions (over $100 from each source this period) $ 2,506 c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 2,656 16. LOANS RECEIVED THIS REPORTING PERIOD $ 0 17. INTEREST RECEIVED THIS REPORTING PERIOD 0 18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ 2,656 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) Gas $ 50.50 Community Food Connection $ 100.00 Supplies $ 84.72 Total of Expenditures ($100 or less each payee) $ 235.22 b. Itemized Expenditures (Over $100 each payee this period) $ 1,749.72 c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 1,984.94 20. LOAN REPAYMENTS MADE THIS PERIOD $ 0 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 1,984.94 22.IN-KIND CONTRIBUTIONS a. Unitemized in-kind contributions ($100 or less from each source this period) $ 0 b. Itemized in-kind contributions (over $100 from each source this period) $ 2,073 c. TOTAL IN-KIND CONTRIBUTIONS RECEIVED THIS PERIOD (add 22.a. and 22.b.) $ 2,073 23. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ 0 b. Itemized Obligations Outstanding (Over $100 each) $ 140.65 c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 121) $ 140.65 SS-1133 (Rev. 4/02) Page 2 of I ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD Alan DeBusk FROM:4/1/20Funt 6/30/2016 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 First Name Middle Name Contribution Received For: Amount of Contribution A1etn - C Last Name/Organization Name ❑ Primary Election General Election C) Address G 14, ❑ Runoff (Local Elections Only) 7 Co S y s Ciry Zip Code Date of Contribution Aggregate This Election ?-?soy Occupation [I J~ / 26 Employer n L;. rl) nC ~~~Cy'~ ~ Ac r> A5 5; c c 4-62 7 First Name Middle Name Contribution Received For: Amount of Contribution A/,~- ^ (f - Last Name/Organization Name ❑ Primary Election )M-General Election 45K c o a lC (3v Ski- ~~O a Address ❑ Runoff (Local Elections Only) 70 C6 City '111 Y<<~~ e Stao~ zipCode J Date of Contribution Aggregate This Election Occupation UZ.u,~sZ ~ Z >d~~LC Employer / ~SSGC'ccZ~tl First Name ddleName Contribution Received For: Amount of Contribution C. Last am amza on Name Primary Election bi-General Election Address ❑ Runoff (Local Elections Only) 0~ t!ot~~ 5~s 5~- City n State Lp 3Code Date of Contribution Aggregate This Election ar V~ Ttir 18o~F Occupation O/ Employer First Name Middle Name Contribution Received or: Amount o Contribution te, , C . Last NamelOrganization Name ❑ Primary Election V~ General Election bc> Address C ❑ Runoff (Local Elections Only) D~ C~ ~u M SI.US S~- City S Zip Code Date of Contribution Aggregate This Election Occupation V W ~'1.e r CL3 • Employer yy j~sSC~C rCr lyl 11~ *0 5. TOTAL ITEMIZED CONTRIBUTIONS CC- (Carry forward to item 3. of next page if additional pages of this form are used.) 2 r 3 C r (If this is the last page of contributions, this amount must be shown in item 15b. of summary.) I-' SS-1131(Rev. 2/06) Page `3 of 1 ( RDA 1159 ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD Alan DeBusk FROMA/1/2016 TO: 6/30/2016 Amount 3. TOTAL ITEMIZED CAMPAIGN CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) Z, 3 C> 4. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED CONTRIBUTION contributions totaling more than $100 from an contributor First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organization Name ❑ Primary Election I general Election D -e 3 Us Address ❑ Runoff (Local Elections Only) 70 ~l C (v ~1 h os S4"City State Zip Code Date of Contribution Aggregate This Election 'M c . /'Iy V4(e rN Occupation Employer C ~SScC, v-7kes Fi t Name Middle Name Contribution Received For: Amount of Contribution Last Name/0 ization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name fiddle me Contribution Received For: Amount of Contribution as Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer First Name Middle Name Contribution ece v Amount o Contribution Last Name/Organization Name ❑ Primary Election eral Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS 5bla b^ (Carry forward to item 3. of next page if additional pages of this form are used.) (if this is the last page of contributions, this amount must be shown in item 15b. of summary.) SS-1131(Rev. 2/06) Page Ll of < < RDA 1159 .ra . ) ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD Alan DeBusk FROM:4/1/2016 TO: 6/30/2016 moun 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) $0.00 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 C In-Kind Contribution Received For: Value of In-Kind Contribution Alan ❑ Primary Election ® General Election Last Name/Organization Name $1,000 DeBusk ❑ Runoff (Local Elections Only) Address 709 Columbus St. Dateotln-KWContribution 5/2/2016 Aggregate this Election $1,000 city Maryville StafN Zip Code 37804 Description of In-Kind Contribution Occupation Employer Web development Owner ACD Associates First Name Lisa 7 Middle Name C