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Hammontree, James [Jim} 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. Da e: 2. Candidate First and Last Name: 3. Candidate e-mail address: 6A) 7, 4. ampai n Address and Phone: City State Zip Code Phone E,11, 7- ~6t ce)~ 7A/ -37,7ot6g~CqV-7,56t 5. Home Address and Phone (if different than item 4 above): City State Zip Code hone 6. Office Sought (include district number, if applicable) 7. Party Affiliation 8. Election Year D i sTX>c T Z -~en4 7- kP-TLA~ L ?c AA/ Z o 1 8 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): Signature of Candidate Signature of Treasurer Signature of Witness A Signature of Witness r7 y x Registry of Election Finance r0~ SS-1120 (rev 12/2013) ~Yd Zl LL 0~ 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: AAM aCandidate's Position: T) l S~IZJcrt 2 J9~~ Residential Address: S /I Lt. VT- o CitY: aL G O State: TN Zip: 3_7 -70 L:2_313 1 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. ndidate's Signature Da e v Witness's Si ature iECEIVED Date N *R 2 31018 A N ELOUNT COUNTY Or ELECT101v 6 Wd Z < « 0~