HomeMy WebLinkAboutCCDR: Burt Hewitt (3)SEC FORM CCDR
REV 03/2008
State of Georgia
Camuaien Contribution Disclosure Report RECEIVED
1. Report Type 2. Filing is being made on behalf of (Select One): ]H51ing once use only
(select one) ® Candidate or Public Officialii /� , J L I
Office Sought or Held: Mt1 Km 61 7
1 Original Report (Include county, m ity, district post orj 'tial circuit)
Committee Name: CA A S ( CrrY CLERK
Amended Report C T1081taffmost
Mark or HaDdQ
Amendment # Report of Organization or Person Other than Candidate's Campaign Committee Delivered Date
3. Identifying and Contact Information
(1)
Full NamelofCa
(3) 134 (o
Mailing Address
or Non -Candidate Campaign Committee
City
state
and / or 1A) Q — Z Ml
Contact Phone Number (We will understand the releaseothis information as permission to call your office if necessary)
(5) If a Candidate or Public Official, is there a cal
campaign, or file the reports? viYes
(7) If so, complete the following:
committee (one or more persons) to make campaign transactions, keep the financial records of the
No (6) If so, is the committee registered with the State Ethics Commission? Q Yes F1 No
Name of Chairperson turd/or Treasurer of Committee
4. Period for which you are Reporting
My Non Election Year
My Election Year
Run -Offs
(Report required only if you are in a Run -Off
Election)
Special Elections
(Report required only if you aro in a Special
Election)
June 30, (year)
March 31, (year)
06 days before Primary
15 days before
Run -Off, (year)
Special Primary,
Dec. 31, Z (year)
June 30, (year)
Q6 days before General
(year)
Wj
Run -Off, (year)
-persons elected to office in each year following
[l September 30, (year)
Q6 days before SSpeccial
15 days before
the year in which the election occurs
Prim Run-Off
Special,(year)
*Persons leaving office with excess funds until
such funds are expanded as provided in the Act
❑ October 25, (year)
(year)
-Unsuccessful candidates with excess funds, or
Q6 days before Special
[] Dec. 31, (year)
who receive contributions to retire debt incurred
until such funds are expended, or such unpaid
M December 31, (yeah)
Run -Off, (year)
debts are ssusfiad (Decenber 31 filing only)
Verification by Oath or Affirmation
State of
County of i�lyt"�
1, 'cW i being duly swom (affirm), depose and say
that the information inOisport 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 of Notary Public
Commission expires
Nils tocounply with
a. Signarme of Candidate
b. Organization/Chairperson/Treasurer
of the Ethics in Govannxert Act shall be guilty of a
M
SEC FORM CCDR
DII�J MHM4
State of Georgia
Campaign Contribution Disclosure Report
Summary Report
CONTRIBUTIONS RECEIVED
1
❑ I have no contributions to report.
In -Kind
Cash Amount
I have the following contributions, including Common Source to report.
Estimated Value
A. If this is the first time to file a disglosure 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 column
and list any net balance on hand brought forward from the previous reporting cycle
2
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 of this Reporting Cycle, list totals
from Line 6 of previous rt in both the in-kind and cash amount columns.
'�
��
3
Total amount of all itemized contributions received in this reporting period which are
2
listed on the "Itemized Contributions" page.
3a
All loans received this reporting period.
0
3b
Interest earned on campaign account this reporting period.
Q
3c
Total amount of investments sold this reporting period.
D
3d
Total amount of cash dividends and interest paid out this reporting period.
0
Total amount of all separate contributions of less than $101.00 received in this
4reporting
period and not listed on the "Itemized Contributions" page.
0
"Common Source" contributions must be aWegated on the "Itemized Contributions"
Total contributions reported this period.
,O
5
(Line 3+3a+3b+3c+3d+4)
Z
6
Total contributions to date. Total to be caried forward to next repos of this reporting cycle':
i(Line
EXPENDITURES MADE
7
[g I have no expenditures to report.
