state of georgia campaign contribution disclosure report · secl'okmccdr state of georgia...

SECl'OKMCCDR

State of GeorgiaCampaign Contribution Disclosure Report

1. Report Type(Select One)

[3 Original Report

l~l Amended Report

Amendment #

2. Filing is being made on behalf of (Select One):0 Candidate or Public Official

Office Sought or Held: Muscoqee County School Board #4(Include county, municipality, district, post or judicial c

Committee Ms me: Committee to Elect Naomi Buckner

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

u oi'ilct use only

Mark or lluudDelivered Date

3. Identifying and Contact Informal on

(0 Naomi Bucknerfall Name ofCandtdatts or Non-Candidate Ctwipali 'ri Cotttmtttee

(3)S2Q Baxlev Way Columbus GA

(2)1/7/2011Today's Date

31907Mailing Address

(4) (706) 563-2258

City

and/or C'OS) 575-7827

Zip Code

Contact Phone Number {We will understand tile relt use of this Information as permission to call your office If necessary)

(5) 1C a Candidate or Public Official, is chert; u campaiyi committee (o«c or more persons) to milled campaign irunwictiGus, keep Ilia financial records oHhe

campai&n. or rile the reports'? [7] Yes D No (6) If so, is UK committee registered with Hie Suite Ethics Commission? [7] Yes f~| No

(7) lfso,comple[etlief<illuwiiiE: Svlister W IliamSami/or Treasurer of Committee

4. Period for which you are Reporting

My Non Election Year

n June 30. (year)

D Dec. 31, (year)

•Puisuns luavinL oilko with OKOUSB t'ulldfl uulil

,11th tulliii ulu oxpundod uu pluviduu ill Ihu Ad

djbls uro LuLialiud (DLConlbol 3 ] filing o:dy)

My Election Year

D March .11, (year)

DJuneSC, (year)

D Septemier 30, (year)

n Octobe:- 25, (year)

[7] December 31, 2010 (year)

Run-Offs(KvPOrt 1 ̂ H,1IVU only if you Bru ill a RuD.OO'

EtatiOfi)

D 6 days before PrimaryRun-Off, (year)

[J 6 days before GeneralRun-Off, (year)

G 6 days before SpecialPrimary Run-Off,

(year)£] 6 days before Special

Run-Off, (year)

Special Elections(1U-JJIJII required only il'you alu in u Speuilil

BtBCtlud

O 15 days beforeSpecial Primary,

(year)

Q 15 days beforeSpecial, (year)

n Dec. 31, (year)

State of Georgia

Verification by Oat

I. Naomi Buckner , beiii£llial Ihe information in this report form is comr. lete, IJLIC, and correct. Ftare the Sitrne as the contents in the electronic fi ing submitted, if also tile

Sworn to and subscribed before me on . 20

Signature oi'Notary Public

My Commiysitm expires

h. or Affirmation

Count

duly sworn (affirm), depose andrthcr, I affirm that the contents inironically filed.

Naomi Buckner

y of Muscogee

ayhis report

a. Signature of Candidateb. Organizatioii/CUairparson/Trcasurer

Ally ytfWOll who khtnvillUly lull! w tulll^ly will or wl.o lilluwul^ly viuluiub ully ul'Ulo oiovislull, Wllw HUiits in Ccvtmmulu Acl illuU \x allihy ol'a nliwlwltfunor.

SEC FORM CCDRKEV U3/200B

State of GeorgiaCampa. gn Contribution Disclosure Report

Summary ReportCONTRIBUTIONS RECEIVED

[3 I have no contributions to report.Dl have the following contribution; i. including Common Source, to report:

In-KindEstimated Value

Cash Amount

A. If this is the first time to file a disclosure report for the current office sought.ENTKRQ in both columns (one time only); or

B. If this is the first report of this Rep rating Cycle*, ENTER 0 in the in-kind columnand list any ngtJmlance on hand brought forward from the previous reporting cyclein the cash amount column (Line 13 jf previous report, or total funds left over atyear end of previous cycle); or

C. If this filing is the second or subsequent filing of this Reporting. Cycle, list totalsfrom Line 6 of previous report in both the in-kind and cash amount columns. $671,67Total amount of all itemized contributions received in this reporting period which arelisted on ihe "Itemized Contributions" page.

