Appointment of Political Treasurer
For State and Local Candidates and Single-Candidate Committees
INSTRUCTIONS
The Appointment of Political Treasurer statement must be used to appoint a political treasurer as required by
the Campaign Financial Disclosure Act (T.C.A. § 2-10-105) for state and local candidates and single- candidate
political campaign committees. A state candidate may not receive or expend funds for an election until a
political treasurer has been appointed for that election. A local candidate pursuant to T.C.A 2-10-101, may be
exempt from completing this form, please check with county election commission for more information. A
candidate may appoint himself or herself as political treasurer. A new form must be filed if the treasurer is changed.
Candidates for state public office must file their original Appointment of Political Treasurer statement ONLY with
the Registry of Election Finance, 404 James Robertson Parkway, Suite 104, Nashville, TN 37243-1360.
Candidates for local public office must file their original Appointment of Political Treasurer statement ONLY with
their county election commission.
1. Date: 2. Candidate First and Last Name: 3. Candidate e-mail address:
4. Campaign Address and Phone:
City State Zip Code Phone
5. Home Address and Phone (if different than item 4 above): City State Zip Code Phone
6. Office Sought (include district number, if applicable) 7. Party Affiliation 8. Election Year
9. Treasurer Name: 10. Treasurer e-mail address:
11. Treasurer Address and Phone: City State Zip Code Phone
12. Candidate and Treasurer Signature (both signatures must be witnessed. Treasurer can not witness candidate's signature):
Signature of Candidate Signature of Treasurer
Signature of Witness Signature of Witness
Registry of Election Finance
SS-1120 (rev 12/2013)
