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Home My WebLink AboutCCDR - 9/25/2009 - CCDR: Al Trevillyan (2) (Migrated from Optiview)SEC FORM CCDR ' RFV 03/20OR State of Georgia Campaign Contribution Disclosure Report RECEIVEIC 1. Report Type 2. Filing is being made on behalf of (Select One): Filing office use only (select one) IP Candidate or Public Official EP 25 W Office Sought or Held: `i?! C,0�4 AIC-1121— Original Report (Include county, municipality, district, post orjudicial circuit) Committee Name: CnYCLERIC ❑ Amended Report fMASAAWAMt Amendment # I ❑ Report of Organization or Person Other than Candidate's Campaign Committee 3. (1) (3) dentifyi g and Contact Information �--/ Zo✓eLCy,*(1 (2) Mark or Hand Delivered Date 4. o - Today's Date 3yyv MailingAddressCity State / Zip Code (4) ( � ' `�� 3 and/ or (7t 9W I iE:2 iv= Contact Phone Number (We will understand the release of this information as permission to callyour 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? Yes ❑ (6) If so, is the committee registered with the State Ethics Commission? ❑ Yes ❑ (7) If so, complete the following: 1 t_ atitL-.cjr Name of Chairperson and/or Treasurer 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) Ej6 days before Primary 15 days before Run -Off, (year) Special Primary, Dec. 31, (year) Ej June 30, (year) 06 days before General (year) Run -Off, (year) "Persons elected to office in each year following E�ZSeptember 30, Qpq (year) [j6 days before Special E] 15 days before the year in which the election occurs Primary Run -Off, Special, (year) 'Persons leaving office with excess funds until such funds are expended as provided in the Act ❑ October 25, (year) (year) 'Unsuccessful candidates with excess funds, or Ej6 days before Special Dec. 31, (year) who receive contributions to retire debt incurred, 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 County of 1, 11L— TQ 6 vt��- %Ji"� being duly 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 on S 20/\(1. Signa re of Notary Public a. Signature of Candidate Ey,M D "AMAVA b. Organization/Chairperson/Treasurer My Commission expirca �►a�nG1 "� �f I�IxM�C n. Any person who kn* W �7r1 91 &ny of the provisions of the Ethics in Government Act shall be guilty of a misdemeanor. SEC FORM CCDR REV 0312008 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 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 column and list any net balance on hand brought forward from the previous reporting cycle 2 in the cash amount column (Line 15 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. 3 Total amount of all itemized contributions received in this reporting period which are b listed on the "Itemized Contributions" page. d 3a All loans received this reporting period. �j ;, 3b Interest earned on campaign account this reporting period. 3c Total amount of investments sold this reporting period. 3d Total amount of cash dividends and interest paid out this reporting period.CID 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. "Common Source" contributions must be aggregated on the "Itemized Contributions" page. C� Total contributions reported this period. 5 (Line a+3a+3b+3c+3d+4 Total contributions to date. Total to be carried forward to next report of this reporting cycle *. 6 Line 2 + 5 EXPENDITURES MADE 7 I have no expenditures to report. In In -Kind Cash Amount 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. B. Second or subsequent filing ENTER Line 12 of 12reviggLLeport, Total amount of all itemized expenditures made in this reporting period which are 9 listed on the "Itemized Expenditures" page. Total amount of all separate expenditures of less than $101.00 that were made 10 in this rep rting period and not listed on the "Itemized Expenditures" page. 11 Total expenditures reported this period. Line 9 + 10 Total expenditures to date. Total to be carried forward to next report of this reporting cycle*. 12 Line 8 + 11 INVESTMENTS 13 Total value of investments held at the beginning of this reporting period. M 14 Total value of investments held at the end of this reporting period. 15 Net balance on hand.' Line 6 - 12 + 14 'AIM * O.C.G.A. 21-5-34(b)(1)(Dxii) 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: (I) At the expiration of the term of office if such candidate is elected and does not seek reelection or election to some other office; mow+ (11) 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/Other Than Candidate Committee Name SEC FORM CCDR REV 03/2008 State of Georgia Campaign Contribution Disclosure Report Outstanding Indebtedness 1�� t cue. E. . 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. Total indebtedness at the close of this reporting period. 7 (Line 1+2+3-4-5-6) Eli21� AM o .. 1 Outstanding indebtedness at the beginning of this reporting period. 2 Loans received this reporting period. 3 Deferred payment of expenses this reporting period n, 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. Total indebtedness at the close of this reporting period. 7 I(Line I + 2 + 3 - 4 - 5 -6 Eictlo1�� .. s 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. Total indebtedness at the close of this reporting period. 7 (Line 1+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/Other Than Candidate Committee Name SEC FORM CCDR State of Georgia Campaign Contribution Disclosure Report Itemized Contributions Must 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 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 2. L 2. Reference: OCGA § 21-5-34(b)(1) Loan Page Total $ Itemized Contributions Page Total $ $ 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. L 2. Reference: OCGA § 21-5-34(b)(1) Loan Page Total $ * Contribution `Type (Monetary, In -Kind, Common Source, Credit Keceived 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 the lending institution or party making the advance or extension of credit Public Officer/Candidate/Other than Candidate Committee Name Page of e SEC FORM CCDR .pv mnmR State of Georgia Campaign Contribution Disclosure Report Itemized Expenditures Must list expenditures made to a single recipient for which the aggregate total is $101.00 or more List Name and Mailing Address of Recipient Expenditure Date Expenditure Type* Occupation & Employer Expenditure Purpose Amount Paid $ Page Total $ * Expenditure Type (Expenditure, In -Kind, Loan Repayment, Refund, Reimbursement, Credit Card, 3rd Party, Deferred Payment, Payment on Deferred Expense, Investment) Public Officer/Candidate/Other Than Candidate Committee Name Page of SEC FORM CCDR Rev 3/2008 State of Georgia Campaign Contribution Disclosure Report Investments Statement 1. Investment Name Account Number Institution/Person Holding Account Mailing Address City, State, Zip Value at beginning of reporting period $ Value at end of reporting period $ Difference in value $ Interest Paid Out $ Cash Dividends $ Investment Transactions Date Person(s) Involved in Transaction Value of investment purchased Value of investment sold Profit Loss 2. Investment Name Account Number Institution/Person Holding Account Mailing Address City, State, Zip Value at beginning of reporting period $ Value at end of reporting period $ Difference in value $ Interest Paid Out $ Cash Dividends $ Investment Transactions Date Person(s) Involved in Transaction Value of investment purchased Value of investment sold Profit Loss Total value of investments at beginning of reporting period $ Total value of investments at end of reporting period $ Total difference in value $ Page Total Cash Dividends: -$ Page Total Interest Paid Out: $ Page Total Profit: $ Page Total Loss: $ Public Officer/Candidate/Other Than Candidate Committee Name Page of SEC FORM CCDR REV 032008 Public Officer/Candidate/Other Than Candidate Committee Name Page