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Hatcher, Cindy a i CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candldate Committees 1. DATE OF REPORT 2.a. NAME OF CANDIDAT OR COMM TTEE R0191-0-7-0 C►n of 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE ol'--D~-v2 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 'Vz1z &r4"'L0Lovisvll) - /V 377 g6 -z3~-oz~, 4.b. CANDIDATE'S HOME ADDRESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone Saw &I 't 5. OFFI 1, SOUGHT (icluge~ district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be ca idatee)) R ! ~ Y ; cq iI S l c~ ►'C X rcfJ'~ ✓G efhf►' ~f !r p ~ Q C r, <k L 7. CATEGORY OR REPORT (Check one) ❑ Cr" ❑ ❑ ❑ ❑ ❑ ❑ FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD aIk-ati-':Z.2 bI$ ~v6 -30 9. (Check one) a. This campaign is exempt from detailed disclosure because contributions (including in-kind) received total $1,000 or less AND expendi- tures total $1,000 or less for this reporting period. (Complete items 12d., 12e. and 12f.) b. ❑ 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 c mittee by the Campaign Financial Disclosure Act. Additionally, I/we swear or affirm that no campaign contrib ons have been xpe ded for the personal financial b efit of'the candidate or for any other nonpolitical purpose as defined by the fed I ternal re n co e. 20 IS -U7 signature candidate d e ture pol al reasurer date i 11. WITNESSSIGNATU -d3-r /A141 signatur witness date big atur f witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ j~ 0 0 b. TOTAL RECEIPTS THIS PERIOD ~I c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ e. TOTAL LOANS OUTSTANDING SP.............................................. $ JU RECEIVED f. TOTAL OBLIGATIONS OUTSTANDING . . . $ ~ rtM1 N BLOUNTCOUNTY SS-1109 (Rev. 2/06) ELECTION Page 1 of RDA 1159 d SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR COMMI TTE (In Full) 14. REPORT COVERING TH PERIOD C t n ' FROM c) 22 TO RECEIPTS E' 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period)... $ on I 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.) r9. BURSEMENTS XPENDITURES (other than loan payments) . xpenditures ($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) $ arm c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b. n e~ kle 20. LOAN REPAYMENTS MADE THIS PERIOD 21. TOTAL DISBURSEMENTS (add 19.c. and 20.) (must be shown in item 12.c.) 9 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 12.f) SS-1133 (Rev. 4102) Page of ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTE l FF REPORT COVERING THE PE IOD r Cf OM : jZ T0: 3 0 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 thar $100 from any contributor) First Name Middle Name Contribution Received For Amount of Contribution C 4 f41 4 L,O+u•> Last Name/Or an¢ation Name / Primary Election El General Election ti 4-C Address 22 ~ A ✓C tit:ov Runoff (Local Elections Only) City Zip Code Date of Contribution Aggregate This Election 37~.7 Occupation Employer T~f c co j-~ _r05 First Name Miodle Name Contribution Received For Amount of 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 FirstName ~iddle Name Contribution Received For Amount of Contribution Last ame rganization 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 Received For Amount of Contribution Last Name/Organization Name ❑ Primary Election ❑ General Election Address ❑ Runoff (Local Elections Only) City State Zip Code late 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.) (If this is the last page of contributions. this amount must be shown in item 15b. of summary.) SS-1131(Rev. 2106) Page -3-L of RDA 1159 ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE NAME 2. REPORT COVERING THE PER D L FROM X T COVERING O 4COMPLEETTEE DIDAT OR COMMI TEE ount ED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 7 APPROPRIATE ITEMS FOR EACH ITEMIZED IN-KIND CONTRIBUTION jm-kind contributions totaling more than $100 from any contributor during the period) -id Middle Name In-Kind Contribution Received For Value of In-Kind Contribution Name [3 Primary Election El General Election ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution occupation Employer Firs; Vame Middle Name In-Kind Contribution Received For 'value of In-Kind Contribution ❑ Primary Election El General Election Last NamelOrganrzah on 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 F rsl Name Middle Name In-Kind Contribution Received For Value of In-Kind Contribution NameiOrgarnzahon Name El Primary Election [-I General Election Last ❑ 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 Contribution Received For. Value of In-Kind Contribution Last Name/Organization zation Name ❑ Primary Election El General Election ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City Sate Zip Code Description of In-Kind Contribution Occupation Employer First Name Middle Name In-Kind Contribution Received For Value of In-Kind Contribution Last NamerorganizatonName ❑ Primary Election ❑ General Election ❑ Runoff (Local Elections Only) Address Date of In-Kind Contribution Aggregate this Election City State Zip Code Description of In-Kind Contribution ccupation mp oyer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS Carry rorware to ;tem 3 of next page if additional pages of this form are usea. If this is the last page of in-kind contributions. this amount must be shown in item 22b. of summary -`r SS-1128 (Rev 2/06) Page of RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1 NAME OF CANDIDATE OR COJNMI TEE 2. REPORT OVERING THE PE 510D Ct FROM: 2.L T0: L13 Q 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 8100 to any payee during the period) First Name Middle Name Purpose of Expenditure Amount of Expenditure Last Name/Business Name ' Ma !9 l v` I ? 1~~ ye ~~«~Cr ~p O_a .1 4 Address 7 E. c- ~~~fhl City AA~~ II St Zip Code J~~Ar ✓1 ll~ Q r 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 NameiBusiness Name Address City State Zip Code First Name Middle Name Purpose of Expenditure Amount of Expenditure Last NamelBuslness 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 onsommo~ 5. TOTAL ITEMIZED EXPENDITURES (Carry forward to item 3 of next page if additional pages of this form are used )~q.~ (If this is the last page of expenditures. this amount must be shown in item 191b. of summary.) 11// SS-1129 (Rev 4102) Page of RDA 1159 1 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT Z.a. NAME OF)CANDIDATE 01 RCPT MMI EE 1 i i_r 0`=s-L 1 F:f 2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE Z 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route /City State Zip Code Phone 4.b. CANDIDATE'S HOME AD RESS (if different than 4.a.) Street or Rural Route City State Zip Code Phone e-( '9L" 5. OFFICE SOUGHT (include district number, if applicable) 6. NAME OF POLITICAL TREASURER (may be candidate) GORY OR REPORT (Check one) 7. CATE 1:1 El E] FIRST SECOND THIRD FOURTH PRE- PRE- MID-YEAR YEAR-END QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD 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 ex nded for the personal financial be~efit of the candidate or for any other nonpolitical purpose as defined by the fe I intemal rev - ue de. signature of candidate date - ignature f surer date 11. WITNESS SIGNATURE LO signatu of witness date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT $ - b. TOTAL RECEIPTSTHIS PERIOD 3 ~U C. v c. TOTAL DISBURSEMENTS THIS PERIOD $ J d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ :..'f:.....y11 j e. TOTAL LOANS OUTSTANDING e S, $ r- r f. TOTAL OBLIGATIONS OUTSTANDING ...............'s c..............}.a.8........... $ A'e G9 t o-OUNTCOUNTY v EIFCTfO~[ cb j' SS-1109 (Rev. 2/06) ~p Page 1 of RDA 1159 ~2y Wd Z4 ``0 SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDATE OR C~MMITTEE (In Full) 14. REPORT COVERING THE PERIOD FROIA;,.I , T0: 2~ Ih ~ ~ I RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) S 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 r this period) (must be listed by category - e.g., printing, postage, gasoline) $ $ $ $ Total of Expenditures ($100 or less each payee) $ 17 ` 6t b. Itemized Expenditures (Over $100 each payee this period) $ c. TOTAL EXPENDITURES (other than loan repayments)(add 