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Medley, Christopher CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For Stab and Local Candidates For Single-Candidate Committees 1. DATE OF REP RT 12.a. NAME OF CANDIDATE OR COMMITTEE f2( 09 20 f f? -1 (f T 115 Ae&-e ~f I~toon^f C'oun~ Co"^"1 kspror~ Wit ELECTION DATE 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. EL hr'Is I~P~1 r a 4.a. CAMPAIGN ADDRESS AND PH E State Zip Code Phone Street O' Rural Route city a//3 k~alCt lol c rill a Nl~t ~'ll~t `T p 37$63 w'!!)(0go-/('63 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) State Zip Code Phone Street or Rural Route City 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) 14 - (j 5s/ , /4 AAO(ersoN Cpvn~ ~.►t/rrSsio~ 54y; s 7. CATEGORY OR REPORT (Check one)❑ ❑ Ll- 11 MI ❑YEAR YEAR-END FIRT SECOND THIRD FOURTH R R RTER ARTER TER PRIMARY ENERAL SUPPLEMENTAL UPPL EMENTAL S.a. BEGINNING DATE OF REPORTING PERIOD B.b. O ENDING DATE I OF REPORTING PERIOD F_ bC4 o(~2or~ 111 111, 1 9. (Check one) ❑ This campaign is exempt from detailed disclosure because terns io12d., 12e. ns (including and in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete 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 Ad. 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. of candidate date signatur f po icaI treasurer signature date 11. WITNESS SIGNATURE date signature witness date signatur witness 12. SUMMARY / a. BALANCE ON HAND LAST REPORT $ 7 . 7(,v0_ °o b. TOTALRECEIPTSTHIS PERIOD OV c. TOTAL DISBURSEMENTSTHIS PERIOD $ 960, d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ 500.00 e. TOTAL LOANS OUTSTANDING AM1 A E. TOTAL OBLIGATIONS OUTSTANDING G r f RECEIVED w A Page 1 of RDA 1159 SS-1109 (Rev. 2106) APR 2 4 2018 BLOUNT COUNT v ELECTION O l wy wd CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE og /.p4 Za (fl lou rA Gtj rte CO ma% ~ ss' en 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE (f 6i s M e,~l-e 4.a. CAMPAIGN ADDRESS AND PHO E Street or Rural Route City State Zip Code Phone 6-/663 o?// WAX-f-Oe(o( e4 rc1e Mar ',{(t 7" 37 o3 865 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) ~fss;oN mss! ic LA- S yell Atw(erson 7. CATEGORY OR REPORT (Check one) L~ FIRST SECOND THIRD FOURTH PRE- PRE- MIDYEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD 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. signature of candidate date signature of political treasurer date 11. WITNESS SIGNATURE signature of witness date signature of witness date 12. SUMMARY cy a. BALANCE ON HAND LAST REPORT $ 7G0. ° ° b. TOTAL RECEIPTS THIS PERIOD c. TOTAL DISBURSEMENTS THIS PERIOD $ ' U d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ ~ oa 5-0 e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ Awk SS-1109 (Rev. 2/06) Page 1 of RDA 1159 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR CQMMITTEE (In Full) 14. REPORT COVERING THE PERIOD O/'l's ~A A P FROM: d 2 1 TO: Z RECEIPTS 1 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ 74o, 0 0 b. Itemized Contributions (over $100 from each source this period) $ / 7Ga c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 16. LOANS RECEIVED THIS REPORTING PERIOD $ 17. INTEREST RECEIVED THIS REPORTING PERIOD 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) 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 $ 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 22.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 22.a. and 22.b.) $ 23. