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HomeMy WebLinkAboutFriends of Jim Hertzler - 2016 Annual Report COMMONWEALTH OF PENNSYLVANIA CAMPAIGN FINANCE STATEMENT File this in lieu of a full report only if aggregate receipts, expenditures, or liabilities incurred each did not exceed $250.00 during the reporting period. FILER IDENTIFICATION 110, REPORT FILED CANDIDATE I COMMITTEE LOBBYIST 3 NUMBER ON BEHALF OF 10, NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST FR eN LS OF --- (\ k-k6 1,F STREET ADDRESS y. 0, Box. Li-s CITYEWO L STATEpc ZIP n DE oas — 3°43 TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION (CHECK ONE) ' C O, e„( 1Y C©,/Y q n n S \yam',/\ 21 Dr\ MO.. DAY YEAR 6TH TUESDAY U'\VI �VI`l1VIl1y`J 11\IWYK Df PRE-PRIMARY FOR OFFICE USE ONLY ///D���AY//Y YEAR � ! 31 MDAY YEAR2ND FRIDAY 2 AERODDRAETPOESR�NG 70 a I � na PRE-PRIMARY 1 \[J Il 30 DAY 3' POST-PRIMARY CD A CASH BALANCE AT END 4. OF REPORTING PERIOD: $ 11597 'O 6TH TUESDAY r•-• (v PRE-ELECTION .....1 TOTAL AMOUNT OF FILER'S 5. OUTSTANDING DEBTS OR LIABILITIES 2ND FRIDAY AT THE END OF REPORTING PERIOD: $ VV ARE-ELECTION Q N B. .d'"" .3s, 30 DAY (V AMENDME POST-ELECTION REPORT?NT YES NO ANNUAL TERMINATION YES NO REPORT REPORT? a AFFIDAVIT SECTION E PAF? e- If ttikfnent is filed on behalf of a Political Committee or Candidates's Committee, the Treasurer must sign here. N If Stetrirnent is filed on behalf of a Candidate,the Candidate must sign here. z hu. t6t4nent is filed on behalf of a Contributing Lobbyist,the Lobbyist must sign here. LL .C�'...(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT �X S TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLED E AND BELIEF,TRUE,CORRECT AND COMPLETE. H 1YORN TO AND SUBSCRIBED BEFORE ME THIS r-- !1z ga >E71. ) DAY OF 20, 1 SIGNATURE OF PERSON SUREPOR7 PRINTED NAME "'4 g m SIGNATRE C)� \(6 I pi IgQ � �^ 0_ .. COMMISSION EXPIRES MO. DAY YR. AREA CODE DAYTIMEELE�ONE NUMBER PART II - If statement is filed on behalf of a Candidate's Authorized Committee, Candidate must sign here. I SWEAR(OR AFFIRM)THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THIS POLITICAL COMMITTEE HAS NOT VIOLATED ANY PROVISIONS OF THE ACT OF JUNE 3, 1937(P.L. 1333,No.320)AS AMENDED. SWORN TO AND SUB CRIBED BEFORE ME THIS /�/�/�� -7 SIGNATURE OFC N4 DI ATE e9-74-0 DAY O � ZO r4�A/ __ COMMONWEALTH oar PENNSYLVANIA t I12 S f, / �2 F6c v -T;r7T1'rr , PRINTED NAME SIGN.TUBE ? ? I — r %, MY COMMISSION EXPIRES Notary PUNIC .REI CODE L/DAYTIME TELEPHONE NUMBERl7\I (/// NO.CARLISLIE+RORO,CUMBERLANDCOUNTY Department of to e :u--.. . • issions,Elections and Legislation DSEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280