Case, [Virginia] Ginny West
CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF REPORT 2.a. NAME OF CANDIDATE OR COMMITTEE
2.b. IF COMMITTEE, NAME OF CANDIDATE 3. ELECTION DATE
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4.a. CAMPAIGN ADDRESS AND PHONE
Street or Rural Route City State Zip Code Phone
/1-417 Mili)R~NpiL-L-LTAf 3MO3 '35'4~3-)-709
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)
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7. CA ORY OR REPO T (Check one)
❑ ❑ ❑ ❑ ❑ ❑ ❑
FIRST S D 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
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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 fede I internal revenue code.
76-f
sin lure of candidate date signature poll reasurer date
11. WITNESS SIGNATURE
signature of witn sig date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $ 0
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b. TOTAL RECEIPTS THIS PERIOD $ ~ )c Z'
c. TOTAL DISBURSEMENTS THIS PERIOD $ XfC
d. BALANCE ON HAND (12.a. plus 12.b. minus 12.c.) $ c/CD
e. TOTAL LOANS OUTSTANDING $
RECEIVED 2)3-81
f. TOTAL OBLIGATIONS OUTSTANDING g......................................... $
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SS-1109 (Rev. 2106) BI-OUNT COUNTY
a Page 1 of RDA 1159
ELECTION y'
~`99PEZ~~d
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, may be
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.
1. Date: 2. Candidate First and Last Name: 3. Candidate e-mail address:
01lao Y / I r1 ~s~ ~G n n VJPs' i in n y, vv ca-s-e
4. Campaign Address and Phon • City State Zip Code Phone
1,4 l7 Cej-a-{- Rz -k 'p ,r maryu it le'TN 318003 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
Blnui-+ Co Comm, , s s; o'A De,rrioe- r t- ~d ! g
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9. Treasurer Name: 10. Treasurer e-mail _address:
11. Treasurer Address and Phone: City State Zip Code Phone
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
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Signature of Candidate S' ture of Treasurer
PM 1 2 a
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Sig ture of Witness Signature of Witness
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Registry of Election Finance
' SS-1120 (rev 1212013) \S~
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. 40-a- r a-
Candidate's Position: Coin i Cofy\MISSIOA S- ►r -C+ ~J JQcT~
Residential Address: l'7 17 G,_e6-C?o-Ck _Dr
City: Maf yvf ((e- State: TN Zip: ~)7107Z
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 l no longer qualify as an exemption, I will file the required campaign
financial disclosure reports with my local election commission.
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Candi te's Signature Date
Witness's Signature Date