SEC FORM CCDR REV O.V2008 State of Georgia Campaign Contribution Disclosure Report I. Report Type (Select One) [3 Original Report i I Amended Report Amendment # 2. Filing is being made on behalf of (Select One): 0 Candidate or Public Official Office Sought or Held: Muscoqee County At-Larqe Representative (Include county, municipality, district, post or judicial circuit) Committee Name: Committee to Elect Cathy Williams, School Boa [ I Report of Organization or Person Other than Candidate's Campaign Committee Filing office use onlj Use Earlier of Post Mark or Hand Delivered Date 3. Identifying and Contact Information (l)Cathleen Williams Full Name of Candidate or Non-Candidate Campaign Committee (3)864 Blandford Avenue Columbus (2) Oct 1.2010 Todm-'s Date GA 31906 Mailing Address (4) (706) 323-0999 Zip Code and / or ( ) Contact Phone Number {We will understand the release of this information as permission to call your office if necessary) (5) If a Candidate or Public Official, is there a campaign committee (one or more persons) to make campaign transactions, keep the financial records of the campaign, or file the reports? 0 Yes Q No (6) If so, is the committee registered with the State Ethics Commission? [7] Yes | | No (7) If so, complete the following: Charles Forbes Davis 4. Period for which you are Reporting My Non Election Year | [June 30, (year) DDec. 31, (year) •Persons elected to office in each year following •Persons leaving office with excess funds until ,ebis ire satisfied (December 31 filing only) My Election Year d March 31, (year) D June 30, (year) \7\ September 30. 2010 (year) Q October 25, (year) I | December 3 1 , (vcar) Run-Offs (Report required only if you arc in a Run-Off Elecuonj [_J 6 days before Primary Run-Off, (year) Q 6 days before General Run-Off, (year) Q 6 days before Special Primary Run-Off, (year) Q 6 days before Special Run-Off. (year) Special Elections Election) 1 | 1 5 days before Special Primary, (year) [~~| 1 5 days before Special, (vear) D Dec. 31, (year) 10-05-10 A state ot Georaia Verification by Oath or Affirmation rv OI-SO-OL County of Muscoqee T. Cathleen Williams , being dulv sworn (affirm), depose and say that the information in this report form is complete, true, and correct. Further, I affirm that the contents in this report are the same as the contents in the electronic filing submitted, if also electronically filed. Sworn to and subscribed before me on , 20 Signature on File Signature of Notary Public Siqnature on File a. Signature of Candidate 3. Organization/Chairperscm/Treasiirer
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State of Georgia Campaign Contribution Disclosure … FORM CCDR REV O.V2008 State of Georgia Campaign Contribution Disclosure Report I. Report Type (Select One) [3 Original Report
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SEC FORM CCDRREV O.V2008
State of GeorgiaCampaign Contribution Disclosure Report
I. Report Type(Select One)
[3 Original Report
i I Amended Report
Amendment #
2. Filing is being made on behalf of (Select One):
0 Candidate or Public Official
Office Sought or Held: Muscoqee County At-Larqe Representative(Include county, municipality, district, post or judicial circuit)
Committee Name: Committee to Elect Cathy Williams, School Boa
[ I Report of Organization or Person Other than Candidate's Campaign Committee
Filing office use onlj
Use Earlier of Post
Mark or HandDelivered Date
3. Identifying and Contact Information
(l)Cathleen WilliamsFull Name of Candidate or Non-Candidate Campaign Committee
(3)864 Blandford Avenue Columbus
(2) Oct 1.2010Todm-'s Date
GA 31906Mailing Address
(4) (706) 323-0999
Zip Code
and / or ( )Contact Phone Number {We will understand the release of this information as permission to call your office if necessary)
(5) If a Candidate or Public Official, is there a campaign committee (one or more persons) to make campaign transactions, keep the financial records of the
campaign, or file the reports? 0 Yes Q No (6) If so, is the committee registered with the State Ethics Commission? [7] Yes | | No
