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HomeMy WebLinkAboutCCDR: Burt Hewitt (2)SEC FORM CCDR AEV 03!2008 ' State of Georgia Contribution Disclosure Report RE 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: L 1 Original Report (Include county, muni ily, district post orjujicial circuit) [� Amended Report Committee Name: �� A S d Crrr CLERK ost Amendment # _ _ [] Report of Organization or Person Other than Candidate's Campaign Committee DeMarlivered or Hand Date 3. Identifying and Contact Information (1) C 14 IDV- y71 WOK GfffW 4TT. IV— (2) Full N oamel j Candidate or Non -Candidate Campaign Committee T s to (3) 13 to NA, Qf W1 Mailing Address / City State Zip Code (4) �Qa 1 ti and J or H . aD _ Z 1 Contact Phone Number (We will understand the release of this irbrmation 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? 14Yes n No (6) If so, is the committee registered with the State Ethics Commission? RYes n No (7) If so, complete the following: �lar 4�7&VTTr Name of Chairperson and/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 are in a Special Election) June 30, (year) March 31, (year) n6 days before Primary rl 15 days before Run -Off, (year) Special Primary, Dec. 31, Z (year) June 30, (year) n6 days before General (year) Run -Off, (year) *Persons elected to office in each year following [� September 30, (year) Q6 days before Special E] 15 days before the year in which the election oc4cursPrimary ions leaving office with excess •Prfunds until Run -Off, Special, (year) such funds arc expended as provided in the Act October 25, (year) (year) •Uosucceasftd candidates with excess funds, or who receive to dem incurred. Q6 days before Specie[ Dec. 31, (year) contributions retire until such funds are expended, or such unpaid December 31, (year) Run -Off, (year) debts are satisfied (December 31 filing only) Verification by Oath or Affirmation State of (f County of I, W being duly sworn (affirm), depose and say that the information in his 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 of Notary Public Commission expires fails toconply with or who a. Sig-n-a'rm of Candidate b. Organization/Chairperson/Treasurer Ethics in Govemmru Act shall be gu ft ofa misdemeanor. E E SEC FORM CCDR IMV 03/2005 State of Georgia Campaign Contribution Disclosure Report Summary Report CONTRIBUTIONS RECEIVED 1 ❑ I have no contributions to report. in- Cash Amount I have the following contributions, including Common Source to re Estimated Value A. If this is the first time to file a disclosure report forthe 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 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 of this Reporting Cycle, list totals from Line 6 of previous report in both the in-kind and cash amount columns. 171 1 JJI 3 Total amount of all itemized contributions received in this reporting period which are "Itemized O <h. CD listed on the Contributions" page. 2 3a All loans received this reporting period. 0 3b Interest earned on campaign account this reporting period. 0 3c Total amount of investments sold this reporting period. 0 3d Total amount of cash dividends and interest paid out this reporting period. Q Total amount of all separate contributions of less than $101.00 received in this 4 reporting period and not listed on the "Itemized Contributions" page. O "Common Source" contributions must be aggregated on the "Itemized Contributions" page. S Total contributions reported this period. (Line 3 + 3a + 3b + 3c + 3d + 4) Z Sp .c:p 6 Total contributions to date. Total to be carried forward to next report of this reporting cycle*1_1;�.00 2+ 5qot/ iine t EXPENDITURES MADE 7 (H 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. 43 �. B. Second or subsequent filing ENTER Line 12 of revious re rt p / Z 9 Total amount of all itemized expenditures made in this reporting period which are i7 p listed on the "Itemized Expenditures" page. 10 Total amount of all separate expenditures of less than $101.00 that were made in this ng period and not listed on the "Itemized Ex ditures" page. O 11 Total expenditures reported this period. D 0 I(Line 12 Total expenditures to date. Total to be carded forward to nest report of this reporting cycle". iy 13.4 L (Line 8 + 11) 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. 6) 15 Net balance on hand. � �� 3-17-33 Line 6 - 12 + 14 * O.C.G.A, 21-5-34(b)(l)(D)(ii) A reporting cycle shall commence on January I of the year in which an elation is to be held for the public office to which a candidate seeks election and shall crude: ;VIWI) At the expiration of the cert 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 reporting cycle for reelection or for some other office begins. Public Officer/Candidate/Non-Candidate Committee Name ��TleojKS� E SEC FORM CCDR REV 03/2008 State of Georgia Campaign Contribution Disclosure Report Outstanding Indebtedness El * E an ye, irs 1 Outstanding indebtedness at the beginning of this reporting period. 