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Home My WebLink AboutCCDR - 9/30/2009 - CCDR: Tina D'Aversa (4) (Migrated from Optiview)SEC FOR4CCDR REV 03/2008 RECEIVED State of Georgia OCT .. g Camnaim Contribution Disclosure Report 1. Report Type 2. Filing is being made on behalf of (Select One): (Select one) Candidate or Public Official Office Sought or Held: City of Milton, Fulton County, Georgia District 5 Q Original Report Amended Report I Committee Name: (Include county, municipality, district, post orjudieial circuit) Amendment # I ❑ Report of Organization or Person Other than Candidate's Campaign Committee 3. Identifying and Contact Information (1) Tina D'Aversa (2) 9/30/2009 Full Name of Candidate or Other Than Candidate Campaign Committee Today's Date (3) 13568 Weycroft Circle Milton GA 30004 Mailing Address City State Zip Code (4) 6784)67067-7 and / or ( ) - Contact Phone Number (We will understand the release of this information as permission to call your office if necessary) Use Earlier of Post Mark or Hand Delivered Date (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 Z (6) If so, is the committee registered with the State Ethics Commission? ❑ Yes ❑ (7) If so, complete the following: 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) E:]6 days before Primary Ej 15 days before Run -Off, (year) Special Primary, Dec. 31, (year) June 30, (year) Ej6 days before General (year) Run -Off, (year) -Persons elected to office in each year following Q September 30, 2009 (year) 06 days before Special E115 days before the year in which the election occurs Primary Run -Off, Special, (year) "Persons leaving office with excess funds until such fonds are expended as provided in the Act October 25, (year) (year) •Unsuccessful candidates with excess funds, or E]6 days before Special 0 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 CLI&County of '�+) I, s. V C S being duly sworn (affirm), depose and say that the information in this report form is complete, true, and correct. Further, I affirm tjaAtecontents in this report are the same as the contents in the electronic filing submitted, if also electronically file.\ Sworn to and subscribed before me on S 20_% c Sign re of Notary Public MEi�RMAPOWAVA """'+ y Commission expires ' C& a. Sigdature of Candidate - b. Organization/Chairperson/Treasurer of the provisions of the Ethics in Government Act shall be guilty of a misdemeanor. SEC FOR14 CCDR REV 032008 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 Corey Koploff Ace4 Color Printing 9/15/2009 Printing Signs and Magnets for Campaign $ 1100.00 Check/Cash 360 True, LLC 5/2009 Web site work Online Service $ 500.00 $500.00 Cash Cade Thacker 5/2009 Technical Support Technical Support $ 280.00 Check/Cash Constant Contact 1/2009-9/2009 Online Email Service Email Service $180.00 Cash Debbie Russell 9/15/2009 Catering Catering $ 640.00 Cash/Check Barter for Less 9/15/2009 Printing Signs and Magnets $1200.00 Cash Cl 3t��Z9 C A, =rej0- s c.,4 $ Page Total a lr� mom.. * Expenditure Type (Expenditure, In -Kind, Loan Repayment, Refund, Reimbursement, Credit Card, 3rd Party, Deferred Payment, Payment on Deferred Expense, Investment) �`��' lI Public Officer/Candidate/Other Than Candidate Committee Name Paae. I of 1. I desire that my name appear on the ballot as follows: °ter (Please Print) 2. (a) I am running in a special election for a partisan office and my party affiliation is (b) I am running as a nonpartisan candidate X]. (c) I am running as an independent candidate [ ]. (d) I am the nominee of the Party (Body) nominated by: [ ] Convention (Certified copy of the minutes of the convention attested by the Chairman and Secretary of the convention is being filed herewith); [ ] Other (Specify method of nomination an statute and party rule governing and allowing such method of nomination): 3. (a) [ ] I am required to file the above Notice followed by a nomination petition containing at least. +* valid signatures due (b) [ ] I am not required to submit a nomination petition, because I am: [ ] Specify [Code § 21-2-132]: 4. (a) [ ] I hereby tender cash/check in the amount of $ / NAME OF BANK: t.1 c, L 6 V? r -- CHECK NUMBER: 1 q 4 a (b) [ ] I hereby file a Pauper's Affidavit, accompanied by a qualifying petition as prescribed in O.C.G.A. Sec. 21-2-132 (g), in lieu of paying the qualifying fee. NOTE: CANDIDATES FOR THE FOLLOWING OFFICES MUST FILE AN ADDITIONAL AFFIDAVIT IN ACCORDANCE WITH THE LISTED CODE SECTION AND MAY HAVE OTHER REQUIREMENTS IN ORDER TO BE QUALIFIED TO SEEK OFFICE. CANDIDATES SHOULD REVIEW THE QUALIFICATIONS FOR THE OFFICE FOR WHICH THEY OFFER FOR ELECTION CAREFULLY. CLERK OF SUPERIOR COURT JUDGE OF THE PROBATE COURT SHERIFF CORONER TAX RECEIVER TAX COLLECTOR TAX COMMISSIONER N O.C.G.A. § 15-6-50(b)(2) O.C.G.A. § 15-9-2(a)(2) O.C.G.A. § 15-16-1(c)(2) O.C.G.A. § 45-16-1(b)(2) O.C.G.A. § 48-5-210(b)(2) O.C.G.A.§ 48-5-210(b)(2) O.C.G.A.§ 48-5-210(b)(2) TO: Sup' erintende t of Elections + 1 V J�� of lv County/Municipality State of Georgia :.�.. SEP -1 NOTICE OF CANDIDACY AND AFFIDAVITT (COUNTY/MUNICIPALITY) CM OF MN M t I, the undersigned, being first duly sworn on oath, do depose and say: that my name is � +tip that my residence address is \3 51, % kl') !:,:J L r , � r CAA (Street Number) (Street) rte`,\ke,.