In -Kind
Cash Amount
El I have the following expenditures to report:
Estimated Value
Total expenditures made and reported prior to this reporting period. if this is the
8
A. First report of this Reporting Cycle*, ENTER 0.
q /3 q Z
B. Second or subsequent filingENTER Line 12 of revious rt.
O
l
/
Total amount of all itemized expenditures made in this reporting period which are
p
9
listed on the "Itemized Expenditures" page.
Total amount of all separate expenditures of less than $101.00 that were made
O
10
in this rep ortin iod and not listed on the "Itemized Ex nditures" page.
11
Total expenditures reported this period
D
O
I(Line
Total expenditures to date. Total to be carded forward to next report of thk reporting cycle t
12
I(Line 8 + 11)
13.4
INVESTMENTS
13
Total value of investments held at the beginning of this reporting period
6
14
Total value of investments held at the end of this reporting period.
15
Net balance on hand.
}�) 2�
Line 6 - 12 + 14
UG 1 i J
* O.C.G.A. 21-5-34(b)(IXDxii) 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 seeks election and shall
,. conclude:
(1) At the expiration of the term of office if such candidate is elected and does not seek reelection or election to some other office;
(II) On December 31 of the year in which such election was held if such candidate is unsuccessful; or
(III) If such candidate is successful and seeks reelection or seeks election to some other office the current reporting cycle shall end when the repotting cycle for reelection or for some other office
begins.
Public Officer/Candidato/Non-Candidate Committee Name
E
SEC FORM CCDR
REV 03/2008
State of Georgia
Campaign Contribution Disclosure Report
Outstanding Indebtedness
Election Cycle*: Election Year:
Amount
1
Outstanding indebtedness at the beginning of this reporting period.
1131075-
f31075-2
2
Loans received this reporting period.
3
Deferred payment of expenses this reporting period
4
Payments made on loans this reporting period.
5
Credits received on loans this reporting period.
6
Payments this reporting 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 reporting period.
2
Loans received this reporting period.
3
Deferred payment of expenses this reporting period
4
Payments made on loans this reporting period.
5
Credits received on loans this reporting period.
6
Payments this reporting 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:
1
Outstanding indebtedness at the beginning of this reporting period.
2
Loans received this reporting period.
3
Deferred payment of expenses this reporting period
4
Payments made on loans this reporting period.
5
Credits received on loans this reporting period.
6
Payments this reporting period on previously deferred expenses.
7
Total indebtedness at the close of this reporting period.
(Line !+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)
Public Officer/Candidate/Non-Candidate Committee Name
�t�Q
SEC FORM CCDR
vrvinr 4
State of Georgia
Campaign Contribution Disclosure Report
Itemized Contributions
Must list contributions received by a single contributor for which the $ggg total is $101.00 or more
Note: Loans are no to er reported in "Itemized Contributions" section. See Loan Re ing section below.
Full Name of Contributor
Mailing Address
(Affiliation of Committee if any)
Contributor
Election
Cycle**
Cash
Amount
In -Kind Contributions
Received Date
Contribution Type*
Occupation &
Employer
Estimated Value
Description
3
00
1.
2.
Reference: OCGA § 21-5-34(b)(1) Loan Page Total $
Itemized Contributions Page Total $ Z�Q, d $
Loan
Reporting
Name of Lender
Mailing Address
Date of Loan
Amount of Loan
Election Cycle**
Person(s) responsible for
repayment of loan
Mailing Address
Occupation &
Place of Employment
Fiduciary Relationship***
1.
2.
1.
2.
Reference: OCGA § 21-5-34(b)(1) Loan Page Total $
* Contribution Type (Monetary, In -Kind, Common Source, Credit Kecelvea on Loan)
** Election Cycle (Primary, General, Special, Special Primary, Run -Off Primary, Run -Off General, Run -Off Special, Run -Off
Special Primary)
***If any such person(s) shall have a fiduciary relationship to a lending' tutio r making the advance or extension of credit
Public Officer/Candidate/Non-Candidate Committee Name Page of _