7t 1310 75— 2 Loans received this reporting period. 3 Deferred payment of expenses this reporting period O 4 Payments made on loans this reporting period. ,Q 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` Eledlon Yaw: 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) El+ tion`. s, 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 I(Line Total indebtedness at the close of this reporting period. I + 2 + 3 - 4 - 5 -6 o,.,* 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 ' �� SEC FORM CCDR REV 3!2008 State of Georgia Campaign Contribution Disclosure Report Itemized Contributions Must list contributions received by a single contributor for whkb the aggregate total is $101.00 or more Note: Loans are no 1 er reported in "Itemized Contributions" section. See Loan Reporting 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 Lilco Vs,QW-00a1qr'k_ 1710-61 p .' 1. 2. Reference: OCGA § 21-5-34(b)(1) Loan Page Total $ Itemized Contributions Page Total $ 29D.01 $ 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 Received 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 'institution r making the advance or extension of credit Public Officer/Candidate/Non-Candidate Committee Name Page of 'Form FD -Local Filing officer ent tl IVED Rev. 3/06 STATE OF GEORGIA JUL FINANCIAL DISCLOSURE STATEMENT ►` 'P/Z4/ V n dment g al Date of this Statement: Covering CalendarZ --v wingk�v �Year: - LL �'dj tement Name of Public Officer or Candidate: C Iy E F.�IJrabfq 3� Fi Middle Last ^ 3� Mailing Address: 6 r{^,1_ V��./ 64 Street or P.O. Box I City County State Zip code Telephone Number: (Office) 770 (off 3 7syo (Home) (_O7"'g06SZ)1 Name of City or County Office Held or Sought: 1 I `. C01i itita l �T Check One: A Elected City or County Officer ❑ Candidate for City or County Office WHO FILES A FINANCIAL DISCLOSURE STATEMENT: Each public officer holding office in Georgia, and each person who qualifies as a candidate for election as a public officer for one of the offices listed below, and all others on the following list. (A) Every constitutional officer; (B) Every elected state official; (C) The executive head of every state department or agency, whether elected or appointed; (D) Each member of the General Assembly; (E) The executive director of each state authority, board or commission and the members thereof; (F) Every elected county official, every elected county or area school superintendent, and every elected member of a county or area board of education; and , (G) Every elected municipal officer. WHEN TO FILE A FINANCIAL DISCLOSURE STATEMENT: Public Officer: A Financial Disclosure Statement is filed not before January 1 and not later than July 1 of each year that a public officer holds office (except the year of election). The information to be provided shall be that from the preceding calendar year. If the public officer chooses not to run for re-election or for another public office no Financial Disclosure Statement need be filed in the year qualifying to succeed him takes place. A public officer shall not be deemed to hold the office in a year in which the public officer holds office for less than 15 days. Candidate for Public Office: A Financial Disclosure Statement covering the period of the preceding calendar year shall be filed no later than the fifteenth day following the date of qualifying as a candidate. Candidates for state wide office file not later than seven days after qualifying for office. Only one Financial Disclosure Statement is required per calendar year. Special requirements for State Wide Candidates: Candidates for a public office elected state wide must file their Financial Disclosure Statements not later than seven days after qualifying or filing a notice of candidacy. State wide candidates must disclose more information than other candidates for public office and the additional disclosure sections required of state wide candidates must be completed in the year of election filing. WHERE TO FILE A FINANCIAL DISCLOSURE STATEMENT: Every public officer who is an elected county official and every candidate for election as a county public official will file a Financial Disclosure Statement with the election superintendent of the county of election. Every public officer who is an elected municipal officer and every candidate for election as a municipal public officer will file a Financial Disclosure Statement with the municipal clerk or, if there is no clerk, with the chief executive officer of the municipality of election. SECTION I MONETARY FEES RECEIVED 1100*1 (This section to be completed by Public Officers only) Identify each monetary fee or honorarium accepted from speaking engagements, participation in seminars, discussion panels, or other activities which relate to the official duties of, or to the office of the public officer, with a statement identifying the fee or honorarium and the