19.a. and 19.b.) $ i 20. LOAN REPAYMENTS MADE THIS PERIOD $ C_ G ? rf 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 12.f.) $ SS-1133 (Rev. 4102) Page of _ ITEMIZED STATEMENT OF CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATIf OR COMMI E 2. REPORT COVERING THE PERIOD L; /ri rt C FRQM t v7 G TO: 2 * 21 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 C~ .1(j Last Name/or am ati n Nat Primary Election ❑ General Election Address, /J _ ❑ Runoff (Local Elections Only) (/~\7 City State Zip Code Date of Contribution Aggregate This Election Le> ,0 Vt -7-7 7, Occupation Employer T1- (e c C-- lk~ First Name Middle Name Contribution Received For: Amount of 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 First Name iddleName Contribution Received For: Amount of Contribution Last ame rganizabon 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 Received For: Amount of 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.) ly t✓- (If this is the last page of contributions, this amount must be shown in item 15b. of summary) W SS-1131(Rev. 2/06) Page - of 7 RDA 1159 r ITEMIZED STATEMENT OF IN-KIND CONTRIBUTIONS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITT E 2. REPORT COVERING THE PERIOD Mlm: TO:'2 Amount_ 3. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS FROM PRECEDING PAGE (enter $0 if first itemized page) 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 In-Kind Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last NamelOrganization 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 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 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 Contribution Received For: Value of In-Kind Contribution ❑ Primary Election ❑ General Election Last NamelOrganization 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 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 mp oyer 5. TOTAL ITEMIZED IN-KIND CONTRIBUTIONS (Carryforward to item 3. of nextpage if additional pages of this form are used.) (If this is the last page of in-kind contributions, this amount must be shown in item 221b. of summary.) SS-1128 (Rev. 2/06) Page of -7- RDA 1159 ITEMIZED STATEMENT OF EXPENDITURES - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD Cr , t C FROM:. TOZC i~ I - 2 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 Last Name Business Name )c. Address t ` y{ V ~ ~ : ~1 dry A ~'~i_ City r J Stale Zip Cod 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 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.) (If this is the last page of expenditures, this amount must be shown in item 19b. of summary.) 0 SS-1129 (Rev. 4/02) Page of RDA 1159 ITEMIZED STATEMENT OF LOANS - CANDIDATE 1. NAME OF CANDIDATE OR COMMITTEE 2. REPORT COVERING THE PERIOD ` IFROM: T0: j -2 3. COMPLETE THE AP OPRIATE ITEMS FOR EACH ITEMIZED LOAN (loans totaling morethan $100 from any source during the period) Complete the Following for the Source of the Loan First Name Middle Name Outstanding Loan Balance Loans Loan Outstanding Loan Balance (Beginning of Period) Received Payments (End of Period) Last Name/Organization Name Address Loan Received For: Date of Loan ❑ Primary Election ❑ General Election City State Zip Code [I Runoff (Local Elections Only) List All Endorsers or Guarantors for Above Loan (If more space is needed please attach a page) First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last NamelOrganization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed Outstanding First Name Middle Name First Name Middle Name Last Name/Organization Name Last Name/Organization Name Address Address City State Zip Code City State Zip Code Amount Guaranteed Outstanding Amount Guaranteed 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 Payments (End of Period) (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.) is, SS-1132 (Rev. 4102) Page of RDA 1159 ITEMIZED STATEMENT OF OBLIGATIONS - CANDIDATE 1. NAME OF CANDIDATE OR O/M7'/ EE 2. REPORT COVERING THE PERIOD Li/, FROM: 2~- iz-Y-c ( TO:Zai -vY- 3. COMPLETE TAE APPROPRIATE ITEMS FOR EACH ITEMIZED Outstanding Balance Debt Incurred Payments