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SEC FORM CCDR
REV 011_1006
State of Georgia
Campaign Contribution Disclosure Report
1. Report Type 2.,Filing is being made on behalf of (Select One): Filing office use only
(Select One)Candidate or Public Official
Office Sought or Held: 1)%1.4n '
Original Report (include county, municipality, district, post ofjudicial circuit)
Amended Report Committee Name: Use earlier of Post
Mark of Hand
Amendment # ❑ Report of organization or Person Other than Candidate's Campaign Committee Delivered Date
3. Identifying and Contact Informations �
(1) Gm )a1 C)O f]iNcn- S, (2)����
Full Name of Candidate or.Yon- didatc Campaign Committee I Toda Date
Arl
h ZQ�0+
(3) BMAJaCid-9-
Mailing Address City State Zip Code
(4) 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, i a campaign committee (one or more persons) to make campaign transactions, keep the financial records of the
campaign, or file the reports? ./ `Yes / vC (6) If so, is the committee registered with the State Ethics Commission? ❑ Yes
(7) If so, complete the following:
Name of Chairperson and/or Treasurer of Committee
4. Period for which you are Reporting
You Mus
I Check Only One Box
My Non Election Year
My Election Year
Run -Offs
(Report require only if you are in a Run -Off
Election)
Special Elections
(Report require only if you are in a Rut -Off
Elation)
June 30, ear)
❑ March 31, (year)
06 days before Primary
❑ 15 days before
Run -Off, (year)
Special Primary,
❑Dec. 31, year)
M June 30, (year)
M6 days before General
(year)
Run -Off, (year)
-Persons elected to office in each y w following
❑ September 30, (year)
[:]6 days before Special
15 days before
the year in which the election occurs
Primary Run -Off,
Special, (year)
-Paz= leaving office with excess funds until
such funds are expended as provided in the Aa
■ October 25, (year)
(year)
•UmuccessfWcandidates with excenfunds, or
[:]6 days before Special
FjDec. 31, (year)
who receive contributions to Mite debt inuxrted,
until s,:ch a n& vv expem ed, arsndt mpsid
December 31, year)
Run -Off, (year)
debts are satisfied (December 71 filing ortly)
Verification by Oath or Affirmation
State of i�. � C� County of "Jul
im-
1, (Sn�OU�is
/ Q , being duly sworn (affirm), depose and say
that the informationport fo complete, true, and correct. Further, I affirm that the enntentghinQthic re.nnret
are the same as the contents in the electronic filing submitted, if also electronically filed (! \O ' ,�.(.eCv
S$&orn to and subscribed before me on 0
(9d V bvL 2,` aoO(P
L70��_
p
a. Signature of Candidate or b. Organization
My
PENALTIES: Any person who knowingly fails to comply with or who knowingly violates any of the provisions of the Ethics in Government Act
shall he guilty of a misdemeanor.
_M
sEC FORM CCDR
— nt nrvuc
State of Georgia
Campaign Contribution Disclosure Report
Summary Report
CONTRIBUTIONS RECEIVED
I have:
In -Kind
1
No contributions to report.
Estimated
Cash Amount
The following contributions, including Common Source, to report:
A. If this is the first time to file a disclosure report for the current office sousht.
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 column
2
and list any net balance on hand brought forward from the previous reporting cycle
in the cash amount column (Line 13 of previous report, or total funds left over at
year end of previous cycle); or
C. If this filing is the second or subsequent filing or this Reporting Cycle, list totals
from Line 6 of previous report in both the in-kind and cash amount columns.
Total amount of all contributions of $101.00 or more received in this reporting period.
3
Each such contribution must be listed on the "Listed Contributions Received" page.
3a
All loans received this period.
3b
Interest earned on campaign account this period.
Total amount of all separate contributions of less than $101.00 each that were
4
reported in this reporting period. "Common Source" contributions must be aggregated
on the "Listed Contributions Received" page.
Total contributions reported this period.
5
Line 3 + 3a + 3b + 4)
Total contributions to date. Total to be carried forward to next report ojthis reporting cycle':
6
Line 2 + 5
EXPENDITURES MADE
e:
7
ex to r or
Cash Amount
Iditures
he folin ex enditures to re ort:
kNo
res ma Mean reporte Fpnor this reporting period. If this is the first report of this
8
Reporting Cycle*, ENTER 0.