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding Over $100 each $ c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 121.) $ 45 SS-1133 (Rev. 4102) Page a of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF ~IDATE OR COMMITT~ 2. REPORT COVERING THE PERIOD FROM: r7 01 TO: t 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 totalin more than $100 from an contributor Middle Name Contribution Received For: Amount of Contribution Firs ame P-4 C, Last Name Organization Name Primary Election ❑ General Election 00,00 ~ Ca F Address ❑ Runoff (Local Elections Only) O 1 i V 2 State Zip Code Date of Contribution Aggregate This Election City TU O u, I 1 37 Occupation c) q /O 5-( o t tAC Employer "8160,rt ~Orur► Sc1wu is Middle Name Contribution Received For: Amount of Contribution First Name e\j Ill Last Name/Organization Name Wrimary Election ❑ General Election 30cl, Od I~lcNe~ ~ Address ^ ❑ Runoff (Local Elections Only) ~ISSttate C d Date of Contribution Aggregate This Election city V 1 1-7-N I Occupation o y 2 0/ Z O t' g Employer Qe~%YV K iddle Name Contribution Received For: Amount of Contribution First Nam ~b >~r ~j as ame /r~►anization Name 'Pl Primary Election C] General Election OQ l7!iuC ~'n er lJ r Address ❑ Runoff (Local Elections Only) State Zi p Cod Date of Contribution Aggregate This Election City V ~ I I 'T1 ~ 0 up-In Employer Middle Name Contribution Received or: mount o Contribution First Name ❑ Primary Election ❑ General Election Last NamelOrganizationNome Address ❑ Runoff (Local Elections Only) State Zip Code Date of Contribution Aggregate This Election Ciry Occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS b~ DO (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.) Page of RDA 1159 SS-1131(Rev. 2106) ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 2. REPORT COVERING THE PERIOD 1, NAME OF CANDIDATE OR CO ITTEE FROM: T0: 1-2 'S P 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 perioAmount of Expenditure Middle Name Purpose of Expenditure First Name -~~b(e 3~'eo Last Name/Business Name uh'~ CCU n ~t v c~h T s(r~bl~SpC Address City ✓ hA State Zip Code 17701 Purpose of Expenditure Amount of Expenditure First Name Middle Name Last Name/Business Name Address City State Zip Code Purpose of Expenditure Amount of Expenditure Middle Name First Name Last Name/Business Name Address City State Zip Cade Purpose of Expenditure Amount of Expenditure First Name Middle Name Last Name/Business Name Address State Zip Code City Purpose of Expenditure Amount of Expenditure First Name Middle Name Last Name/Business Name Address City State Zip Code Purpose of Expenditure Amount of Expenditure First Name Middle Name Last Name/Business Name Address State Zip Code City 5. TOTAL ITEMIZED EXPENDITURES 30-0 (Carry forward to item 3. of next page if additional pages of this form are used.) (It this is the last page of expenditures, this amount must be shown in item 19b. of summary.) Page of RDA 1159 Afflh, SS-1129 (Rev. 4102) CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATEOFREPORT 2.a. NAME OF CANDIDATE OR COMMITTEE e) q o 26,1 `bl .5 Nt~c~~t v~ cz~nj~j ofnbl;SjL~ 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE V r~ 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 31/3 LOc.41.eC-,-QU Crrz ,P_ ar ~tll i 7 0' -166 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) 7. CATEGORY OR REPORT (Check one) IF RST SECOND THIRD FOURTH PR - PR - MI 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 v i !(b• ~i S.- 3 3% Zvi 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. W 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 p~urrppose4as defined by the federal internal revenue code. lie, signatu a of candidate ate Sig re of political treasurer d to 11. NESS SIG URE signatu of fitness date sig a of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ b. TOTAL RECEIPTSTHIS PERIOD )00. c. TOTAL DISBURSEMENTS THIS PERIOD / 2•7 d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ 1311-91. e. TOTAL LOANS OUTSTANDING $ f. TOTAL OBLIGATIONS OUTSTANDING $ RECEIVED SS-1109 (Rev. 2/06) Page 1 of RDA 1159 APR 1 1 2018 rx0UWCOUW