SEC FORM CCDR RE! o;.:oo& State of Georgia Campaign Contribution Disclosure Report 1. Report Type (Select One) v/ JX Original Report I 1 Amended Report Amendment # . Jlling is being made on behalf of (Select One): Candidate or Public Official Office Sought or Held: KLBC r Committee Name: I I Report of Organization or Person Other than Candidate's Campaign Committee Use Earlier of Post Mark or Hand Delivered Date 3. Identifying and Contact Information Full Name of Candidate or Non-Candidate Campaign Committee Mailing Address Zip Code 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^campaign committee (one or more persons) to make campaign transactions, keep the financial records of the campaign, or file the reports? J^U Yes | 1 No (6) If so, is die committee registered with the State Ethics Commission? GJ^ 5 I ! (7) If so, complete the following: TO A/l (f / L"& g~ ~ T ji £ $ $ U/?-£ Si- Name of Chairperson and /or Treasurer of Committee 4. Period for which you are Reporting My Non Election Year Qj June 30, _ _ (year) DDec. 31, (year) the year in which the election occurs •Persons leaving office with excess funds until such funds are expanded as provided in the Acl who receive contributions to retire debt incurred, debls are satisfied (December 31 tiling only) My Election Year Q March 3 1 , (year) D June 30, (year) ^September 30,Z///Qyear) fj October 25, (year) |~~1 December 3 1 , (year) Run-Offs (Report required only if you are in a Run-Off | | 6 days before Primary Run-Off, (year) [_] 6 days before General Run-Off, (year) n 6 days before Special Primary Run-Off, (year) Q 6 days before Special Run-Off. (year) Special Elections n ^ days before Special Primary, (year) Q 1 5 days before Special, (year) D Dec. 31, (year) State of Georgia i T^rM (^ I Lt Verification by Oat 10-0 ^^ .beins that the information in this report form is complete, true, and correct. Fu are the same as the contents in the electronic filing submitted, if also elec / -Hi I /1/i/W i/vfc»» IIMI * SwomXoartd subscribed before me on (0 (jf\ UtfN#£20U>.\»AP PL ( k?/JK/^l, 'ou /^2 i or Affirmation 6-1 0 P02 j: v Count duly sworn (affirm), depose and s ther, I affirm that the contents in t tronically filed. $''"' n/ , M&^MJ yof Muscoqee ay tis report A]L fi£- Sign^rfe of Notary Public «• | Q^OB-Gfl&iJ^iirSof Candida^ J ^ iny person who kr,o,™,!y ,1 1, ,. comply ,vi,l, or who ta™ing''«,l$6 E6 W\^ o, ,h, Elhi« i« Govcnmicn. Ac, sh.il b, gu-Uy of a m.sdc^.nor.
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zcm& - Columbus, Georgia · 2010. 10. 6. · "zcm& Cash Amount O \ A 7Z6Z o.Oo \4~7z£,i7 1 4 7* (£7 INVESTMENTS 13 14 15 Total valu e of investment s held at th beginnin g thi reportin
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SEC FORM CCDRRE! o;.:oo&
State of GeorgiaCampaign Contribution Disclosure Report
1. Report Type(Select One)
v/JX Original Report
I 1 Amended Report
Amendment #
. Jlling is being made on behalf of (Select One):Candidate or Public Official
Office Sought or Held:
KLBC rCommittee Name:
I I Report of Organization or Person Other than Candidate's Campaign Committee
Use Earlier of Post
Mark or HandDelivered Date
3. Identifying and Contact Information
Full Name of Candidate or Non-Candidate Campaign Committee
Mailing Address Zip Code
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 campaign committee (one or more persons) to make campaign transactions, keep the financial records of the
campaign, or file the reports? J^U Yes | 1 No (6) If so, is die committee registered with the State Ethics Commission? GJ^5 I !