Line 12 of previous report)
9
Total amount of all expenditures of $101.00 or more made in this reporting period.
Total amount of all separate expenditures of less than $101.00 each that were made in this reporting
10
period.
1 I
Total expenditures reported this period.
�(
(�
(Line 9 + 10)
r
Total expenditures to date. Total to be carried fonward to next report ojthis reporting cyclet
12
(Line 8 + 11)
l}JS
13
Net balance on hand.
(Line 12 - line 6
• O.C.G.A. 21-5-34(b)(I)(D)(ii) A reporting cycle shall commence on January I of the year in which an election is to be held for the public office to which a candidate
ceks election and shall conclude:
(p At the expiration of the term of office if such candidate is elected and does not seek reelection of election to some other ogee;
(11) On December 31 of the year in which such election was held if such candidate is unsuccessrul; or
(Ill) If such candidate is successful and seeks reelection or seeks election to some other office the current reporting cycle shall end when the reporting cycyle for
reelection or for some other office begins
Public Officer/Candidate/Non-Candidate Committee Name
SEC FORM CCDR
RFV RI zcne
State of Georgia
Campaign Contribution Disclosure Report
Outstanding Indebtedness
Election. cIe*: > ` Elect>tort Year:
'.
Amount'
1
Outstanding indebtedness at the beginning of this period.
2
Loans received this period.
2
Deferred payment of expenses this period
4
Payments made on loans this period.
5
Credits received on loans this period.
6
Payments this period on previously deferred expenses.
7
Total indebtedness at the close of this reporting period.
(Line 1+2+3-4-5-6)
{
Etectiop Cycle*.�t� _ "r Election, Year:, ° _
Amount '
1
Outstanding indebtedness at the beginning of this period.
2
Loans received this period.
2
Deferred payment of expenses this period
4
Payments made on loans this period.
5
Credits received on loans this period.
6
Payments this period on previously deferred expenses.
7
Total indebtedness at the close of this reporting period.
Line 1+2+3-4-5-6)
Election Cycle*:'' Election Year:
Amount
1
Outstanding indebtedness at the beginning of this period.
2
Loans received this period.
2
Deferred payment of expenses this period
4
Payments made on loans this period.
5
Credits received on loans this period.
6
Payments this period on previously deferred expenses.
7
Total indebtedness at the close of this reporting period.
(Linel+2+3-4-5-6)
* Election Cycle (Primary, General, Special, Special Primary, Run -Off Primary, Run -Off General, Run -Off Special,
Run -Off Special Primary)
_fyi�
Public Officer/Candidate/Non-Candidate Committee Name
@q
SEC FORM CCDR
Ai n
State of Georgia
Campaign Contribution Disclosure Report
Listed Contributions Received of $101.00 or More
Full Name of Contributor
Mailing Address
PAC Affiliation if applies)
Contributor
Election
C cle**
Cash
Amount
In -Kind Contributions
Received Date
Contribution Type*
a. Occupation
b. Employer
Estimated Value
Descri tion
$
--- - --
------ --- - —
$
$
Page Total
The Act requires all public officers, candidates, and campaign committees to list contributions received and expenditures made which are
individually $101.00 or more and to disclose the total amount of all contributions received and expenditures made which are individually
less than $101.00.
* Contribution Type (Monetary, In -Kind, Loan, Common Source, Credit Received on Loan)
** Election Cycle (Primary, General, Special, Special Primary, Run -Off Primary, Run -Off General, Run -Off Special,
Run -Off Special Primary)
Public Officer/Candidate/Non-Candidate Committee Name Page of
a
SEC FORM CCDR
Kry uiuuuo
State of Georgia
Campaign Contribution Disclosure Report
Listed Exuenditures Made of $101.00 or More
List Name and Mailing Address
of Recipient
Expenditure Date
Expenditure Type*
Occupation or Place
of Employment
Expenditure Purpose
Amount
$
Page Total $
The Act requires all public officers, candidates, and campaign committees to list contributions received and expenditures made which are
individually $101.00 or more and to disclose the total amount of all contributions received and expenditures made which are individually
less than $101.00.
* Expenditure Type (Expenditure, Loan Refund, Refund, Reimbursement, Credit Card, 3rd Party, Deferred Payment, Payment on
Deferred Expense)
Public Officer/Candidate/Non-Candidate Committee N -: Page of
SEC FORM CCDR
RFV mrn f.