Outstanding Balance OBLIGATION (obligations totaling more than $100 owed to any (Beginning of Period) This Period This Period (End of Period) person/vendor at the end of the reporting 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 23b. on summary page.) 0 SS-1127 (Rev. 4/02) Page of RDA 1159 CAMPAIGN FINANCIAL DISCLOSURE STATEMENT For State and Local Candidates For Single-Candidate Committees 1. DATE OF REPORT 12.a. NAME OF CANDIDATE OR CO ITTEE 2-b. IF COMMITTEE, NAME OF CANDIDATE f-c 3. ELECTION DATE 4.a. CAMPAIGN ADDRESS AND PHONE Street or Rural Route City State Zip Code Phone 122 Gna~d~ I ed 3-7?T7 . C 4.bANDIDATE'S 1 MIE AD RESS (if different than 4.a.) 'OZU Street or Rural Route City State Zip Code Phone - S a1IN~ - 5. OFFICE SOUGHT (in de district number, if applicable) 6. NAME OF POLITICAL TREASURER (may candidate) t~J a t wc) ~l~t I 7. CATEGgRY OR REPORT (Check one) FIRST SECOND THIRD FOURTH PRE- UARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL S PPLLEEMENTAL 8.a. BEGINNING DATE OF REPORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD 9 o 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 contri tions have been expended for the personal financial eneft of the candidate or for any other nonpolitical purpose as defined by the fe a internal revenue code. signature f a didate *'d ate signatu f po reasurer ~ date 11. TNESSSIG TURE signature of witness date signature of witness date 12. SUMMARY a. BALANCE ON HAND LAST REPORT b. TOTAL RECEIPTS THIS PERIOD $ c. TOTAL DISBURSEMENTS THIS PERIOD $ d. BALANCE ON HAND (12.a. plus 12.b, minus 12.c.) e. TOTAL LOANS OUTSTANDING a ..1 1 f. TOTAL OBLIGATIONS OUTSTANDING AFGi~........... ,Q $ 9 SS-1109 (Rev. 2106) r L'l p~ Page 1 of~ RDA 1159 Q C 0, CO oNMp. OF 6 8 L9Gi SUMMARY PAGE - CANDIDATE 13. NAME OF CANDIDAT O C MMITTEE (In Full) 14. REPORT COVERING THE PERIOD FR0M:2vty_vlT0:,Z6ic^,,3 _31 RECEIPTS 15. CONTRIBUTIONS (other than loans and interest) a. Unitemized Contributions ($100 or less from each source this period) $ b. Itemized Contributions (over $100 from each source this period) $ 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 12.f.) $ SS-1133 (Rev. 4102) Page of Appointment of Poiitical Treasurer For State and Local Candidates and Single-Candidate Committees INSTRUCTIONS The Appointment of Political Treasurer statement must be used to appoint a political treasurer as required by the Campaign Financial Disclosure Act (T.C.A. § 2-10-105) for state and local candidates and single- candidate political campaign committees. A state candidate may not receive or expend funds for an election until a political treasurer has been appointed for that election. A local candidate pursuant to T.C.A 2-10-101, maybe exempt from completing this form, please check with county election commission for more information. A candidate may appoint himself or herself as political treasurer. A new form must be filed if the treasurer is changed. Candidates for state public office must file their original Appointment of Political Treasurer statement ONLY with the Registry of Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360. Candidates for local public office must file their original Appointment of Political Treasurer statement ONLY with their county election commission. 2. Candidate First and Last Name: 3. Candidate e-mail address: 1. Date: A~,a~r .~1 yw~ eo . too? AiO1 -01-I ~ CA (\j tAAVAer 4. Campaign Address and Phone: City State Zip Code Phone Gf,av.1 IL f?a 10V,-S 5. Home Address and Phone (if different than item 4 above): City State Zip Code Phone 6.Office Sought (include district number, if applicable) 7. Party Affiliation 8. Election Year ~ $ llr4e. EXccvfivc Cv/~,n• c~ z"Od,rtn c 1;c.t/1 g g+P 9. Treasurer Name: 10. Treasurer e-mail address: 1--f-ti r4-7 pecrI 11. Treasurer Address and Phone: City State Zip Code Phone C 16.6 l 22~ G/av~l l~•^l~ kd, Lows✓. j1/ ;!7777 Gg -aj24 12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature): Signature of Candidate Signature of Treasurer Signature of Witness Signature of Witness . Cd =y Registry of Election Finance SS-1120 (rev 12/2013)