(7) If so, complete the following: TO A/l (f / L"& g~ ~ T ji £ $ $ U/?-£ Si-
Name of Chairperson and /or Treasurer of Committee
4. Period for which you are Reporting
My Non Election Year
Qj June 30, _ _ (year)
DDec. 31, (year)
the year in which the election occurs•Persons leaving office with excess funds untilsuch funds are expanded as provided in the Acl
who receive contributions to retire debt incurred,
debls are satisfied (December 31 tiling only)
My Election Year
Q March 3 1 , (year)
D June 30, (year)
^September 30,Z///Qyear)
fj October 25, (year)
|~~1 December 3 1 , (year)
Run-Offs(Report required only if you are in a Run-Off
| | 6 days before PrimaryRun-Off, (year)
[_] 6 days before GeneralRun-Off, (year)
n 6 days before SpecialPrimary Run-Off,
(year)Q 6 days before Special
Run-Off. (year)
Special Elections
n days beforeSpecial Primary,
(year)
Q 1 5 days beforeSpecial, (year)
D Dec. 31, (year)
State of Georgia
i T^rM (^ I Lt
Verification by Oat
10-0
^^ .beinsthat the information in this report form is complete, true, and correct. Fu
are the same as the contents in the electronic filing submitted, if also elec
/ -Hi I /1/i/W i /v fc»» I I M I *SwomXoartd subscribed before me on (0 (jf\ UtfN#£20U>.\»AP PL
( k?/JK/^l,'ou /^2
i or Affirmation
6-1 0 P02 j:vCount
duly sworn (affirm), depose and s
ther, I affirm that the contents in t
tronically filed.
$''"' n / ,M&^MJ
yof Muscoqee
aytis report
A]L fi£-Sign^rfe of Notary Public «• | Q^OB-Gfl&iJ^iirSof Candida^ J ^
iny person who kr,o,™,!y ,1 1, ,. comply ,vi,l, or who ta™ing''«,l$6 E6W\^ o, ,h, Elhi« i« Govcnmicn. Ac, sh.il b, gu-Uy of a m.sdc^.nor.
SEC FORM CCDRREV 05/2008
State of GeorgiaCampaign Contribution Disclosure Report
Summary Report
CONTRIBUTIONS RECEIVED
i
2
3
3a
3b
3c
3d
4
5
6
7
8
9
10
11
12
1 1 1 have no contributions to report.C^J have the followins 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 0 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 filina is the second or subsequent filine 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.
nterest 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 SIOI .OO received in thisreporting period and not listed on the "Itemized Contributions" page.'Common Source" contributions must he aggregated on the "Itemized Contributions" page.Total contributions reported this period.(Line 3 + 3a + 3b + 3c + 3d + 4)Total Contributions to date. Total to be carried forward to next report oj 'this reporting cycle*.
(Line 2 + 5)
In-KindEstimated Value
0
a
oco
EXPENDITURES MADEf~l I have no expenditures to report.^"Thave the followins 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 filina ENTER Line 12 of previous report.
Total amount of all itemized expenditures made in this reporting period which areisted on the "Itemized Expenditures" page.
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 to be carried forward to next report of this reporting cycle*.
(Line 8 +11 )
In-KindEstimated Value
OOodC
Cash Amount
O
l < & < g S ~ 6 , 2 7
iArlL.ZZ.
C3,CQ
6,00&OQ
0,QO
"zcm&Cash Amount
O
\ A 7Z6Zo.Oo
\4~7z£,i7
1 4 7* (£7INVESTMENTS
13
14
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)
OO0
* O C.G A 2 l-5-34(b)(1 )('D)(ii) A reporting cycle shall commence on January 1 of the year in
11) At the expiration of the lerm of office if such candidate is elected and does not seek reeled
[III) If such candidate is successful and seeks reelection or seeks election to some other office the current reporting cycle shall
begins S
Public Officer/Candidate/Non-Candidate Committee Name f j
SEC FORM CCDR
State of GeorgiaCampaign Contribution Disclosure Report
Outstanding indebtedness at the beginning of this reporting period. - —
Loans received this reporting period. s^
Deferred payment of expenses this reporting period s'
Payments made on loans this reporting periodX^
Credits received on loans this reporting' period.
Payments this reporting penpdi 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 s^^
Payments made on loans this reporting period. .S
Credits received on loans this reporting period.
Payments this reporting period^fi previously deferred expenses.
Total indebtedness at the-t:lose of this reporting period.(Line 1 + 2 + 3 - 4 - 5 - 6 )
Election Cycle*: Election Year:
1
2
3
4
5
6
7
Outstanding indebtedness at the beginning of this reporting period.
Loans received this reporting period. j^
Deferred payment of expenses this reporting perip.tr
Payments made on loans this reportingjjrfiod.
Credits received on loans this reporting period.
Payments this reportine,period on previously deferred expenses.
Total indebtedness at the close of this reporting period.(Line 1 + 2 + 3 - 4 - 5 - 6 )
Amount
Amount
Amount
'- Election Cycle (Primary, General, Special. Special Primary. Run-Off Primary, Run-Off General Run-Off Special,Run-Off Special Primary)
Publ ic OfiH-L-r < an i : J , )u Non-( andidate Committee Name^
SEC FORM CCDR
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 longer reported in "Itemized Contributions" section. See Loan Reporting section below.
