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Home My WebLink AboutCCDR - 6/30/2009 - CCDR: Burt Hewitt (4) (Migrated from Optiview)t SEC FORM CCDR SEEO REV 06/2009 Campaign 1. Report Type (Select One) x Original Report Amended Report Amendment # 3. Identifying and (1) C Full Name of andidal H State of Georgia Contribution Disclosure Report - Statewide Elected Executive Officer 2. Filing is being made on behalf of (Select One): Filing office use only Candidate or Public Officio /M, j n /1 / 1 L ` Office Sought or Held: /'' / '1' +/ -►41 &,tf�l l � , y (Include county, municipciity, district, post or .udi ial circuit) Committee Name: Use Earlier of Post Report of Organization or Person Other than Candidate's Campaign Committee Mark or Hand Delivered Date Q or Non -Candidate Campaign Committee (2) tatel Today's Date (3) /r(6 Au- MaailinpgAddress 7City State Zip Code (4) Ai�j--k- � and / or Contact Phone Number (We will understand the rel se of this information 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? Yes ❑ No (6) Ifs so, is the committee registered with the State Ethics Commission?loxes []No (7) If so, complete the following: 13J c-4 Name of Chairperson and/or Treasurer of Committee 4. Period for which you are Reporting You Must Check Onlv One Box 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, 2gA (year) March 31, (year) 6 days before Primary 15 days before Run -Off, (year) Special Primary, Dec. 31, (year) June 30, (year) 6 days before General (year) Run -Off, (year) 'Persons elected to office in each year following September 30, (year) 6 days before Special 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 6 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 off O LNC 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 me on , 20_ Signature of Notary Public Commission expires 4LTIES: Any person who knowingly fails to comply with or who knowingly violates (j7L*-- a. Signature of Candidate b. Organization/Chairperson/Treasurer of the Ethics in Government Act shall be guilty of a misdemeanor. d SEC FORM SEEO REV 06/2009 State of Georgia Campaign Contribution Disclosure Report - Statewide Elected Executive Officier 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 2 and list any net balance on hand brought forward from the previous reporting cycle 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. /Gi Total amount of all itemized contributions received in this reporting period which are _ 3 listed on the "Itemized Contributions" page. 3a All loans received this reporting period. 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. 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. Total contributions reported this period. 5 (Line 3 + 3a + 3b + 3c + 3d + 4) 6 Total contributions to date. Total to be carried forward to next report of this reporting cycle*. l l (Line 2 + 5) EXPENDITURES MADE 2 ❑ I have no expenditures to report. 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 previous re ort. V'L 1 I 9 Total amount of all itemized expenditures made in this reporting period which are listed on the "Itemized Expenditures" page. 10 Total amount of all separate expenditures of less than $101.00 that were made r in this reporting eriod and not listed on the "Itemized Expenditures" page. �----" " I l Total expenditures reported this period. (Line 9 + 10 12 Total expenditures to date. Total to be carried forward to next report of this reporting cycle'`. (Line 8 + 11) INVESTMENTS 13 Total value of investments held at the beginning of this reporting period. Mme. =_ 14 Total value of investments held at the end of this reporting period. ----" 15 Net balance on hand.,: 2-22-33 (Line 6 - 12 + 14)'". * O.C.G.A. 21-5-34(b)(1)(D)(ii) A reporting cycle shall commence on January 1 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 tenn of office if such candidate is elected and does not seek reelection or election to some other office; (I1) On December 31 of the year in which such election was held if such candidate is unsuccessful; or (I 11) 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 fo some other office begins. Public Officer/Candidate/Other Than Candidate Committee Name M SEC FORM SEEO REV 06/2009 State of Georgia Campaign Contribution Disclosure Report - Statewide Elected Executive Officier Outstanding Indebtedness 4 a � ( 1 Outstanding indebtedness at the beginning of this reporting period. `316 Z 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) q 3p J v 'W Outstanding indebtedness at the beginning of this reporting period. 1 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. � (Line 1+2+3-4-5-6) 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 SE,E..O SEC EOIN1 CCOR REV 6/2009 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. C3 Mark if associated*with a regulated entity 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 stimated Value Description 2. 1. 2. Reference: OCGA § 21-5-34(b)(1) Loan Page Total $ Regulated Entity Page Total L Regulated Entity Total Itemiz Contribution Page Total $ Loan Re orting Name of Lender Mailing Address ate of Loan Amount of Loan Election Cycle*** Person(s) responsible for repayment of loan Mailing Address Occupation & Place of Employment Fiduciary Relationship**** f 1. 2. 1. 2. Reference: OCGA § 21-5-34(b)(1) Loan Page Total $ * Any person who may be employed by a regulated entity, including a person in whose name a license or lease is held, or who is an officer of a regulated entity 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-OffSpecial, Run -Off Special Primary) If any such persons shall have a fiduciary relationship to the lending institution or party making the dvance or extension of credit Public Officer/Candidate/Non-Candidate Committee Name Page of SEC FORM SEEO State of Georgia Campaign Contribution Disclosure Report - Statewide Elected Executive Officier Itemized Expenditures Must list expenditures made to a single recipient for which the aggregate total is X101.00 or more List Name and Mailing Address of Recipient Expenditure Date Expenditure Type* Occupation & Employer Expenditure Purpose Amount Paid $ f, $ $ �1. $ Page Total $ v * Expenditure Type (Expenditure, In -Kind, Loan Repayment, Refund, Reimbursement, Credit Card, 3rd Party, Deferred Payment, Payment on Deferred Expense, Investment) wry, Public Officer/Candidate/Other Than Candidate Committee Name 1 Page __� of - SEC FORM SEEO ne., rilnno State of Georgia Campaign Contribution Disclosure Report - Statewide Elected Executive Officier Investments Statement Account Number 1. Investment Name Institution/Person Value at beginning of reporting period $ Holding Account Mailing Address Value at end of reporting period $ Difference in value $ Interest Paid Ou City, State, Zip Cash Div' ends $ Investment Transactions Date Person(s) Involved in Transaction Value of investment purchased Value of investme.4 sold Profit Loss Account Number 2. Investment Name Institution/Person lue at beginning of reporting period $ Holding Account Value at end oI'reporting period $ Mailing Address Difference in value $ Interest Paid Out $ City, State, "Lip Cash Dividends $ Investment Transactions Date Persons) Involved in Transak&n Value of investment purchased Value of investment sold Profit Loss �A Total value of invest nts at beginning of reporting period $ Page Total Cash Dividends: Page Total Interest Paid Out: $ Total valu of investments at end of reporting period $ Page Total Profit: "Total difference in value $ Page Total Loss: Public Officer/Candidate/Other Than Candidate Committee Name WUAL Page of IN m SEC FORM SEEO REV 062009