In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ® General Election Last Name/OrganizationName Gibson (wife) $200 ❑ Runoff (Local Elections Only) Address 709 Columbus St. Date ofin-Kind Contribution 6/7/2016 Aggregate this Election $ . SwrN Zip Code 37804 Description of In-Kind Contribution City Maryville 1 Occupation Employer Facility usage Owner Smith Event Centers First Name Lisa Middle Name C In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ® General Election Last Name/Organization Name Gibson $200 (wife) ❑ Runoff (Local Elections Only) Address 709 Columbus St. Date of In-Kind Contribution 6/14/2016 Aggregate this ElactiGn $829 City Maryville stat@.FN Zip Code 37804 Description ofln-KirdContribution Occupation ployer Facility Usage Owner Smith Event Centers First Name Middle Name In-Kind Contribution Received For. Value of In-Kind Contribution Lisa C ❑ Primary Election ® General Election Last Name/Organization Name $280 Gibson (wife) ❑ Runoff (Local Elections Only) Address 709 Columbus St. Date of In-Kind Contribution 6/27/2016 Aggregate this Election $829 city Ma ille State TN z~pcode 37804 Description of In-Kind Contribution Occupation Employer Signs Owner Smith Event Centers First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution Lisa C ❑ Primary Election IM General Election $149 Last Name/OrganizationName Gibson (wife) ❑ Runoff (Local Elections Only) Address 709 Columbus St. Date of In-Kind Contribution 6/29/2016 Aggregate this Election $829 city Maryville Stagy Zip Code 37804 Description of In-Kind Contribution pan PloYar Advertisement Owner 7 TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) $1,829 (If this is the last page of in-kind contributions, this amount must be shown in item 22b. of summary.) SS-1128 (Rev. 2/06) Page of RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD Alan DeBusk FROM:4/1/2016 TO: 6/30/2016 moun 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) $1,829 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 B In-Kind Contribution Received For: Value of In-Kind Contribution Scott Primary Electron ® General Election Last Name/Organization Name $244 DeBusk ❑ Runoff (Local Elections Only) Address 309 Carter Ave Date ofln-WContribution 6/25/2016 Aggregate this Election 244 city Maryville statg„N zip Code 37803 Description oflnAnd Contribution Occupation Employer l Advertisement Agent Delta Airlines First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last Nam anization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election city state Zip code Description of In-Kind Contribution Employer First Name fiddle Name In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ® General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind C button Received For: Value of In-Kind Contribution ❑ Prima lection ® General Election Last Name/Organization Name ❑ Runoff (Coca lections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For: Value of In-Kind Contribution Primary Election 29 General Election Last Name/Organization Name ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggreg this Election city State Zip Cade Description of In-Kind Contribution Occupation Employer =thisis ED IN KIND CONTRIBUTIONS em 3. of next page if additional pages of this form are used.) $ 2,073 ge of in-kind contributions, this amo unt must be shown in item 22b. of summary.) SS-1128 (Rev. 2/06) Page of _/L RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD Alan DeBusk FROM:4/1/2016 TO: 6/30/2016 mount 3. TOTAL ITEMIZED CAMPAIGN 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) First Name Middle Name Purpose of Expenditure Amount of Expenditure 1 Last Name/Business Name k 46 c, XdY~A Address City state Zip Code Ix, First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address R~A 14 city I cr, W l State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name C Address ~(pGl Wi0 KJ City State Zip Code gU-4 (1b K- 2 First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Z(~7 Address city Stale Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name ~c:c~ ~ / +~r31C1 ~~VS2('~tS r''j~> 3~` pcl Address city State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name r / ~4r ( ~ / N1es ~C` ~/.SZ S f Jl~ (v O~ Address 07 City S~ Zip Code / <v. -7 5. TOTAL ITEMIZED EXPENDITURES (Carry forward to item 3. of next page 9 additional pages of this form are used.) 7 U (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) AfflkL SS-1129 (Rev. 4102) Page 7 of /I RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD Alan DeBusk FROM:4/1/2016 TO: 6/30/2016 moun 3. TOTAL ITEMIZED CAMPAIGN 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) First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name n , _ _ %r{~ y Address Y SSO rZ e c- iRl v i ~f City S L ^ S7-K Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name + A5 Address / 4-T0~;7~s 5 . City 11 State Zip Code o S TzJr' 7X First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City C~ State Zip Code ~(C oct TN. -7'7-7c>( First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address 6, 4, c J v f 1 r> g city State Zip Code b L S du (-e /Q First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address ` n ~ ~ ~ ✓ 2 7~ InS a ,rKC~~ S~', City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Vr, S+', P, l ( Address 2 7 3 (11 C' M Ci - l Sf. 