HomeMy WebLinkAboutCCDR - 12/31/2009 - CCDR: Tina D'Aversa (Migrated from Optiview)SEC FORM CCDR D
REV 03/2008 _
State of Georgia -
Campaign Contribution Disclosure Report Or
1. Report Type 2. Filing is being made on behalf of (Select One): Filing office use only
(Select One) Candidate or Public Official ) ] I
Office Sought or Held: o I vnr t
Original Report (Include count , mcunicipLLality, district, postQrjudici I circuit)
Committee Name: r
(�v1T� /, � avtnTy t ��.�rr�s (ti
Amended Report Use Earlier of Post
F-1 Report of Organization or Person Other than Candidate's Campaign Committee Mark or Hand
Amendment # Delivered Date
3. Identifying and Contact Information
Full Name of Candidate or Other Than Candidate Campaign Committee
(3) 13 S L % 1..�_°.�t ��y -� �- C( rd @
Mailing Address City State
N
(2) 1%I
Todaa.y s ate
-(�,'r,
Zip Code
(4) L17) 4:5 1 - b b'1'l and / or ( ) -
Contact Phone Number (We will understand the release 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 (6) If so, is the committee registered with the State Ethics Commission? E]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)
El June 30, (year)
March 31, (year)
FJ6 days before Primary
Ej 15 days before
Run -Off, (year)
Special Primary,
Dec. 31, (year)
June 30, (year)
F-16 days before General
(year)
Run -Off, (year)
*Persons elected to office in each year following
E] September 30, (year)
[__16 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
F-1 October 25, (year)
(year)
*Unsuccessful candidates with excess funds, or
E]6 days before Special
Dec. 31, (year)
who receive contributions to retire debt incurred,
until such funds are expended, or such unpaidru
December 31, P (year)
rj
Run -Off, (year)
debts are satisfied (December 31 filing only)
Verification by Oath or Affirmation
L � } County of
State of � r >< c..., h'
1, )� a )A.V C., r3-Abeing 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 20jay
g ureryublic ���� a. Ignature of Candidate
b. Organization/Chairperson/Treasurer
WWI
My Commission expiresd
Any person who knowingly fails to comply with or who k� ntviolates any of the provisions of the Ethics in Government Act shall be guilty of a misdemeanor.
14
e
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
IZ 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 Com, list totals
from Line 6 of previous report in both the in-kind and cash amount columns.
O
Total amount of all itemized contributions received in this reporting period which are
o 1 S - �`'
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)
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 -Kind
Cash Amount
ER 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.
�f?V
Total amount of all itemized expenditures made in this reporting period which are
9
listed on the "Itemized Expenditures" page.
1 .110
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.
Total expenditures reported this period.
l l
Line 9 + 10
Total expenditures to date. Total to be carried forward to next report of this reporting cycle`.
12
Line 8 + 11)
ri C1
INVESTMENTS
13
Total value of investments held at the beginning of this reporting period.
14
Total value of investments held at the end of this reporting period.
1
15
Net balance on hand.
Line 6 - 12+14)
1 tic.lu�;r.
11,
W
* 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
sso%, conclude:
4 (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;
%*MO'' (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 reporting cycle shall end when the reporting cycle for reelection or for some other office
begins.
Public Officer/Candidate/Other Than Candidate Committee Name
%V,44 1 J C, t.J; , q 3
r S
2 bf
SEC FORA CCDR
State of Georgia
Campaign Contribution Disclosure Report
Outstanding Indebtedness
Owl
�...
Outstanding indebtedness at the beginning of this reporting period.
1
2
Loans received this reporting period. t3 b . so
o n c ll
3
Deferred payment of expenses this reporting period 4levi v vs
4
Payments made on loans this reporting period. 3, b o s. b o
0 o
0 ` ` `,r
5
Credits received on loans this reporting period.
6,
o
6
Payments this reporting period on previously deferred expenses.
6. b
2
Total indebtedness at the close of this reporting period.
(Line I+2+3-4-5- )
4e0.10
leem
�
a
�1 ess at the being period.2
porting 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)
E'lttip#
A 19 i a!f' 3 dj.,k t� "hFe
�M+ �� r��
�� s
.
Amou>tt
---�—
:
1
Outstanding indebtedness at the beginning of this r rting 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.
17
(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)
3 e
Public Officer/Candidate/Other Than Candidate Committee Name
N
sec FORM CCnR
REV 1!2008
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
Imo1.
�4�iN
2.
1h pa.0o
II
;'%, Js ,.
31 d oa.1,
n"I k,
�p 0
Reference: OCGA 21-5-34(b)(1) Loan Page Total $ 0
Jj
o
J b12 1 41
C 1 T" Llan, S
0,
n -k1.
)t7 r
Itemized Contributions Page Total $ $b0.O0 $ t 00. 00
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***
/ /S v
2.
1h pa.0o
II
;'%, Js ,.
31 d oa.1,
2.
�p 0
Reference: OCGA 21-5-34(b)(1) Loan Page Total $ 0
�0 4i'
* Contribution Type (Monetary, In -Kind, Common Source, Credit Received on Loan) it %,n j
** Election Cycle (Primary, General, Special, Special Primary, Rtm-Off Primary, Run -Off General, Rum -Off Special, Run -Off
At 4.
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 3 of
on
SEC FORMtCCDR
REV 03r2UU6
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
CfAI ;ti' o ,5
10 31
o97
I,
1: L _ r <
10
a
PIC, 517pv
r
c f
'
f! J
Page Total $ 13 U
* 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
SFC FORM CCDR
_. ¢tonna
State of Georgia
Campaign Contribution Disclosure Report
Investments Statement
1. Investment Name
CA
Account Number
Institution/Person
Holding Account
Mailing Address
City, State, Zip
O
{-
Value at beginning of reporting period $
Value at end of reporting period $
Difference in value $
Interest Paid Out $
Cash Dividends $
Investment Transactions
Date
Persons
Involved in TrAgaction
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 o investment sold
Profit
Loss
Total value of investments at be inning 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
M
M
SEC FORM CCDR
State of Georgia
Campaign Contribution Disclosure Report
Addendum Statement
The Addendum Statement should be used for explanation of any additional information needed to complete an accurate filing of this report.
Public Officer/Candidate/Other Than Candidate Committee Name Page 07 of