(7) If so, complete the following: Charles Forbes Davis
4. Period for which you are Reporting
My Non Election Year
| [June 30, (year)
DDec. 31, (year)
•Persons elected to office in each year following
•Persons leaving office with excess funds until
,ebis ire satisfied (December 31 filing only)
My Election Year
d March 31, (year)
D June 30, (year)
\7\ September 30. 2010 (year)
Q October 25, (year)
I | December 3 1 , (vcar)
Run-Offs(Report required only if you arc in a Run-Off
Elecuonj
[_J 6 days before Primary
Run-Off, (year)
Q 6 days before General
Run-Off, (year)
Q 6 days before Special
Primary Run-Off,
(year)
Q 6 days before Special
Run-Off. (year)
Special Elections
Election)
1 | 1 5 days before
Special Primary,
(year)
[~~| 1 5 days before
Special, (vear)
D Dec. 31, (year)
10-05-10 Astate ot Georaia
Verification by Oath or Affirmation
rv O I - S O - O LCounty of Muscoqee
T. Cathleen Williams , being dulv sworn (affirm), depose and say
that the information in this report form is complete, true, and correct. Further, I affirm that the contents in this reportare the same as the contents in the electronic filing submitted, if also electronically filed.
Sworn to and subscribed before me on , 20
Signature on File
Signature of Notary Public
Siqnature on Filea. Signature of Candidate3. Organization/Chairperscm/Treasiirer
SEC FORM CCDR
State of GeorgiaCampaign Contribution Disclosure Report
Summary ReportCONTRIBUTIONS RECEIVED
i
2
3
3a
3b
3c
3d
4
5
6
G I have no contributions to report.[7] 1 have the following contributions, including Common Source, to report:
A. If this is the first time to file a disclosure report for the current office sought.ENTER 0 in both columns (one time only); or
B. If this is the first report of this Reporting Cycle*, ENTER Q in the in-kind columnand list any net balance on hand brought forward from the previous reporting cyclein the cash amount column (Line 13 of previous report, or total funds left over atyear end of previous cycle); or
C. If this filing is the second or subsequent fiiintz of this Reporting Cvcle. list totalsfrom Line 6 of previous report in both the in-kind and cash amount columns.
Total amount of all itemized contributions received in this reporting period which areIsted on the "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 interest paid out this reporting period.
Total amount of all separate contributions of less than S 10 LOO received in thisreporting period and not listed on the "Itemized Contributions" page.'Common Source" contributions must be aggregated on the "Itemized Contributions" page.Total contributions reported this period.(Line 3 -r 3a + 3b + 3c - 3d + 4)Total contributions to date. Total to be carried forward to next report of this reporting cycle*.
(Line 2 + 5)
In-KindEstimated Value
Cash Amount
$8,764.86
$7,717.00
$3,173.00
$10,890.00
$19,654.86
EXPENDITURES MADE
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8
9
10
u12
["] I have no expenditures to report.[7] I have the following expenditures to report:
Total expenditures made and reported prior to this reporting period. If this is theA. First report of this Reporting Cycle*, ENTER 0.B. Second or subsequent filing ENTER Line 1 2 of previous report.
Total amount of all itemized expenditures made in this reporting period which arelisted on The "Itemized Expenditures" pase.Total amount of all separate expenditures of less than S 1 0 1 .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 to be carried forward lo next report of this reporting cycle*.
(Line 8 4- 1 1 )
In-KindEstimated Value
Cash Amount
$1,472.19
$14,514.07
$160.70
$14,674.77
$16,146.96
INVESTMENTS1314
15
Total 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) $3,507.90
Public Officer/Candidate/Nan-Candidate Committee Name
e shall end when the reporting cycle for n
Cathy Williams
SEC HORM CCDRREV 03,2008
State of GeorgiaCampaign Contribution Disclosure Report
Outstanding Indebtedness
Election Cycle*: Election Year:
i
2
3
4
5
6
7
Outstanding indebtedness at the beginning of this reporting period.