- Fv\fie C- !2411 300oy (City) (County) (State) 0 (Zip Code) that my post office address is that my telephone number is �D'A — S1 — O (Business) (Home) that my profession, business, or occupation (if any) is ¢ N cAlc, c �rd� `\tee �f\S'I C cV% r that the name of my precinct is V— o v r r. \� o a A S ; that I am an elector of the county/municipality of my residence eligible to vote in theelectionin vAich I am `a candidate; that the name of the office I am seeking is \ T o C w nC 1 ,LTtlt my date of birth is �\ \3 \°`�, ; that I have been a legal resident (Furnish Circuit, District, or Post ifApplicable) t ie State of Georgia for a0 ears; that I have been a legal resident of VU \k—o f\ county for 13 years; that I have been a legal resident of my district (if applicable) for 3 • of years; that I have been a legal resident of my circuit (if applicable) for N a years; that I am a citizen of the United States; that I am eligible to hold such office; that I am a candidate for such office in the Q C' ► tY.gc- to be held on the `� ��r� day of b\/ %,rLs 20 0 1 ; (Election) that I have never been convicted and sentenced in any court of competent jurisdiction for fraudulent violation of primary or election laws, malfeasance in office, or felony involving moral turpitude or conviction of domestic violence under the laws of this State, any other State, or of the United States, or, if so convicted that my civil rights have been restored; and at least ten years have elapsed from the date of completion of the sentence without subsequent conviction of another felony involving moral turpitude; and that I am not a defaulter for any federal, state, county, municipal, or school system taxes required of such officeholder or candidate if such person has been finally adjudicated by a court of competent jurisdiction to owe those taxes, but such ineligibility may be removed at any time by full payment thereof, or by making payments to the tax authority pursuant to a payment plan, or under such other conditions as the General Assembly may provide by general law (pursuant to Ga. Const. Art. II, Sec. II, paragraph III), and that I will not knowingly violate any provisions of the Georgia Election Code (O.C.G.A. Ch. 21-2) or of the rules or regulations adopted thereunder. I understand that any false statement knowingly made by me in this Notice of Candidacy and Affidavit will subject me to criminal penalties as provided by law and I hereby request you to cause my name to be placed on the ball s to be used in such election as a candidate for the office I am seeking. w� (Sig a re of Candidate) IvaW Sworn to and subscribed before me this I r t (Notary Public) JEAKMRWW4fiiG#ARIWI Commission Expires_ h"hftA"CL GA (Required by Ga. Election Code, Sec. 21-2-132.) day of :S 200q Form-NC-C&M-05 (over) 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 Contributor 5/2009 �' Candidate 13568 Weycroft Circle Milton, GA 30004 In -Kind Contributions Received Date Occupation & Estimated Value Mailing Address Election Cash (Affiliation of Committee if any) Contribution Type* Employer Cycle** Amount Description Olde Blind Dog Ron Wallace 6/16/2009 Restaurant Primary $0 $500.00 In -Kind Food Beacon Newspaper 6/14/2009 Newspaper Primary $500.00 John Fredericks In -Kind $0 Advertsiement Roger and Anna Festa 9/15/2009 Friend, Real Estate and Gas Services Primary $500.00 $500.00 Cash Check Curtis Mills 9/15/2009 Friend, Consulting Services Primary $250.00 $250.00 Check See attached for list of smaller contributions less than $250 this period. ��\\ 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*** Tina D'Aversa 13568 Weycroft Circle Milton, GA 30004 5/2009 �' Candidate 13568 Weycroft Circle Milton, GA 30004 Candidate, teacher $1000.00 2. 3�D,po 2. Cat..—Patq� Reference: OCGA § 21-5-34(b)(1) Loan Page Total $ t,000.00 * Contribution Type (Monetary, In -Kind, Common Solace, Credit Received on Loan) ,w■. * * 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 SEC FORM CCDR Q— znnnsu State of Georgia Campaign Contribution Disclosure Report Investments Statement 1. Investment Name 0 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 NamePage I of SEC FORIdCCM REV O32OOR Campaign Contributions June 1, 2009 - September 30, 2009 City of Milt. Rob Hassett 1759 Wilder Court Dunwoody, GA 3033f 200.00 �,„ Rebecca Croucher 135 Watermill Falls Milton, GA 30004 150.00 Nancy and James Webb 100.00 Denise Meyer 100.00 Tara Chambers 830 Barberry Drive Milton, GA 30004 50.00 Alfred Soldavini 15395 Thompson Road Milton, GA 30004 50.00 Erin Hannaford 13591 Weycroft Circle Milton, GA 30004 40.00 Alex Lim 13565 Weycroft Circle Milton, GA 30004 100.00 Lance Large 250.00 Jim Cregge 50.00 Roger Festa 340 Champion Hills Drive Milton, GA 30004 500.00 Curtis Mills 16355 Birmingham Highway Milton, GA 30004 250.00 Lisa Cauley 500.00 R.L. Ridgeway 14295 Thompson Road Milton, GA 30004 25.00 Todd Ashley 1225 Whiltshire Drive Milton, GA 30004 250.00 Donald and Joan Borzilleri 540 Kings County Court Milton, GA 30004 25.00 Kevin and Lisa Fazzari 225 Champions Fairway Court Milton, GA 30004 25.00 Rose Presrianni and Thomas Kul 305 Providence Oaks Point Milton, GA 30004 75.00 2,740.00