All loans received this reporting period.

Interest earned On campaign account this reporting period.

Total amount of investments sold this reporting period.

Total amount of cash dividends and Ir terest paid out this reporting period.

Total amount of all separate contnbut ons of less than £101.00 received in thisreporting period and not listed on the 'Itemized Contributions" page.'Common Source'1 contributions roust be aggregated on the "Itemized Contributions" pa;Total contributions reported this period,(Line 3 + 3a -I- 3b + 3c + 3d + 4)Total Contributions tO date. Total to be c wn&lforward to next report of this reporting cycte*.

(Line 2 + 5) $671.67

EXPENDITURES MADE(3 I have no expenditures to report.Q 1 have the following expenditures to report:

in-KindCash Amount

Total expenditures made and reported prior to this reporting period, if this is theA. First report of this Reporting Cyc'e", ENTER 0.B. Second or subsequent filing ENT1LR Line L^pTotal amount of all itemized expeodit" ires made in this reporting period which arelisted on the "Itemized Expenditures" gage.Total amount of all separate expenditures of Less than $101.00 that were madein this reporting period and not listed on the "Itemized Expenditures" page.Total expenditures reported this period.(Line 9 + 10)Total expenditures tO date. Total ta be a mW'forward to next report of this reporting cycle*.

(Line 8 -I-11)

14

INVESTMENTSTotal value of investments held at the beginning of this reporting period.

Total value of investments held at the end of this reporting period.

Net balance on hand.(Line 6-12+ 14)

* O.CG. A: 2 1 -5-34(b)(l )(DX>0 A reporting cycle shall n Jaiuiaiy 1 of ihe yw in which w I* to ba held for the public ollice lo wliidi it vamlidulu swAts (flection iind sliull

(I) At UK; u s p L M U u t i d' l l i u i t fni i <JL" o iHuu ifsucli nrnJidiiLe is elect ;d und does not seek reelection or election to some oilier officij;

(II) On Dciiuiiibci 31 ofil'.L ycEi1 in whid) such election WJL- lieia il s<x\\ utiiulidtte (x mwwti&ful, or(Jli) If such candidate is successful and a:ek5 reeleclioa or awka cl' 'Ction Lo aonw other Ot'fica tho cun'UiU ivpQfting Cycle diull «id wlien tins I'epOrtinii

begins.Public Offlcer/Candldate/Nori-Candidate Coi nmittee Name _ Naomi BliCkner

SECl-'GllMCCDRKfiV IM1UUB


Outstanding Indebtedness

1

2

3

4

5

61

Outstanding indebtedness at the beglrning of this reporting period.

Loans received this reporting period.

Deterred payment of expenses this re] wrung period

Payments made on loans this reporting period-

Credits received on loans tills reportiig period,

Payments this reporting period on previously deferred expenses.

[Total indebtedness at the close of this reporting period.I (Line 1 + 2 + 3 - 4 - 5 - 6 )

1

2

3

4

5

6

7

Outstanding indebtedness at the begir ning of this reporting period.


Deferred payment of expenses this reporting period

Payments made on loans this reporting period.

Credits received on loans this reportir g period.

Payments this reporting period on pre i'lously deferred expenses.

Total indebtedness at the close of this repotting period.(Line 1*2 + 3 - 4 - 5 - 6 )

Outstanding indebtedness at the beginning of this reporting period.

2

3

4

5

6

7


Deferred payment of expenses this reporting period

Payments made on loans this reporting period.

Credits received on loans this reporting period.

Payments this reporting period on previously deferred expenses.