Full Name of ContributorMailing Address(Affiliation of Committee if any)
Contributor
Received DateContribution Type*
Occupation &Employer
ElectionCycle"
CashAmount
In-Kind Contributions
Estimated Value
Description
7/7 (L&Tlt&O
7/ 2 / / / O
7 / z / / ' 0 C
14 Z4HC0
•'Itemized Contributions Page Total $
Loan Reporting
Name of LenderMailing Address
Date of LoanAmount of LoanElection Cycle**
Person(s) responsible forrepayment of loan
Mailing: Address
Occupation &Place of EmploymentFiduciary Relationship*
T / I 4 - / / 0 n (•?>£>
Reference: OCGA § 21-5-34(b)( 1) Loan Page Total $ {&fC\'2-
Contribution Type (Monetary, In-Kind, Common Source, Credit Received on Loan)Election Cycle (Primary, General, Special, Special Primary. Run-Off Primary, Run-Off General, Run-Off Special, Run-OffSpecial Primary)
* If any such person(s) shall have a fiduciary relationship to the lending institution or party making the advance or extension of credi1
CflM7££iu pag,_/_ of 4;Public OfficL't-.-Candkiatt-'Non-Caniiidatc Committee Name
SEC FORM CCDRREV 3/2GOS
State of GeorgiaCampaign Contribution Disclosure Report
Itemized ContributionsMust list contributions received by a single contributor for which the aggregate total is S101.00 or more
Note: Loans are no longer reported in "Itemized Contributions" section. See Loan Reporting section below.
Full Name of ContributorMailing Address(Affiliation of Committee if any)
^Q^ f\JCE?^- £~ &f^ Tfitfi I-
2SSi 52sLM:£7 14 1L L 1 f CftfJ TI^E^LL-
*J 'i A ^ \J I *- f- $6£r ^OQ I
Q-f t f^ O^f E i L ^ M D(°( ^,1 S f )^'^^L£
( q a. \ S " ' O&U? ^^
P AfA ^-L*^ fl\ 5SS••n p i fO£\NCO^
Contributor
Received DateContribution Type*
u / 1 \5 / / 0
ClitcxS/iixll^c H EC*<S/?o//o^- H -£?C P"<5/?.5//Cl
C rf-EC M
*5 1 ZC>/ / O
CfVECk
Occupation &Employer
"as*6t)OK1Ctj^^'fyc~l~ / O /^
^.^^(L |C*<JAJ
Od/OS^lFl ^^
^OUSS1^ Ft
AWSORAM^
ElectionCycle**
G-fcr/VJ
CashAmount
'ffecf
I uuu
2400°°
caou
z<z
Itemized Contributions Page Total %/Q. QQ
In-Kind Contributions
Estimated Value
Description
C
c
O
O
L:
sP.Oc1
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***
1.
2.
1.
2.
Reference: OCGA § 21-5-34(b)(l) Loan Page Tota $ C • (^ 0
Contribution Type (Monetaiy, In-Kind, Common Source, Credit Received on Loan)Election Cycle (Primary, General, Special, Special Primary. Run-Off Primary, Run-Off General, Run-Off Special, Run-OffSpecial Primary)
' If any such person(s) shall have a fiduciary relationship to the lending inst i tut ion or party making the advance or extension of credit
Public Offlcer/Candidatc/Non-Cundldatc Committee -Name j}\ <f\ Qj£ C /^A/Tj? € I L Page "Z" <>'" <ty~
SEC FORM CCDR
State of GeorgiaCampaign Contribution Disclosure Report
Itemized ContributionsMust list contributions received by a single contributor for which the aggregate total is 5101.00 or more
Note: Loans are no longer reported in "Itemized Contributions" section. See Loan Reporting section below.
Full Name of ContributorMailing Address(Affiliation of Committee if any)
Contributor
Received DateContribution Type*
OccupationEmployer
ElectionCycle**
CashAmount
In-Kind Contributions
Estimated Value
DescriptionKG Lie Y
1 1, so MCs
R P
/ ' / / o 'ZOO00 nfl n/Ve5 T
&0"L C) Li a / / o c
RLItemized Contributions Page Total CtCO
Loan Reporting
Name of LenderMailing Address
Date of LoanAmount of LoanElection Cycle**
Person(s) responsible forrepayment of loan
Mailing Address
1.
2.
1.