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 expenditures, this amount must be shown in item 19b. of summary.) SS-1129 (Rev. 4102) Page of ( RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD Alan DeBusk FROM:4/1/2016 TO: 6/30/2016 moun 3. TOTAL ITEMIZED CAMPAIGN 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) lll~ Middle Name Purpose of Expenditure Amount of Expenditure First Name Last Name/Business Name < V Address rw c.,i City ~J State Zip Code I~ I I It ~,v. WA 2 s Middle Name Purpose of Expenditure Amount of Expenditure First Name Last Name/Business Name Q Address -7 City State Zip Code (,dc, (+k0-11 W 2 l Middle Name Purpose of Expenditure Amount of Expenditure st Name Last Na usiness Name Address City State Zip Code First Name Purpose of Expenditure Amount of Expenditure Middle Name Last Name/Business Name Address City State Zip Code Middle Name P se of Expenditure Amount of Expenditure First Name Last Name/Business Name Address City State Zip Code Middle Name Purpose of Expenditure Amount of Expenditure First Name Last Name/Business Name Address City State Zip Code EENWEEM~ 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 expenditures, this amount must be shown in item 19b. of summary.) Page of RDA 1159 AML SS-1129 (Rev. 4102) ITEMIZED STATEMENT OF LOANS - CANDIDATE 2. REPORT COVERING THE PERIOD 1. NAME OF CANDIDATE OR COMMITTEE Alan DeBusk FROM4/1/2016 T0. 6/30/2016 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling more than $100 from any source during the period) n Balance Complete the Following for the Source of the Loan Loan Outstan!offLPPefinod)) First Name N/Outstanding Loan Balance Loans menu (E(Beginning of Period) Received Payments Last Name/Organization Name Loan Received For. Date of Loan Address ❑ Primary Election ❑ General Election City State Zip Code ❑ Runoff (Local Elections Only) List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page) Middle Name First Name Middle Name F' t Name Last Na Organization Name Last Name/Organization Name Address Address State Zip Code City State Zip Cade City Amount Guaranteed Outstanding Amount Guaranteed Outstanding Middle Name First Name Middle Name First Name Last NamelOrganization Name Last Name/Organization Name Address Address State Zip Code city State Zip Code City mount Guaranteed Outstanding Amount Guaranteed Outstanding Middle Name First Name Middle Name First Name ast Name/Organization Name Last Name/Organization Name Address Addres city Slate Zip Code City State Zip Code Amount Guaranteed Outstanding First Name Amount GuaranteedOu ding Middle Name First Name Middle Name Last Name/Organization Name Last NamelOrganization Name Address Address State Zip Code City S Zip Code City Amount Guaranteed Outstanding Amount Guaranteed m Outstanding 4. Totals for all Loans (complete on last page of itemized loans) Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Total loans received should also be shown in item 16. on summary page.) (Beginning of Period Received Pa menu End of Period (Total loan payments should also be shown in item 20. on summary page.) N/A (Total outstanding loan balance should also be shown in item 12.e. on front page.) Page of r RDA 1159 AML SS-1132 (Rev. 4102) ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 2. REPORT COVERING THE PERIOD 1. NAME OF CANDIDATE OR COMMITTEE FROM: 4/1/2016 TO: 6/30/2016 Alan DeBusk (End of ing PeriOnce 3. COMPLETE THE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding of Period) DThislPeriod ThPayments is Period Outstanding OBLIGATION (obligations totaling more than $100 owed to any (Beginning personlvendor at the end of the reporting period) Middle Name First Name Last Name/BusinesSName Facebook $0.00 $140.65 $0.00 $140.65 Address 1601 Willow Road State ZPCode city Menlo Park CA 94025 Description o b igation Advertising charge billed on 6/30/201 t Name Middle Name Last Name ess Name Address gtate City Zip Code Description of Obligation First Name le Name Last Name/Business Name Address City State Zip Code Description of Obligation First Name Middle Name Last NameBBusiness Name Address City State Zip Code Description of Obligation First Name Middle Name Last NameBusiness Name :A:ddre:ss City State Zip Code Description of Obligation 4. TOTALS $0.00 $140.65 $0.00 $140.65 (Total from Outstanding Balance - (End of Period) column must also be shown in item 23b. on summary page.) Page of ~ RDA 1159 SS-1127 (Rev. 4/02)