person from whom it was accepted. (You may attach additional sheets of paper if necessary.) I eceived: 10 monetary fee or honorarium. o Monetary fee(s) or honoraria as shown below. Identify Fee or Honorarium Name of Person from Whom Accepted And Amount Accepted SECTION II FIDUCIARY POSITIONS Name all fiduciary positions held by the candidate for public office or the public officer. (You may expand this section if necessary to include all positions.) A fiduciary position is any position imposing a duty to act primarily for another's benefit as officer, director, manager, partner, guardian, or other designations of general responsibility of a business entity. A business entity is any corporation, sole proprietorship, partnership, limited partnership, limited liability company, limited liability partnership, professional corporation, enterprise, franchise, association, trust, joint venture, or other entity, whether profit or nonprofit. (You may attach additional sheets of paper if necessary.) err I held: ❑ No fiduciary positions in any business entity. ,,KFiduciaty positions in the following business entity(ies). IDENTIFY: 1. Title of each position. 2. Name and address of business entity. 3. Principal activity of each business entity. Business entity #2 Business entity #3 Business entity #4 SECTION III DIRECT OWNERSHIP INTERESTS IN BUSINESS ENTITY Direct ownership interest is the holding or possession of good legal or rightful title of property or the holding or enjoyment of real or beneficial use of the property by any person and includes any interest owned or held by a spouse of the person if such interest is held jointly or as tenants in common between the person and spouse. Identify the name, address and principal activity of any business entity and the office held by and the duties of the candidate for public office or public officer within a business entity as of December 31 of the covered year in which a direct ownership interest: (A) Is more than 5 percent of the total interest in the business; or (B) Has a net fair market value of more than $10,000. (You may attach additional sheets of paper if necessary.) I held: ❑ No direct ownership interests in any business entity. Direct ownership interests in the following business entity(ies). IDENTIFY: 1. Name and address of business entity. 2. Principal activity of business entity. 3. The office held by the candidate or the public officer within the business entity. 4. The duties of the candidate or the public officer within such business entity. Business entity #2 Business entity #3 Business entity #4 Business entity #5 Ownership Interests Check One or Both If Applicable ,q Ownership interest is more than 5% d Ownership interest has a net fair mar- ket value of more than $10,000.00 ❑ Ownership interest is more than 5% ❑ Ownership interest has a net fair mar- ket value of more than $10,000.00 ❑ Ownership interest is more than 5% ❑ Ownership interest has a net fair mar- ket value of more than $10,000.00 ❑ Ownership interest is more than 5% ❑ Ownership interest has a net fair mar- ket value of more than $10,000.00 ❑ Ownership interest is more than 5% ❑ Ownership interest has a net fair mar- ket value of more than $10,000.00 SECTION IV DIRECT OWNERSHIP INTERESTS IN REAL PROPERTY Direct ownership interest is the holding or possession of good legal or rightful title of property or the holding or enjoyment of real or beneficial use of the property by any person and includes any interest owned or held by a spouse of the person if such interest is held jointly or as tenants in common between the person and spouse. Identify each tract of real property in which the candidate for public office or public officer has a direct ownership interest as of December 31 of the covered year when that interest has a fair market value in excess of $10,000.00. "Fair market" value means the appraised value of the property for ad valorem tax purposes. (You may attach additional sheets of paper if necessary.) Check one box to show the applicable valuation range for each tract. (You may attach additional sheets of paper if necessary.) I had: ❑ No ownership interests with a fair market value in excess of $10,000.00 Ownership interests with a fair market value in excess of $10,000.00 IDENTIFY: 1. County where property is located. 2. State where property is located. 