IEC FOR\, CCDR REV 0; loas

State of Georgia Campaign Contribution Disclosure Report

1 (4) ?A&$- 3.3 g-f and or ( - Contact Phone .\-umber Ore will iindersiond the ieieort qi lhu informofion arpermisrion ro coil your ofice fnecessanj

1. Report Typc (Select One)

Original Report

@\mended Report

.;\mendment

( 5 ) l i a Candidate or Public Offic~al. is there a carnpalzn commltree (one or more persons) ro make cvmpzxan tiansacnanr. keep rhc financial records ofthe cnmpu:gn, or file the iepons" ayes mO (6) I f so . 1s the comm~aee regisirred a i ~ rhe Stars Erhlcs Commiis>on" yes D No

(7) if so, complete the fallowing Snme ofChoirperson and/or Treasurer ofCommiriee

1. Period for which you are Reporting

2. Filing is being made on behalf of (Select One): e n d i d a t e or Public o f i ~ i p

Office Soueht or Held: .ORN c / L PF /lnc/iide cnunw municipolin,

CommitteeName:

3. Identifying and Contact Information

(1) Full .%me of Candidore or .Yon-Condxdaie Corn aign Cornmitier

I ~ ~ ~ ~ / z - ~ ~ L ~ , T E z L . ; C Q L M ~ ~ U S , & ~ .~iariing ~ d d r e s s C J ~ srore &PoC ZIP Code

C] Report of Organization or Person Other than Candidate's Campaign Committee

Filing offire use only

t -se Earlier of Past

Mark or Hand Delivered Date

I Verification by Oath or Affirmation I

>I? Yon Election Year

June 30. (!'ear)

O D e c . 3 1 ; - (year)

- ~ ~ ~ ~ ~ i ~ ~ ~ ~ ~ ~ ~ ~ i i l ~ ~ ~ ~ ~ ~ ~ h ) ~ ~ i ~ ~ i ~ ~ ~ ~ Ulrlrulnuhlihrh. e>ecnon orrvr -Pe,ranr ienllng office w m rxi..r ivnb """1

fm& arlnpeidrdicr;m.ldcdddulul hrr

.Lnrurrirrful candrdarn wlh tr ies 'unhr. or *hu rr:elie ronnbvtlonl to rct lred~ot incurred, W ~ I ~ ~ a i v n d r a r e r x p r n d e d o r r u c ~ wpod deb85 arerrnrhed (DlcembeiI: niingonly8

state o & ~ ~ ~ ~ i ( 9 Count) o i f l ? ~ ~ G PS

I & ~ I ( ~~5 6, LI d~;%:beins d u y n l o m (a f inn , depose m d r y that the information in this repon form is compiste. me. and correct. Funher. 1 affim thxt the contents in this repon

are ths same as the contcnts in the eirctranic filing submitted, ifalio elec~ronically fiisd. r.

\ I y Election Year

O h l a r c h 3 I . (year)

U J u n e 30, ( y e a r )

d e p r e m b e i ; s ~ 1 L < y e a r )

O O c t o b e r 25. (year)

G ~ e c e m b r r 3 1; (ycar)

Run-Offs (Rlpan riqulrec on" tiyouare m a Run4P

Elecno")

0 6 da)s before P r i m q Run-Off. f. (year)

0 6 days before General Run-Off.. (year)

O h days before Special prima^ Run-Off.

__ (?car) 0 6 days before Special

Run-Off. ( ) e a r )

Special Elections (Rcmn regu~redaniy ailnu are in a Spcc,al

Ll.rnon,

I5 days before Sprcial P r imap .

( y e a r )

15 days befors Special. (year)

e ~ e c , 3 I . (year)

SIC PO%\, CCDR RL\ 03 100%

State of Georgia Campaign Contribution Disclosure Report

Summarv R e ~ o r t I

-. - - d A

i CONTRIBUTIONS RECEIVED I

I /ENTER 0 in both columns (one time onl?): o r I I,, I

I

If this is the first report of this Reporting Cycle*. ENTER 0 in the in-kind column nd list any net balance on hand brought fonvard from the previous reporting cycle

the cash amount column (Line 13 of previous report. or total funds left over at

h a w no contributions to report. 1 have the following contributions. includinp Common Source. to repon: !d

.A. If this is the first t ime to file a disclosure report for the current oftice sou'zht.

4

5

18 1 .A. First repon of this Reponing C!cle*. EXTER 0. 1 0 1

Estimated Value

have n o expenditures to report. I have the folloiring expenditures to report:

o CG.4 21-5-34(b)II)(D)~i~) .A rrpaninl cycle shall commence 0x1 lanuan I oirhe jear ,n r h l c h an elecnon 1% to be held ior rbe public office r o x h l s h a candidate i cck i eieclion and ihail soncludc'

(i) 41 the expiraflon o iBe term a ia f i s r i i i u r h cvldidale 5s clccted and docs not seek rrelectloi> or elecnon to some other office.

(111 h December J l ufche year in i v h c h such clccnun war held zfrurh crndldir* ,i uniirccriihl. or

(111) l i i u c h crndidaw i s iuccei i f i l and iecki r~elecr ian or ree ls elecrlnn ra some other oifice the cunenl repornng cycle shall end *llenLh iepornng c i i l e for reelecnon or for some other oficc

biglni. f

Public OfficerlCandidateiNon-Candidate Committee Name @ ~ f i ~ M $ " ~ / ~ / f i L GUM P6,6 N

Cash Amount

EXPENDITURES MADE I ~ - I

reportins period and not listed on the "Itemized Contributions" page. "Common Source" contributions must be aggep.ted on the "hemired Cantributions" page. Total contriburions reported this period. ( L i n e 3 + 3 a - 3 b ' 3 c + 3 d A 4 ) Total contributions to date. Tolnllo be carried forwordlo n a z repon of this reponingqcic'.

