Bolinger, Nikki CAMPAIGN FINANCIAL DISCLOSURE STATEMENT
For State and Local Candidates
For Single-Candidate Committees
1. DATE OF E RT 2.a. NAME OF CANDIDATE OR COMMITTEE
44 lR 02 2 NI klc4 3bI ,��
2.b. IF COM ITTEE,NAME OF CANDIDATE 3.ELECTION D TE
4.a.CAMPAIGN ADDRESS AND PHONE
Street or Rural Routehy'y'► fff��� Y�C�i`tyD State Zip Code Phone
4.b.CANDIDATES HOME ADDRESSfferent than 4.a.)� l ler / gigg44.35
Street or Rural Route City State Zip Code Phone
5. OFFICE SOUGHT(include districtdi ber,if applicable) f )a v)!kE OF POLITICAL TREASURER7a /may be 7 Jat235 '/g3S
Otooly CeNyimiSsian 1t)1- s(3 U'f s4'o 2( A' £ft6,e,
7. CATEGORY O REPORT(Check one) Q
FIRST SECOND THIRD FOURTH 0- PRE- MI EAR YEAR-END
QUARTER QUARTER QUARTER QUARTER PRIMARY GENERAL SUPPLEMENTAL SUPPLEMENTAL
8.a.BEGINNING DATE OF PORTING PERIOD 8.b. ENDING DATE OF REPORTING PERIOD
1I I ,9 3)311?
9.(Check one)
a.`Eti 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 int nal revenue code.
f-eSaWillt\-' t/44,2- /1/6/Z
si nature of candida date /-si nature f itical treasurer//�� g �llf( date
11. WITNESS SIGNATURE
lilia- A 11 7 / 2
na i ness date signature of witness date
12. SUMMARY
a. BALANCE ON HAND LAST REPORT $ D
b. TOTAL RECEIPTS THIS PERIOD °$� $
c. TOTALDISBURSEMENTSTHISPERIOD '`r_CE(VED $ 0
AF!? 2022 ')
d. BALANCE ON HAND(12.a.plus 12.b.minus 12.c.) $ (/
_�
e. TOTAL LOANS OUTSTANDING $
f. TOTAL OBLIGATIONS OUTSTANDING $ (9
-";' SS-1109 (Rev. 2/06) Page 1 of RDA 1159
SUMMARY PAGE - CANDIDATE
13. NAME OF CANDIDATE OR COMMITTEE(In Full) 14.REPORT COVERING THE PERIOD
FROM: TO:
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) $ 0
c.TOTAL CONTRIBUTIONS(other than loans and interest)(add 15.a. and 15.b.) $ CD
16. LOANS RECEIVED THIS REPORTING PERIOD $ a
17. INTEREST RECEIVED THIS REPORTING PERIOD $ C\
18. TOTAL RECEIPTS (add 15.c., 16., and 17.) (must be shown in item 12.b.) $ C )
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.) $ 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) $ 0
f �
c. TOTAL OBLIGATIONS OUTSTANDING(add 23.a.and 23.b.) (must be shown i item 12.f.) $ l )
SS-1133(Rev.4/02) Page of
Print Form
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.
•
3 $ a N. &- gol t1 2( b of(rn+emt cziee' rnua 1.eosin
1. ate: 2.Name of Candidate or ommittee: 3.Candidje e-mail address()
4.Campaign Address and Phone: City State Zip Code Phone bt"
130( ' ac42r '1 124 e U. MotTl IL.t `--f J 31.tvi zs-cfct35
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 Affliation 8.Election Year
buyvki CAnnticsSicv) Ot5-I, %c 1 b-cmoct- ao z2
9.Treasurer Name: 10.Treasurer e-mail address:
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J
11.Treasurer Address and Phone: City State Zip Code Phone gaS
12.Candidate and Treasurer Signature(both signatures must be witnessed. Treasurer can not witness candidate's signature):
I certify under the penalty of perjury that the information given on this form is true and accurate.In addition,I understand that
the Regis ry of Election Finance/County Election Commission must be notified f an chap e in this information.
Signature of Candidate ,> 20 .gnature of Treasurer
2022Co
ignature of Witness `‘(. N Signature of Witness
Registry of Election Finance SS-1120
(rev 10/2021)