MOWN SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMITTEE (In Full) 14. REPORT COVERING TH PERIOD T i 5 Y VC FROM: r- . TO: -03 31 j, RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions $100 or less from each source this period) Spa b. Itemized Contributions (over $100 from each source this period) $ s D c. TOTAL CONTRIBUTIONS (other than loans and interest)(add 15.a. and 15.b.) $ 16. LOANS RECEIVED THIS REPORTING PERIOD $ Y~ 17. INTEREST RECEIVED THIS REPORTING PERIOD $ Q~ 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) o r a ~ar> Cd•~ec 5 $ 32- .15- Mir.~e~ Wri5~( $ I00,0c Total of Expenditures $100 or less each payee) b. Itemized Expenditures (Over $100 each payee this period) $ 9 c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ 20. LOAN REPAYMENTS MADE THIS PERIOD $ 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) $ 22.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 22.a. and 22.b.) $ 23. OBLIGATIONS a. Unitemized Obligations Outstanding ($100 or less each) $ b. Itemized Obligations Outstanding (Over $100 each) $ c. TOTAL OBLIGATIONS OUTSTANDING (add 23.a. and 23.b.) (must be shown i item 121.) $ _ 1J SS-1133 (Rev. 4102) Page of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF %[Dl DA TE OR COMMI E 2. REPORT COVERING THE PERIOD 5 C ,j FROM: ( V T0: ©3 31 Lvi S~ 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 any contributor) First Name Middle Name Contribution Received For: Amount of Contribution Last Name/Organization Name ~aPrimary Election El General Election /00 60 An tr r• Address ❑ Runoff (Local Elections Only) C lrc~e City State Zip Code Date of Contribution Aggregate This Election ~kk tittle 03 C)l~lu(zbr~ Occupation 1J~rst Employer ,1 tJ First Name Middle Name Contribution Received For: Amount of Contribution v~ Last Name/Organization Na a 13Pnmary Election ❑ General Election Address I ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election ar vi it e 01 -7 0 Occupation .Reft 031 / I/ I~ re Employer First Name iddle Name Contribution Received For: Amount of Contribution Last Name /Organization Name 14PNmary Election ❑ General Election 75~~ ~v Address ❑ 3~ Runoff (Local Elections Only) oy q L ri~~ City State Zip Code Date of Contribution Aggregate This Election AI CoA --r /,J 3Occupation "~l~w r1 k e V 3 L 4s-4 SAC mp oyer First Name Middle Name Contribution Received For: Amount o Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code Date of Contribution Aggregate This Election Occupation Employer 5. TOTAL ITEMIZED CONTRIBUTIONS (Carry forward to item 3. of next page if additional pages of this form are used.) ?0 (If this is the last page of contributions, this amount must be shown in item 15b. of summary.) e W SS-1131(Rev. 2/06) Page ( of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMI TEE 2. REPORT COVERING THE PERIOD C 1 i S ~-e FROM: O i In, TO: D 3 13ilIg mount 3. TOTAL ITEMIZED CAMPAIGN EXPENDITURES FROM PRECEDING PAGE (enter $0 ff 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 S; n G' til Aa~ X6,7 5 Address S , BLS 115 h(,1!>, w br -5,61, 4e loo ,J -its- City State Zip Code 1 054 n =x 7 V 5Y First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name t.; S F'S N~~l ~-~cK Address Jtj ^ ~Z ll er L l~G X90 . City State Zip Code Kcax u'l Lt-f- 'T JJ ~s o t First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name ' C -7 Address ~7s S+ 11~~5 City Slate zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address city state Zip Code 5. TOTAL ITEMIZED EXPENDITURES / tI (Carty 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. 