2
Occupation &Place of EmploymentFiduciary Relationship***
Reference: OCGA § 21-5-34(b)( 1) Loan Page Total $ £2 , £/ c
Contribution Type (Monetary, In-Kind, Common Source, Credit Received on Loan)Election Cycle (Primary, General, Special, Special Primary, Run-Off Primary, Run-Off General, Run-Off Special, Run-OffSpecial Primary)
' If any such person(s) shall have a fiduciary relationship to the lending institution or party making the advance or extension of credit
Public Offker/Candidatc/Non-Candkliitc Committee Name f]/] ftfi fc C flf^"/'£'&i L- I'age <S of _f
SEC FORM CCDRREV 3/2008
State of GeorgiaCampaign Contribution Disclosure Report
Itemized ContributionsMust list contributions received by a single contributor for which the aggregate total is SIOI.OO or more
Note: Loans are no longer reported in "Itemized Contributions" section. See Loan Reporting section be ow.
Full Name of ContributorMailing Address(Affiliation of Committee if any)
U'\M??e:/u.Y cn-fj Tt^tf.
^^l^%6^^& D/VN f^ OAJ So o QC&c ^ fy\ f-'/J IGA' K\G-I<^DFT^
& V£?MT
|fi Dow GPS
Contributor
Received DateContribution Type*
Cf /3CV/0
CtfK/t
SlL§Q//2a^sH
-S-G/^S hr''6 CHECKS
Occupation &Employer
C>0 O D f^ ' ^"
00,**
ElectionCycle**
<se/u
«
CashAmount
I 000°'
zaitf
l%80-
In-Kind Contributions
Estimated Value
Description
C
G
D
Itemized Contributions Page Total $ 1 h? I ' $ (3" 00
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***
1.
2.
1.
2.
Reference: OCGA § 2 1 -5-34(b)( 1 ) Loan Page Total $ 0,6OContribution Type (Monetary, In-Kind, Common Source, Credit Received on Loan)Election Cycle (Primary, General, Special. Special Primary, Run-Off Primary, Run-Off General, Run-Off Special. Run-OffSpecial Primary)
' If any such person(s) shall have a fiduciary relationship to the lending institution or party making the advance or extension of credi
Public Otflter/Canilictatc/Non-CandidMe Committee Name fl/\ /^-K C/9/UTj££^ L~ Page "f of ^
SEC FORM CCDRREV 03/2008
State of GeorgiaCampaign Contribution Disclosure Report
Itemized ExpendituresMust list expenditures made to a single recipient for which the aggregate total is SIOI.OO or more
List Name and Mailing Addressof Recipient
Expenditure DateExpenditure Type*
Occupation &Employer
Expenditure Purpose Amount Paid
71101 ft
\/ ice. t•3-0 H"
f>OLi
-20 f 6POOQ
cot-- PTs /6 ST.<90
fto
Page Total S_
Public Officer/Candida te/Non-( "jmilidate Committee Name (/ ^ ' rj frx i^ **- t^; ^ V-
SEC FORM CCDR
REV 03,':<K)K
State of GeorgiaCampaign Contribution Disclosure Report
Itemized ExpendituresMust list expenditures made to a single recipient for which the aggregate total is $101.00 or more
List Name and Mailing Addressof Recipient
Expenditure DateExpenditure Type*
Occupation &Employer
Expenditure Purpose Amount Paid
1-7 I \l\Sfttl
600
Pfilm//o Q, ILL
Page Total S_
Public Ofncer/Candillate/Non-C aniliilatr ( nm.nitlM Nami- fV\ ft K, fc. Q- ft N ( V-^, L L
SKC FORM CCDRRev 3/2008
State of GeorgiaCampaign Contribution Disclosure Report
Investments Statment
1. Investment Name
Institution/Person
Mailina Address
City, State, Zip
Account Number
/Value at beginning of reporting period $
Value at erjdof reporting period $
/ Difference in value $
Interest Paid Out $
/ Cash Dividends $
Investment Transaction^Date Person(s) Involved in Transaction Value of investment purchased
/Value of investment sold Profit Loss
2. Investment Name /
Institution/Person /Holding Account
Mailins Address
City, State, Zip /
Account Number
Value at beginning of reporting period $
Value at end of reporting period $
Difference in value $
Interest Paid Out $
Cash Dividends $
Investment TransactionsDate Person(s) Involved in Transaction Value of investment purchased
Total value of investments at bceinnins of reporting period S
Total value of investments at end of repor ins period $
Total difference in value $
Value of investment sold
Page Total Cash Dividends
Page Total Interest Paid Out
Page Total Profit
Page Total Loss
Profit Loss
$
S
$
$
Public Officer/Candidate/Non-Candidate Committee Name
State of GeorgiaCampaign Contribution Disclosure Report
Addendum StatementThe Addendum Siatemcnt should be used for explanation of any additional information needed to complete an accurate filing of this report.
Public Oflicer/Candidate/Non-Candidate Committee Name W[ j\ ft- f^