Total indebletliiess at the close of this reporting period.(Line 1 + 2 + 3 - 4 - 5 - 6 )

* Elecdon Cycle (Primary, General, Special, S[ ecial Primary, Run-Off Primary, Run-Off General. Run-Off Special,Run-Off Special Primary)

Publ ic Oificer/Ciindidatc^on-CandldiLle CoiiiiuilUi- N imc _ Naomi Buckner


Itemized ContributionsMust liut contributions received by u single contributor for which the aggregate total is Slul.Olt or more

Note; Loun HIM no lofll>er n ported in "ItonmL-il Contributions" m'tlon. SL-L- ] oan Reporting section below.

Full Name of ContributorMailing Address(Affiliation of Committee if any)

N/A

Contributor

Rec :ived DateCon tribution Type*

Occupation &Employer

ElectionCycle**

Itemized Contributions Page Total

CashAmount

in-ICind Contributions

Estimated ValueDescription

$ s

Loan Reporting

Name of LenderMailing Address

N/A

Dat! of LoanAm( >unt of LoanElection Cycle**

Person(s) responsible forrepayment of loan

Mailing Address

1.

2.

1.

2.

Occupation &Place of EmploymentFiduciary Relationship***

Reference: OCOA § 21-5-34(b)(l) Loan Page Total $

Contribution Type (Monetary, In-Kind, Common Source, Credit Received on Loan)** Election Cycle (Primary, General, Speck, Special Primary, Run-Off' Primary, Run-Off General, Run-Off Special, Run-Off

Special Primary)*** If iiny such person(s) shall have afiduciaiv relationship to the lending institution or party maldng the advance or extension of credit

Public Orlictr/CuutMale/.Non-Candidatt Committee Name Napmi BUCkngF P»S6 4 ^ 7

SEC PQftM COKItliV 03/200E


Itemized ExpendituresMust list expenditures made to a single recipient for which the aoii-neate total is $101.00 or more

List Name and Mailing Addressof Recipient

N/A

Expendit iro DateExpenditure Type*

Occupation &Employer

Expenditure Purpose Amount Paid

$

s

£

$

$

$

$

$

Page Total

Expenditure Type (Expenditure, In-Kind, Lc an Repayment, Refund, Reimbursement, Credit Card, 3rd Parly, Deferred Payment,Payment on Deferred Expense, Investmont)

Public Ofllcciv'Candidute/Non-Cuiididalc Committee N nuc _ Naomi BucKner Pam 5 of 7

SEC FORM CCDR


Investments Statment

, Investment NameAccount Number

Institution/PersonHolding Account _

Mailing Address

City, State, Zip

Value at beginning of reporting period £

Value at end of reporting period $

Difference in value $

Interest Paid Out $

Cash Dividends $

Investment TransactionsDate Persojifs) Involved in Transaction Value of investment purchased Value ofiriyejStrnent sold Profit Logs

2. Investment NameAccount Number

institution/PersonHolding Account _

Mailing Address

City, State, Zip

Value at beginning of reporting period $

Value at end of reporting period $

Difference in value $

Interest Paid Out $

Gash Dividends $

Investment TransactionsDate Personfs) InvolvticLin Transm :tinn Value of investment purchased Value ̂ investment sold Profit Loss

, value or'inv^st;tqentii''at begipining qt' reportjfig porind $

. Total value of'irtvestm&nts.^t end of reriprtingperiod $

, ' • . . ' . . : . Total diference i n valpe $

Piige Total Cash Dividends; $

Page Total Interest Paid Out: $

Page Total Profit:j

Page Total Loss: $.

Public OIfii-LT/Candi(Jiite/.N(}n-C:iiiilii!;iti; Cuinuiil1 uc JSamc Naomi Buckner Pago 6

SEC TORM CCDftKEV M/1W»


Addendum StatementThe Addendum Statement should bi used foi explanation of any additional information needed to complete an accurate tiling of this f

N/A

Public Oflker/Cantlilla(c/Non-C»ntlitl»tt Committee N ime Naomi Buckner

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