Professional Documents
Culture Documents
State of Georgia
Campaign Contribution Disclosure Report
1. Report Type 2. Filing is being made on behalf of: Filing Office Use
Candidate or Public Official Only
E-Filed on
Original Report C2009000102 - 1/6/10 10:32 am
Committee to Elect Jim Nichols
James Attaway Nichols IV Use Earlier of Post
State Representative, District 109 Mark or Hand
Delivered Date
3. Identifying and Contact Information
(1) James Attaway Nichols IV (2) 01/04/2010
Full Name of Candidate or Non-Candidate Campaign Committee Today's 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 (6) If so, is the Committee registered with the State Ethics Commission? YES
June 30, 2009 March 31, 2009 6 days before Primary 15 days before
Run-Off, 2009 Special Primary,
X Dec. 31, 2009
June 30, 2009 2009
Persons elected to office in each year 6 days before General
following the year in which the election
occurs
Run-Off, 2009 15 days before
September 30, 2009 Special, 2009
Persons leaving office with excess funds
until such funds are expended as provided in
6 days before Special
the Act Primary Run-Off,
October 25, 2009
Unsuccessful candidates with excess funds, 2009
or who receive contributions to retire debt Dec. 31, 2009
incurred, until such funds are expended, or
December 31, 2009 6 days before Special
such unpaid debts are satisfied (December
31 filing only) Run-Off, 2009
The electronic filing of this document constitutes an affirmation that the statement is true, complete,
and correct. As per modifications of the Ethics in Government Act, filing a separate notarized
affidavit is no longer required. See O.C.G.A. §§ 21-5-34.1(e) and 21-5-50(e).
Campaign Contribution Disclosure Report for 2009 December 31st - Non-Election Year - Original
Electronically Filed with the State Ethics Commission on: 1/6/2010 10:32:20AM -- Confirmation #C200900010224112
SEC FORM CCDR
REV 06/2009 FILER ID: C2009000102
State of Georgia
Campaign Contribution Disclosure Report
Summary Report
CONTRIBUTIONS RECEIVED
1 I Have: In-Kind Cash Amount
The following contributions, including Common Source, to report: Estimated Value
3 Total amount of all itemized contributions received in this reporting period which are
listed on the "Itemized Contributions" page. $0.00 $450.00
EXPENDITURES MADE
I Have: In-Kind Cash Amount
7
The following expenditures to report: Estimated
INVESTMENTS
13 Amount of investments at the beginning of this reporting period. $0.00
14 Total amount of investments at the close of this reporting period. $0.00
Campaign Contribution Disclosure Report for 2009 December 31st - Non-Election Year - Original
Electronically Filed with the State Ethics Commission on: 1/6/2010 10:32:20AM -- Confirmation #C200900010224112
SEC FORM CCDR
REV 06/2009
State of Georgia
Campaign Contribution Disclosure Report
Outstanding Indebtedness
Primary 2010 Indebtedness Amount
Campaign Contribution Disclosure Report for 2009 December 31st - Non-Election Year - Original
Electronically Filed with the State Ethics Commission on: 1/6/2010 10:32:20AM -- Confirmation #C200900010224112
SEC FORM CCDR
REV 06/2009 FILER ID: C2009000102
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
Campaign Contribution Disclosure Report for 2009 December 31st - Non-Election Year - Original
Electronically Filed with the State Ethics Commission on: 1/6/2010 10:32:20AM -- Confirmation #C200900010224112
SEC FORM CCDR
REV 06/2009 FILER ID: C2009000102
State of Georgia
Campaign Contribution Disclosure Report
Loan Reporting
Date of Loan Person(s) responsible for Occupation &
Name of Lender Amount of Loan repayment of loan Place of Employment
Mailing Address Election Cycle Mailing Address Fiduciary Relationship
Campaign Contribution Disclosure Report for 2009 December 31st - Non-Election Year - Original
Electronically Filed with the State Ethics Commission on: 1/6/2010 10:32:20AM -- Confirmation #C200900010224112
SEC FORM CCDR
REV 06/2009
FILER ID: C2009000102
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 Expenditure Date Occupation & Expenditure Purpose Amount
Recipient Expenditure Type Employer Paid
Campaign Contribution Disclosure Report for 2009 December 31st - Non-Election Year - Original
Electronically Filed with the State Ethics Commission on: 1/6/2010 10:32:20AM -- Confirmation #C200900010224112
SEC FORM CCDR
REV 06/2009
State of Georgia
Campaign Contribution Disclosure Report
Investments Statement
Investment Name There are No Investments this reporting period
Institution/Person Account Number
Holding Account
Address There are No Investments this reporting period Value at beginning of reporting period
Address Value at end of reporting period
City, State, Zip Cash Dividends
Interest Paid Out
Investment Transactions
Campaign Contribution Disclosure Report for 2009 December 31st - Non-Election Year - Original
Electronically Filed with the State Ethics Commission on: 1/6/2010 10:32:20AM -- Confirmation #C200900010224112