Maxwell,_Eric_10_31_16_CCDR_CCDR_10252016_f073fc87c9f54794bdad2fbb1aaa7e1b.pdf

Page 1 of 10 4/ 14 CFC-CCDR 1/14 Campaign Contribution Disclosure Report Georgia Government Transparency and Campaign Finance Commission 200 Piedmont Ave nue S.E. I Suite 1402 West Tower I Atlanta, GA 30334 1404-463- 1980 I www.ethics.ga.gov 1. Report Type Use Earlier of Post Mark or Hand Delivered (Select One) ~ina Date I 0 Amendment rga niza tion or l>erso n Other than Ca ndidate 's C ampaig n Co mmittee Committee Name: OCT 1 ~ 16 PH 4:25 ~~------~ -------------------------- Amendment # _ __ Filer ID: (Filer ID that begins with the letter "NC..) . Identifying and Contact Information o) l~ \ ) \ E"'- \<.. \'"<'\ ~Vft._\\ (2)'\0 \o Today:S Date Full Name of Candidate or ~~1er Thf\n Candidate Campaign Committee (3) -z.-z.~- A Suv~ b.\.\"'-1\ S\. ~"'\R~\ ' C:!A City Mailing Address (4) _ _ _ _ _ _ _ _ __ _ __ _ _ __ Primary Contact Phone Number 30L.\% State i p Code and/ or _________________________________ E-Mail (5) If a Candidate or Public Official is there a campaign committee (one or more persg)l5} to make campaign transactions, keep 0 Yes ~o financial records of the campa ign or fil e the reports? (6) lfyes, is the commi ttee registered with the Commi ssion? 0 Yes 0 No (7) If yes, complete the following: - - - - - - - - - - - - - - + - - - - - , - - - - - - - - - - Name of Committee Chailperson Name of Committee Treasurer 4. Period for which you are Reporting You Must Check Onl One Box My Non Election Year 0 January 31, _ _ (year) 0 June 30, _ _ (year) My Election Year 0 0 0 January 31, _ _ (year) Run-Offs (Report required only if you are in a Run-Off Election) 0 6 days before Primary Run-Off _ _ (year) 0 6 days before General Run-Off _ _ (year) I----:S::-u-p-p-:-l-em-en-t,....a71-:::: R:-e-p-o-rt...,.in_g__ June 30, _ _ _ (year) 0 6 days before Special 0 June 30, (year) 0 September 30, _ _ (year) Primary Run-Off ___(year) 0 6 days before Special 0 December 31, _ _ (year) ~October 25, '2..0\ll(year) Run-Off _ _ (year) •Persons leaving office with excess funds unt il 0 Dec. 3 1, _ _ (year) such funds are expended as provided in the Act March 3 1, _ _ (year) Special Election 0 15 days before Special Primary, _ _ (year) 0 15 days before Special, _ _ _ (year) 0 Dec. 3l , _ _ (year) •unsuccessful candidates with excess funds, or who receive contributions to retire debt incurred, unt il such funds are expended, or such unpaid debts are satisfied (December 31 filin on) Page -L of 12_ Page 2 of 10 CFC CCDR 1/1 4 State of Georgia Campaign Contribution Disclosure Report Summary Report CONTRIBUTIONS RECEIVED ~ave no contributions to report. I 2 3 3a ' I have the following contributions, including Common Source, to report: 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. lfthis is the first report of this Election Cycle*, ENTER 0 in the in-kind column and list any net balance on hand brought forward from the previous election cycle in the cash amount colum n (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 Election Cyc le, 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 is listed on the "Itemized Contributions" page. All loans received this reporting period. In-Kind Estimated Value Interest earned on campaign account this reporting period. 3c Total amount of investments so ld this reporting period. 3d Total amount of cash dividends and interest paid out this reporting period. 4 Total amount of all separate contributions of $100 or less received in this reporti ng period and not li sted on the "itemized Contributions" page. "Common Source" contributions must be aggregated on the "Itemized Contributions" page. Total contributions reported this period. (Line 3 + 3a + 3b + 3c + 3d + 4) Total contributions to date. Total to be carried forward to next report of this election cycle* . (Line 2 + 5) 5 6 ,.; I ··:"' :., 3b \ t:>. q.;;-{pq~ 'D c) ·;~ Cash Amount oO 3.SlX>· : 0 ··:·'· ..:.i.; &t~.~~~:M2·~.~·-.:- 0 0 ~)-~~~it::·"':~:: .' ; ., :.• ,. .. 0 ··:·..:: '· .:r:/? 5DoD 0 0 0 \~ ~ .'\'\ 0 \. EXPENDITURES MADE ~ have no expenditures to report. 