HomeMy WebLinkAboutCCDR - 6/30/2009 - CCDR: Tina D'Aversa (3) (Migrated from Optiview)' SEC FORM CCDR SEEO
REV 06/2009
State of Georgia
Campaign Contribution Disclosure Report - Statewide Elected Executive
1. Report Type 2. Filing is being made on behalf of (Select One): Filing office use only
(Select One) Candidate or Public Official JUN 25
Office Sought or Held: 1 ',t C " ` / `1T IN
XOriginal Report (Include county, mun ci ality, district, post orjudicial circuit)
--�� N t;ITY CLE
Amended Report Committee Name: I a � a i
v Use Laudopohm
ru el A Mark or Hand
Amendment # Report of Organization or Person Other than Candidate's Campaign Committee
Delivered Date
3. Identifying
-and Contact Information
(1) 1 n,'C.- MCkr t% #.�J(��
Full Name of Candidate or Non -Candidate Campaign Committee
(3) ` 3 LW
% 4..''4 C_ f '►
Mailing Address
City
(2) (P a� •009
Today's Dat
State Zip Code
(4) L'1 fj'j$*7- 069n and / or ( ) -
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 re rts9. ❑ Yes IdNo (6) If so, is the committee registered with the State Ethics Commission? ❑ Yes ❑No
(7) If so, complete the following: d
Name of Chairperson and / or Treasurer of Committee
4. Period for which you are Reporting
You Must Check Only 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, (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 intoned,
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
t
State of C L b: e, 1 0.. County of Q r"
I_ t5 f\ c- t
N 1f Q, r A 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_"
e,(.0
6Sig"ofry Pu#&NETTE R MARCHIAFAKiA
Notary Public, Fulton Co., GA
My Commission Expires August 29, 2009
My Commission expires
- ""/)1
a. Signa re of Candi a
b. Organization/Chairperson/Treasurer
(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 misdemeanor. I
SF.F.O
SEC FORM CCDR
ICC V U/GUU•l
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.
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
Estimated Value
Description
C3 01cle.
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1.
foo. clip
2.
❑
'd
Reference: OCGA § 21-5-34(b)(1) Loan Page Total $
500, a0
Adv f-4,1 S tit
❑ � � +ro, rQ� M.r l C -L -S
Regulated Entity Page Total $ Itemized Contribution Page Total $ $ b e D
Regulated Entity 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****
✓,_
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1.
2.
'd
Reference: OCGA § 21-5-34(b)(1) Loan Page Total $
* Any person who may be employed by a regulated entity, including a person 'n whose name a license or lease is held, or who is an officer oit a regulated entity
,owr .. * * Contribution Type (Monetary, In -Kind, Common Source, Credit Received Loa p�
* * * Election Cycle (Primary, General, Special, Special Primary, Run -Off Prim A n -Off General, Run -Off Special, Run -Off Special Primary)
* * * * If any such persons shall have a fiduciary relationship to the lending instit n or party making the advance or extension of credit
Public Officer/Candidate/Non-Candidate Committee Name Page Aa of
• SEC FORMSEEO
RFV n6/2009
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
k 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
Q
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
d
C. If this filing is the second or subsequent filing of this Reporting Com, list totals
from Line 6 of previous report in both the in-kind and cash amount columns.
Total amount of all itemized contributions received in this reporting period which are
3
listed on the "Itemized Contributions" page.
1
3a
All loans received this reporting period.
00 0
3b
Interest earned on campaign account this reporting period.
—0
3c
Total amount of investments sold this reporting period.
.
_ zi
3d
Total amount of cash dividends and interest paid out this reporting period.
y
0
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.
1
Total contributions reported this period.
5
(Line 3+3a+3b+3c+3d+4)
1°
Total contributions to date. Total to be carried forward to next report of this reporting cycle*.
6
(Line 2 + 5)
t
"'
EXPENDITURES MADE
7
F -1I 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.
Y;0
B. Second or subsequent filing ENTER Line 12 of previoqLLeTort.
a
9
Total amount of all itemized expenditures made in this reporting period which are
C�
listed on the "Itemized Expenditures" page.
Jl'
10
Total amount of all separate expenditures of less than $101.00 that were made
in this reporting eriod and not listed on the "Itemized Expenditures" page.
11
Total expenditures reported this period.
�� 0 O ' 0 o
(Line 9+ 10)
12
Total expenditures to date. Total to be carried forward to next report of this reporting cycler.
(Line 8 + 11)
INVESTMENTS
13
Total value of investments held at the beginning of this reporting period.
z
14
Total value of investments held at the end of this reporting period.
�-
15
Net balance on hand.
p
(Line 6 - 12 + 14)
* O.C.G.A. 21-5-34(b)(1)(13)(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 tern 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
(111) 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
M
SEC FORM SEEO
State of Georgia
Campaign Contribution Disclosure Report - Statewide Elected Executive Officier
Outstanding Indebtedness
� k
e
N Y
I MIX'
I Outstanding indebtedness at the beginning of this reporting period.
4®�
2
Loans received this reporting period.
o 0 4 • ®�
3
Deferred payment of expenses this reporting period
.W. a
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.
�t
(Line 1+2+3-4-5-6)
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.
7
(Line 1+ 2+ 3 4 5 6)
ng t',
I'M WWl
A
.:�IMA'�' ,.iii .:' i. n$
s aEL
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,
pwww+. Run -Off Special Primary)
Public Officer/Candidate/Other Than Candidate Committee Name
SEC FORM SEED
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 $101.00 or more
List Name and Mailing Address
of Recipient
Expenditure Date
Expenditure Type*
Occupation &
Employer
Expenditure Purpose
Amount Paid
$ V• f) C)
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o
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0� �n
[9 Al
� 190 r a
D
Page Total s. 9 6 0, %} D
* 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 I of
SEC PORYf SEEO
State of Georgia
Campaign Contribution Disclosure Report - Statewide Elected Executive Officier
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 oI'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 sot d
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'l'han Candidate Committee Name Page --J— of