3. General description of property (give street address or location, size of tract, and nature or use of property). Property #1 Property #2 Property #3 Property #4 Property #5 `tgrr The Value of this tract is ❑ Between $10,000 and $100,000 ❑ Between $100,000.01 and $200,000 More than $200,000 The Value of this tract is ❑ Between $10,000 and $100,000 ❑ Between $100,000.01 and $200,000 ❑ More than $200,000 The Value of this tract is ❑ Between $10,000 and $100,000 ❑ Between $100,000.01 and $200,000 ❑ More than $200,000 The Value of this tract is ❑ Between $10,000 and $100,000 ❑ Between $100,000.01 and $200,000 ❑ More than $200,000 The Value of this tract is ❑ Between $10,000 and $100,000 ❑ Between $100,000.01 and $200,000 ❑ More than $200,000 SECTION V SPOUSE'S DIRECT OWNERSHIP INTERESTS IN REAL PROPERTY Identify each tract of real property in which the filer's spouse has a direct ownership interest as of December 31 of the covered year when that interest has a fair market value in excess of $10,000.00. (You may attach additional sheets of paper if necessary.) Check one box to show the applicable valuation range for each tract. (You may attach additional sheets of paper if necessary.) My spouse had: ❑ No ownership interests with a fair market value in excess of $10,000.00 AOwnership in the following tracts with a fair market value in excess of $10,000 IDENTIFY: 1. County where property is located. 2. State where property is located. 3. General description of property (give street address or location, size of tract, and nature or use of property). The Value of this tract is ❑ Between $10,000 and $100,000 ❑ Between $100,000.01 and $200,000 "ore than $200,000 Property #2 The Value of this tract is ❑ Between $10,000 and $100,000 ❑ Between $100,000.01 and $200,000 ❑ More than $200,000 Property #3 The Value of this tract is ❑ Between $10,000 and $100,000 ❑ Between $100,000.01 and $200,000 ❑ More than $200,000 Property #4 The Value of this tract is ❑ Between $10,000 and $100,000 ❑ Between $100,000.01 and $200,000 ❑ More than $200,000 Property #5 The Value of this tract is ❑ Between $10,000 and $100,000 ❑ Between $100,000.01 and $200,000 ❑ More than $200,000 @q 0*. Filer's Occupatiot Filer's Employer Employer's Addre Employer's Princi Filer's Spouse's r Spouse's Occupat Spouse's Employer Address of Spouse's Employer Principal Activity of Spouse's Employer SECTION VI EMPLOYMENT AND FAMILY MEMBERS Names of Filer's Dependent Children SECTION VII INVESTMENT INTERESTS List the name of any business or subsidiary thereof or investment (do not list individual stocks and bonds that are held by mutual funds), in which the filer (either individually or with any other legal or natural person or entity) owns a direct ownership interest that: 1. Is more than 5 percent of the total interests in such business or investment, or 2. Hasa net fair market value of more than $10,000.00. Business or Investment Entity #I Name Business or investment E�,nhty #, 2 Name %��tj,_JJD Business or Investment Entity #3A Name vim' Business or Investment Entity #4 n Name A SECTION VIII KNOWN BUSINESS OR INVESTMENT INTERESTS OF SPOUSE AND DEPENDENT CHILDREN Identify any business or investment known to the filer in which the Filer's spouse or dependent children have a direct ownership interest (either individually or with any other legal or natural person or entity) if any one of the following is true (do not list individual stocks and bonds that are held by mutual funds): 1. the subject interest is more than 5 percent of the total interest in the business or investment, 2. the subject interest has a net fair market value exceeding $10,000.00, or 3. the subject interest is one in an entity for which the Filer's spouse or a dependent child serves as an officer, director, equitable partner, or trustee. Business or Investment Entity #1 Name Business or Investment Entity #2 Name Business or Investment Entity #3 Name Business or Investment Entity #4 Name 1� e SECTION IX ANNUAL PAYMENTS RECEIVED BY THE PUBLIC OFFICER OR BUSINESS ENTITY FROM THE STATE OF GEORGIA (This section to be completed by Public Officers only) Identify all annual payments in excess of $20,000.00 received by the public officer — or by any business entity in which the public officer has an ownership interest of more than 10 percent of the business or has an ownership interest having a net fair market value of more than $20,000.00 — from the State, any agency, department, commission or authority created by the State and authorized and exempted from disclosure under O.C.G.A. § 45-10-25. (You may attach additional sheets of paper if necessary.) I received: J�No annual payments in excess of $20,000.00 from any State entity. d Annual payments in excess of $20,000.00 from the below named State entity(ies). IDENTIFY: 1. Name and address of State entity making the payments. 2. Amount of annual payment. 3. The general nature of the consideration rendered for the payment(s). State entity source #I 11 W State entity source #2 VERIFICATION BY OATH OR AFFIRMATION State of Georgia County of I, the undersigned, being duly sworn (affirm), depose and say that the information in this statement is complete, true, and correct. Sworn to and subscribed before me on 20 C��#� Signature of Candidate or Public Officer Signature of Notary Public PENALTIES: Any person who knowingly fails to comply with or who knowingly violates any of the provisions of the Ethics in Government Act shall be guilty of a My Commission expires misdemeanor.