7 8 9 10 11 12 · I have the following expenditures to report: Total expenditures made and reported prior to this reporting period. If thi s is the A. First report of this Election Cycle*, ENTER 0. B. Second or subsequent filing ENTER Line 12 of previous report. Total amount of all itemized expenditures made in this reporting period which are listed on the "Itemized Expenditures" page. Total amount of all separate expenditures of $100.00 or less that were made in this reporting period and not listed on the "itemized Expend itures" page Total expenditures reported this period. (Line 9 + 10) Total expenditures to date. Total to be carried forward to next report of this election cycle*. (LineS+ II ) 0 0 ...... \ 0 , \ \.oO t:;O z l.oO~ D C) 0 '2..6 ()f0~'6 c) \ "2. ~ loq~~ 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. TOTAL NET BALANCE ON HAND 15 Net balance on hand. (Line 6- 12 + 14) >l~r~~;K·~--~;\i;: ,~6:1:-·'t.: _;>. tj,.:. .'~~l 0 0 ••• 0 \ ~ ~~- ab • O.C.G.A. 2 1-5-3( 10) : ElectiOn cycle means the pen od from the day followmg the date of an elect1on or appomtm ent of a person to elect1ve pubhc office through a nd of the next such election of a person to the sam e public offi ce and shall be construed and applied separately for each elective o ffi ce including the date. Public Officer/Candidate/Other Than Candidate Comm ittee Name Page Z.. of ~ Page 3 of 10 CFC CCDR 1/14 State of Georgia Campaign Contribution Disclosure Report Outstanding lndebtness Election Year: '"2.()\lr, Election Cycle*: b-.1\.Q~ '2.~c...-t.,·.~ Amount 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. 0 5 Credits 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 Year: Election Cycle*: 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 rep01ting period. 5 Credits 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*: Election Year: 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 previo usly deferred expenses . 7 Total indebtedness at the close ofthis reporting period. (Line I + 2 + 3 - 4 - 5 - 6) () 0 0 C) u Amount Amount • 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 Public Officer/Candidate/Other Than Candidate Committee Name --~\:;..;=-=-n_<--=-_.:.\:::__ V\__:_'Z...=~~~=-=---:\-'-\____ Page :3_ of S Page 4 of 10 CFC CCDR 1/1 4 State of Georgia Campaign Contribution Disclosure Report Itemized Contributions Must list contributions received by a single contributor for which the aggregate total more than $100.00 . Note: Loans are no longer reported in "Itemized Contributions" section. See Loan Reporting section below. In-Kind Full Name of Contributor Contributor Election Cash Mailing Address Cycle** Amount Contributions (Affiliation of Committee if any) Estimated Value Received Date Occupation & Contribution Type* Employer Description First Name or Busi ness Name Date \.::..tl c.- \'-'\ t.X w--t\\ \ol ' el \\.t Last Name ~ci~·~-L ·zz.s-~ ~ ~\""""S\. \ Address \==""~\ ~"'\\. bf\- 3o"L\<\Address2 0 Monetary City 0 ln-Kind State I Cash Amt. Occupation Employer 0Primary !ik(eneral O special 0 Special Primary 0 Run-Off Primary 0 Run-Off General 0 Run-Off Special 0 Run-Off Special Primary Est. Value ~on Description 0 Common Source Zip 0 Credit Received on Loan Aff. Comm. First Name or Business Name Date "E.nc... \""\t:x ~\ Last Name -u_~-~ S-l. ll"'l"f\i\1 \ 0 12-4\-l \\p b~~~ \ Address ~'2...1 c1~v\\ J,,A-3lJL\<t Addre~s2 0 Monetary State Employer 0 In-Kind City I Cash Amt. Occ upation ~ary Est. Value l~ eneral O special 0 Special Primary 0 Run-Off Primary 0 Run-Off General 0 Run-Off Special 0 Run-Off Special Prim ary Description 0 Common Source Zip 0 Credit Received on Loan Aff. Comm. First Name or Business Name Date Last Name Address Address2 pMonetary Employer 0 Primary 0 General O spec ial 0 Special Primary 0 Run-Off Primary 0 Run-O ff General 0 Run-Off Special 0 Run-O ff Special Primary Est. Value Description Oln-Kind City State Cash Amt. Occupation I Zip 0 Common Source 0 Credit Received on Loan Aff. Comm . Itemized Contributions Page Total $ 3..~ Public Officer/Candidate/Other Than Candidate Committee Name 1-l":\c. '(:__ ~ \ 7'1t' \. ~\\ $ Page ~of~ Page 6 of 10 CFC-CCDR i/i4 Loan Reporting Name of Lender & Mailing Address Lender Name (First Name, Business, lnst.) I.Date of Loan 2.Amount of Loan 3.Eiection Cycle** 1. Person(s) responsible for repayment of loan & Mailing Address First Name ! .Occupation & 2.Place of Employment 3.Fiduciary Relationship* ** I. 2. Last Name 2. 