Loans received this reporting period.
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 indebtedness at the close of this reporting period.(Line 1+2 + 3 - 4 - 5 - 6 )
Election Cycle*: Election Year:
1
2
3
•I
5
6
7
Outstanding indebtedness at the beginning of this reporting period.
Loans received this reporting period.
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 indebtedness at the close of this reporting period.(Line 1 + 2 + 3 - 4 - 5 - 6 )
Election Cycle*: Election Year:
i
2
3
4
5
6
7
Outstanding indebtedness at the beginning of this reporting period.
Loans received this reporting period.
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 indebtedness at the close of this reporting period.
(Line 1 + 2 + 3 - 4 - 5 - 6 )
Amount
Amount
Amount
1 Election Cycle (Primary. General. Special. Special Primary, Run-Off Primary, Run-Off General, Run-Off Special,
Run-Off Special Primary)
Public Officer'fandidate'Non-Cnndiclatf Committee Name Cathy Williams
SiiC 1 Oi!M CCDRREV 3 2008
State of GeorgiaCampaign Contribution Disclosure Report
Itemized ContributionsMust list contributions received by a single contributor for which the aggregate total is $101,00 or more
Note: Loans are no onger reported in "Itemized Contributions" section. See Loan Reporting section below.
Full Name of ContributorMailing Address(Affiliation of Committee if any)
Guy Sims1431 Millington RoadColumbus, GA 31904
Pete RobinsonP. 0. BOX 807Fortson, GA 31808
Richard LaneP.O. Box 8144Columbus, GA 31908
Christopher Brazell3901 Eve CourtColumbus, GA 31904
-rank Holbrook37041 2th AveColumbus, GA 31904
Contributor
Received DateContribution Type*
Occupation &Employer
Retired
Attorney
Retired
HVAC Contractor
ElectionCycle**
CashAmount
$115.00
$200.00
$250.00
$150.00
$200.00
Itemized Contributions Page Total $ 915.00
In-Kind Contributions
Estimated Value
Description
$
Loan Reporting
Name of LenderMailing Address
Date of LoanAmount of LoanElection Cycle**
Person(s) responsible for Occupation &repayment of loan Place of Employment
Mailing Address Fiduciary Relationship***
I .
2.
2
Reference: OCGA $ 21-5-34(b)(l) Loan Page Tota $
SEC FORM CCDR
State of GeorgiaCampaign Contribution Disclosure Report
Itemized ExpendituresMust list expenditures made to a single recipient for which the aggregate total is S101.00 or more
State of GeorgiaCampaign Contribution Disclosure Report
Investments Statment
1. Investment NameAccount Number
Institution/PersonHolding Account _
Mailing Address
Value at beginning of reporting period
Value at end of reporting period $
City-, State, Zip
Difference in value $
Interest Paid Out $
Cash Dividends $
Investment TransactionsDate Person(s) Involved in Transaction Value of investment purchased Value of investment sold Loss
2. Investment NameAccount Number
Institution/PersonHolding Account _
Mailing Address
Value at beginning of reporting period $
Value at end of reporting period $
City, State, Zip
Difference in value $
Interest Paid Out $
Cash Dividends $
Investment TransactionsDate Person(s) Involved in Transaction Value of investment purchased Value of investment sold Profit
Total value of investments....aLbeginiiing.of,repo_rtirig period $
Total value of investments at end of reporting juried $
Total difference in value $
Page Total Cash Dividends: $
Page Total Interest Paid Out: $
Page Total Profit: $
Page Total Loss: $
Cathy Williams
SEC FORM CCDRREV Oj':008
State of GeorgiaCampaign Contribution Disclosure Report
Addendum StatementThe Addendum Statement should be used for explanation of any additional information needed to complete an accurate tiling of this report.