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Home My WebLink AboutCCDR - 10/25/2009 - CCDR: Tina D'Aversa (6) (Migrated from Optiview)SFC FORM CCDR SEEO REV 06/20119 Campaign vow 1. Report Type (Select One) Original Report Amended Report mow' _. State of Georgia Flhuhj) Contribution Disclosure Report - Statewide Elected Executive Officer 2. Filing is being made on behalf of (Select One): Candidate or Public Official Office Sought or Held: C , i I"� r I ��y� �',', J ^ ' I' ✓� (Include coup , municipality, district, post or judicial circuit) Committee Name: Amendment # I Report of Organization or Person Other than Candidate's Campaign Committee 3. Identifying and Contact Information rr\\q r s, (2) Full Name of Candidate or Non -Candidate Campaign Committee (3) I3S�� LJCry C��r�.�e �� I' ern Mailing Address City Zip Code (4) (b?�i yS�� _ (o.t� and/or ( ) - Contact Phone Number (We will understand the release of this information as permission to cal/your office if necessary) lYli�ot�'jce 1�IY ;rTY Rli 'iIOF TOM 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 ONo (6) If so, is the committee registered with the State Ethics Commission? ❑ Yes ❑No (7) If so, complete the following: 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 incurred, until such funds ere expended, or such unpaid December 31, (year) Run -Off, (year) Idebts are satisfied (December 31 filing only Verification by Oath or Affirmation State off -r-9t 0�_, County of u n f\ 1 1 I, (1 G�� } (! t'j being duly sworn (affirm), depose and say that the information in this report form is complete, true, and correct. Further, I affirm that thec tents in this report are the same 3S the contents in the electronic filing submitted, if also electronically filed. Sworn to and subscribed before me on 2064 Sigi tura of Notary Public a. JEANET66TE��.�R,, ,MpA''�.IIAFAVA b fY1NNt My Commission expires rah 1A7. Gf who I of the Ethics in Government Act shall be guilty of a misdemeanor. . SEC FORM SEEO RFV nRrznba 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 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 p 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. pbE , G ts Q 3a All loans received this reporting period. P gP 3b Interest earned on campaign account this reporting period. IT 3c Total amount of investments sold this reporting period. �aF 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. 5 Total contributions reported this period. j� Q (Line 3 + 3a + 3b + 3c + 3d + 4) 6 "gtal contributions to date. Total to be carried forward to next report of this reporting cycle *. (Line2+� EXPENDITURES MADE 1 S, a 7 ❑ 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. j' `( B. Second or subsequent filing ENTER Line 12 of previous report. 3rb d r Total amount of all itemized expenditures made in this reporting period which are 9 listed on the "Itemized Expenditures" page. 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. s Q Line 9 + 10 j 12 Total expenditures to date. Total to be carriedforward to next report ofthis reporting cyclet (Line 8 + 11) C; INVESTMENTS 13 Total value of investments held at the beginning of this reporting period.,cK ..'., 14 Total value of investments held at the end of this reporting period. 15 Net balance on hand. (Line 6-12+14 �' �i�/i...rk�"��'�'`��a>. * O.C.G.A. 21-5-34(b)(1)(D)(ii) A reporting cycle shall commence on January I ofthe 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 term of office if such candidate is elected and does not seek reelection or election to some other office; (11) 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 r rting cycle shat d In the rep ngng cy�tio r for some other office begins. � ' i Public Officer/Candidate/Other Than Candidate Committee Name I � C_ (ji I b C\r" SEC FORM SEUO RFV 06/2M)9 State of Georgia Campaign Contribution Disclosure Report - Statewide Elected Executive Officier Itemized Expenditures Must list expenditures made to a single recipient for which th aggregate total is $101.00 or more List Name and Mailing Address of Recipient Expenditure Date Expenditure Type* Occupation & Employer Expenditure Purpose Amount Paid 1+G -.ii' Soo "L Pr, n, C.r i4 pG1Cj i r, Y\ S CS h. �. b /1 s4%1 l\T I 6 ri ! M `� ► �. r t 1 5��. i✓ t C_1�1 lZ b �JV ss W6rs�a��v� p (� $ �o aQ tQ G , J S -Ttn L 4 tl,s'y PCUS-f,�,— 36�, d _, irk, I e -(,_j flrcl 3a c� Fi V Jr, �> S CLUJ--4-� Cr4-t— r $ V b (/ at.ca, j $ Page Total b S a * Expenditure Type (Expenditure, In -Kind, Loan Repayment, 7und, Rei sement, Credit Card, 3rd Party, Deferred Payment, Payment on Deferred Expense, Investment) i 1 Public Officer/Candidate/Other Than Candidate Committee Name Page of _ N SE,E..O SEC FORM CCUR 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. ® 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 1 S4- CC_U1a 1a I of p I I. lr_/yV�I('(1(j/l � 1 y 1'�. t. l N { 1� �i kQ- t-- Reference: OCGA § 21-5-34(b)(1) Loan Page Total t 1 ❑ A -"j A .o r nil—�o �:3 ��' < , ❑ 01)1Z_ e)1 Id �Q �� 0 1 SOO, r,clt Regulated Entity Page Total Regulated Entity Total Itemized Contribution Page Total $A �,�� $ 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**** I . 2. C. I vL 13St lujGc Y J+ ,MJ 1+°1"16A 3 �L 4ce- fi t�tiJ I. lr_/yV�I('(1(j/l 1� 2. �. r 0v N) t-- 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 tease is held, or who is an officer of a regulated entity ** Contribution Type (Monetary, In -Kind, Common Source, Credit Received on Loan) 4 *** Election Cycle (Primary, General, Special, Special Primary, Run -Off Primary, R-Oft'General, Run -0 � pecial, Run -Off Special Primary) **** If any such persons shall have a fiduciary relationship to the lending institute or making the ante or extension of credit Public Officer/Candidate/Non-Candidate Committee Name 1 )lit U4 Page of 23 -Oct -09 Tina D'Aversa Re-election Campaign Fund L.D. Willis and Marilyn Willis $ 50.00 Neil Chambers $ 100.00 Theodore and Janice Cox $ 100.00 Darby Jordan $ 50.00 Steven Colitz $ 50.00 RLP Corporation $ 250.00 Delta Information Systems $ 200.00 Herschel Becker $ 100.00 Kiran Athota $ 50.00 Rajesh Jampala $ 75.00 Murthy Rallapalli $ 200.00 Jeff Anton $ 50.00 Clyde Burt Hewitt IV $ 250.00 Paul English $ 100.00 James Cregge $ 50.00 Machinery International Inc. $ 1,000.00 Carl Mays $ 10.00 $ 2,685.00 • $EC FORM SEEO REV 06/2009 M State of Georgia Campaign Contribution Disclosure Report - Statewide Elected Executive Officier Outstanding Indebtedness 1 Outstanding indebtedness at the beginjing 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 1Credits 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) 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 lCredits 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) 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 ICredits 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 Cycle (Primary, General, Special, Special Primary, Run -Off Primary, Run -Off General, Run -Off Special, Run -Off Special Primary) agrr► � 1p Public Officer/Candidate/Other Than Candidate Committee Name ' ✓ f IN st:C rgxM sEEO ne., Annno 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 $ L 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, Gip 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 I.,oss 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 Of icer/Candidate/Other Than Candidate Committee Name 1 �L k of l� l.r age v -� m