4/02) Page of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 2.a. 76~ OF CANDIDATE OR COMMITTEE v z s /Zo ( Fr ' s - e l.e 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE A / lo t Y Street or Rural Route City State Zip Code Phone Q l l 3 W a1,.t k ~l ca. Maw i ft-f_ -TiQ 37 a '362 6 v-l 6G3 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) Cc va 6 7. CATEGORY OR REPORT (Check one) ❑ ❑ ❑ ❑ ❑ ❑ FIRST SECOND THIRD F TH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL AL SUPPLEMENTAL S.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD Oq V.0 (-7 15- I ~ 9. (Check o he) 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, l1we 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. OI Zs rf( - S- l signs ure o candida a date sign litical treasurer date 11. WITNESS SIG E ~ 12 A~ signatur date si nature of witness ^ to 12. SUMMARY a 2 201a on ot4 co % a GOUN a. BALANCE ON HAND LAST REPORT $ O b. TOTAL RECEIPTS THIS PERIOD gZ.32 c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND 12.a. plus 12.b. minus 12.c. $ / -7' G o e. TOTAL LOANS OUTSTANDING $ S f. TOTAL OBLIGATIONS OUTSTANDING $ roeo SS-1109 (Rev. 2/06) Page 1 of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COM ITTEE 2. REPORT COVERING THE PERIOD t l 2 FROM:O t T0: /Z 2v/7 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 ),t ) S (~,,rok 23 Last NamelBusiness Name V; s~ ~Y : ItT Y G a. Address ~r o't7 s ~ m w` S a City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name C U-595, -7 Address ~ r C a City State Zip Code M 4c 7-W 3 -7~01 First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Namel9 siness Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name Address City State Zip Code 5. TOTAL ITEMIZED EXPENDITURES (Carry forward to item 3. of next page if additional pages of this form are used.) v/7( (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) SS-1129 (Rev. 4/02) Page of RDA 1159 I ITEMIZED STATEMENT OF LOANS - CANDIDATE 2. REPORT COVERING THE PERIOD 1. NAME OF CANDIDATE OR COMMITTEE FROM: TO: ~1 d 2(, ~ 7 I Z 31 ZoC7 ri5{ { 3. COMPLETE THE APPROPRIATE IT S FOR EACH ITEMIZED LOAN (loans totaling more than $100 from any source during the period) Complete the Following for the Source of the Loan Loan Outstanding Loan Balance Middle Name Outstanding Loan Balance Loans Payments (End of Period) First Name (Beginning of Period) Received C65 500 Last Name/organ i~atiO,nCName Date of Loan MM 0O9]~~11`` an Lo Received For: Address L4I v 07 ~I V ZJn e v W (A ❑ Primary Election 13 General Election 6 l Slate ip Code 2v17 City *k-i y6 v-5 ❑ Runoff (Local Elections Only) v1~({ List All Endorsers or Guarantors for Above Loan (Ii more space is needed please attach a page) Middle Name Middle Name First Name First Name Last NamelOrganizalion Name Last NamelOrganization Name Address Address State Zip Code State Zip Code City city Amount Guaranteed Outstanding Amount Guaranteed Outstanding Middle Name Middle Name First Name First Name Last Name/Organization Name Last Name/Organization Name Address Address State Zip Code State Zip Code City City mount Guaranteed Outstanding Amount Guaranteed Outstanding Middle Name Middle Name First Name First Name Last Name/Organization Name Last Name/Organization Name Address Address State city Zip Code State Zip Code City mount Guaranteed Outstanding Amount Guaranteed Outstanding Middle Name Middle Name First Name First Name Last Name/Organization Name Last Name/Organization Name Address Address State City Zip Code State Zip Code City mount Guaranteed Outstanding Amount Guaranteed Outstanding Outstanding Loan Balance Loans Loan Outstanding Loan Balance Pa menu 4. Totals for all Loans (complete on last page of Itemized loans? End of Period page.) (Beginning of Period Received (Total loans received should also be shown in item 16. on summary (Total loan payments should also be shown in item 20. on summary page.) (Total outstanding loan balance should also be shown in item 12.e. on front page.) RDA 1159 Page of SS-1132 (Rev. 4102)