(L ine2 5 5 )

Cash Amount

6 2 & 0

1 ' Id Estimated Value oral expenditures made and reported prior to this reporting period. I f this is the I

State of Georgia Campaign Contribution Disclosure Report

Outstanding Indebtedness

1 1 lOutstandin_g indebtedness at the beginning of this reporting period. 1 0 I

c.

I 2 /Loans received this reponing period. I

Election Cycle*: G E ~ E RAL Election Year: 00 S

I 3 I ~ e f e r r c d payment of expenses this reportinz period I

!\nluunt

-- ~~~- ~

1 6 IPaymcnts this reponing period on previously deferred expenses.

4

5

I I

Total indebtedness at the close of rhis reporting period. l i L i n e I + 2 ~ 3 - 4 - 5 - 6 )

Election Cycle*: Election Year:

Pa!ments made on loans this reporting psr~od.

Credits receiced on loans this reporting period.

I 1 /outstanding indebtedness at the beginning of this reportins period. I I

0

0

1 2 l ~ o a n s received this reporting period. 1 I I 3 l ~ e f e r r e d pabment of expenses this reporting period I I 1 4 1~a)ments made on loans this reporting period. I 1

5

6

7

Credits received on loans this reporting period.

Payments this reponing period on previously deferred expenses.

Total indebtedness at the close of this reponing period. l . l , . . I - : - : - J - i - - I

* Election Cycle (Primar). General, Special. Special Primal?, Run-Off Primal?, Run-Off Gzneral. Run-Off Special. Run-Off Speci31 Primaq j

Election C~cle*: Election Year:

1

2

3

4

5

6

-

Public OffrceriCandidatefi~n~Caadidate Committee Name & D ' ~ a ~ , k A P/f /6

.\ml,uot

outstanding indebtedness at the beginning ofthis reponin,. period.

Loans received this reporting period.

Deferred payment of expenses this reporting period

Pa!ments made on loans this reporting period.

Credits received on loans this reporting period.

Payments this reporting period on preiiousl? deferred expenses.

Total indebtedness at the close of this revonins ueriod.

SEr i O K \ I CCDK KE\ 3 I""

State of Gcorgia Campaign Contribution Disclosure Report

Itemized Contributions

Full Name oiContributor

Itrrnircd Contributions Page Toral $2 20440$ 0 I Loan Reporting

Reference: OCG.4 21-5-.?J(b)(l) Loan Pugc Toral $ 0 " Contribution Type (Monet~i). In-Kind. Common Source. Credit Received on Loan) * * 1:lection Cycle (Primary. General. Special. Specid Primary. Run-Off Primary Run-Oif G~nr ra l . Run-OiTSpccial. Run-OSf

Sneci31 Pr iman)

l-arne of Lender k l a i l i n ~ Address

*** If an!. such person(s) shall ha\'e a l i d u c i s ~ rrlati ce or extension of credit

Pllblic OflicerrCnnrlidPtriN~~n-C;1t~didate Committee Sa

Dare of Loan Amount afJ..o;m Elcclion C>cle**

Prrso~i(s) respoiisihle for r e p o ~ m m t of loall

Mailing Address

1.

Occupation & Place of Employment Fiduciai? Relationship***

RE\ 01<COB

State of Georgia Campaign Contribution Disclosure Report

Itemized Expenditures -

\.lust list expenditures made to a single recipient for nhil

I I List Name and Mailing Address Expenditure Date Occuparion & of Recipient Expenditure Type' Employer

the aezrecate total is $101.00 or more

Expenditure Purpose Amount Paid I

Page Total $ 4 6 ~ ‘ 00

* Expenditure Type (Expenditure, In-K~nd, Loan Repayment, Refund. Reimbursement, Credit Card. 3rd Pan?, Deferred Payment, Payment on Deferred Expense, Investment)

, Yublic OfieeriCandidatePion-Candidate Committee Xame

SECFORLI CCDR Re, 3 1008

State of Georgia Campaign Contribution Disclosure Report

Investments Statement

Difemncr in value $

CiQ.. State* Zip

Holding Account

.Llailin_e Address

. - -

Value at cnd of reponing period $

Instirution!Person 1:alur ar beginning ofreportin8 peliod S Holding Account

Mailing ..\ddrcss

Cip. Statc. Zip

2 . Investment Name

1 Cash Div>dcnLis c;

Account Number

I "

Investment Transactions Date -

Total ialue of in! ssrnients 31 hseinnina o f re~or t inz ~ e t i o d $

.lordl va1~1e ~ F i i n e s t m m l s at end oi'rmunine ccriod $

Page Total Cash Di\ idmds: S a P a ~ e Total Interest Paid Out: 6 0

Page Total Profit: S 0

Total ditibrence in ~ a l u e $ 4

Personjsi ln\olied in 'Transaction

Pagc Total Loss: F 0 - Public OfficrriTandidateiNon-Candidate Commiftce Name &D WI ) ~ I V I & L ~ ~ W L / C A ~ ~ ~ ~ nf d

Value orinvestmrnr nurchased \;slue of invrstment sold Frofit &

State of Georgia Campaign Contribution Disclosure Report

Addendum Statement i h e Addendum Srarement should beused for eiolanation of an\ additional information needed lo cornpiere an accurate filinp of this repon. .

, Public Oflirer/C.uldidate~on-Candidate Committee h ' m e