3. Address 3. () Lender Last Name Address Address2 City State I Zip Lender Name (First Name, Business, lnst.) Lender Last Name Address Address2 City State I Zip 0Primary 0General Ospecial 0 Special Primary 0 Run-Off Primary 0 Run-Off General 0 Run-Off Special 0 Run-Off Special Primary 0 O candidate 0 Other Than Candidate Committee Name City State I Zip I. First Name 1. 2. Last Name 2. 3. Address 3. 0Primary 0 General 0 Special 0 Special Primary 0 Run-Off Primary 0 Run-Off General 0 Run-Off Special 0 Run-Off Special Primary Reference: OCGA § 21-5 -34(b)(I) Publ ic Officer Address2 0 Public Officer Address2 O candidate 0 Other Than Candidate Committee Name City State I Zip $ Loan Page Total Contnbut10n Type (Monetary, ln-Kmd, Common Source, Credit Received on Loan) •• Election Cycle (Primary, General, Special, Special Primary, Run-Off Primary, Run-Off General, Run-Off Special, Run-Off Special Primary) ••• lfany 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 _B Page 7 of 10 CFC-CCDRI /1 4 State of Georgia Campaign Contribution Disclosure Report Itemized Expenditures Must list expenditures made to a si ngle recipient for which the aggregate total more than $100.00. List Name and Exp. Date Occupation & Expenditure Mailing Address of Recipient Employer Purpose Exp. Type* First ~ame ~~ s..,'t\~ ~ Date ') "" -(\. ' "' Last Name \\ S' c:::::;~b/Y\ ~ \ol\to/ \c \~~~ \"'- Address Din-Kind D Loan Repayment D Refund D Reimbursement D Credit Card D 3rd Party D Deferred Payment D Payment on Deferred Expense D Investm ent Address'! City j Zip First Nan~~ s.,"'. \ ,, f.\ Date "\ \\ ~ <::::;,\!.W\tuj<- \'N ~ \ 1 Address2 City I Zip V:~~C~ <S;:h,v~~~-~~ 11~~~0 q't\-s. Employer Occupation ~;_~t- ~\u- fs'~(.b ~L,\ 1\~~~( QExpenditure Din-Kind D Loan Repayment DRefund D Reimbursement D Credit Card D 3rd Party D Deferred Payment D Payment on Deferred Expense 0 Investment Date 0 {2<4:1\ ~ Last Name Employer Occupation vs Y\~,\ bJ Address Address2 City State s L Address State \o( '-S/ \b '4 ~ ~ LastName rl?~~r ...... I~x penditure " \ ~ (---:7~ ::VL.~\) State Occupation \ ~~ X Amount Paid I Zip Expenditure Din-Kind D Loan Repayment 0Refund D Reimbursement 0Credit Card D3 rd Party DDeferred Payment D Payment on Deferred Expense D Investment Employer Page Total$ 2 {pQ£3'~ • Expenditure Type (Expenditure, In-Kind, Loan Repayment, Refund, Reimbursement, Credit Card, 3rd Party, Deferred Payment on Deferred Expense, Investment) Public Officer/Candidate/Other Than Candidate Committee Name Public Officer/Candidate/Other Than Cand idate Committee Name Page ~of CO Page 9 of 10 CFC-CCDR 1/1 4 State of Georgia Campaign Contribution Disclosure Report Investments Statement 1. Investment Name Account # Value at beginning of reporting period $ Institution/Person Holding Account t-1 / A Value at end of reporting period $ Mailing Address Difference in value$ Address2 Interest Paid Out$ City State Investment Transactions Date Person(s} Involved in Transaction Zip Cash Dividends $ Value of investment QUrchased 2. Investment Name Value of investment sold Profit Loss Account # Value at beginning of reporting period$ Institution/Person Holding Account Value at end of reporting period$ Mailing Address Difference in value$ Address2 Interest Paid Out $ City State Investment Transactions Date Person(s} Involved in Transaction Zip Cash Dividends $ Value of investment QUrchased Total value of investments at beginning ofre11orting 11eriod $ Total value of investments at end of reQorting Qeriod $ Total difference in value $ Public Officer/Candidate/Other Than Candidate Commi ttee Name Value of investment sold Page Total Cash Dividends: $ Page Total Interest Paid Out: $ Page Total Profit: $ Page Total Loss: $ Profit Page ~of Loss _li Page 10 of 10 CFC-CCDR 111 4 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 Information that is to be reported in the body of the report should not be listed on Addendum Statement Public Officer/Candidate/Other Than Candidate Committee Name Page fi_ of <(3