Livesay, Tracie
FINANCIAL DISCLOSURE STATEMENT EXEMPTION
Pursuant to TCA § 2-10-101(b) a candidate is exempt from filing financial
disclosure statements due to the following:
1. The service for the office which I seek is part-time and the compensation
is less than $1,000 per month,
AND
2. 1 do not plan to spend more than $1,000 on my campaign.
*Candidates running for Chief Administrative Officer (i.e. Mayor) of the county or
city are NEVER exempt from filing and should file the required campaign financial
disclosure reports regardless of compensation or spending.
CANDIDATE'S INFORMATION:
Candidate's Name: (2
Candidate's Position: v Co\1 1A.,
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Residential Address: O
City: 22~os).~p(a State: TN Zip: ?j~ 3
I hereby state that I meet the above qualifications for exemption and am
therefore exempt from filing financial disclosure statements. If any of the above
change and I no longer qualify as an exemption, I will file the required campaign
financial disclosure reports with my local election commission.
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Candidate's Signature 1-? Date
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Witness's Signature
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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, 404James 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. Candidate First and Last Name: 3. Candidate e-mail address:
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4. Campaign Address and Phone: City State Zip Code Phone
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S. Home Address and one (if different than I em 4 above): City State Zip Code Phone
6. Office Sought (include district number, if applicable) 7. Party Affiliation 8. Election Year
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9. Treasurer N e: 10. Treasurer e-mail address:
11. Treasurer Addresrand Phone: City State Zip Coe Phone
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12. Candidate and Treas r Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
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Signature of Candidate Signature of Treasurer
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Signature of Witness era Signature of Witness
. Registry of Election Finance
SS-1120 (rev 12/2013)