HomeMy WebLinkAboutDiener, Georgianne - 2017 2nd Friday Pre-Primary 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 l/ 2. 3.
NUMBER ON BEHALF OF O' CANDIDATE.' 1` COMMITTEE>;' <LOBBYIST.,;. .
NAME OFUNG COMMITTEE,CANDIDATE OR LOBBYI
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Smet f ADDRESS /�\\
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CRY STATE ZIP CODE
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TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) MO. DAY: nom%' i' .
10TH TUESDAY %DWA,/P o Sc/,"20.50,m d 5 /h �i7
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PRE-PRIMARY. FOR OFFICE USE ONLY
+DAY. :
2ND FRIDAY '2' DATES OF / ry�
PRE-PRIMARY:<:�:::. ✓ REPOR REPNG 0 D / c2,/,7 TO 6j 01 p)(
30 DAY... .
POST-PRIMARY..: ::.:
CASH BALANCE AT END =
a. OF REPORTING PERIOD: $
6TH TUESDAY?<:.:s. W Jr
PRE-ELECTION'. MI D:30TOTAL AMOUNT OF FILER'S T._.. -t
2ND FRIDAY.;_
OUTSTANDING DEBTS OR LIABIUTIES
PRE-ELECTION: AT THE END OF REPORTING PERIOD: $
6CS
nr
30 DAY: : .,:.
AMENDMENT
POST-ELECTION REPORT?
YES NO L--
7.
2r. 0
TERMINATION YES NO -.< CO
REPORT;' REPORT?: I�
AFFIDAVIT SECTION
PART I-
If statement is filed on behalf of a Political Committee or Candidates's Committee,the Treasurer must sign here.
If statement is filed on behalf of a Candidate,the Candidate must sign here.
If statement is filed on behalf of a Contributing Lobbyist,the Lobbyist must sign here.
I SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OFP KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS I/ . % !A^rll/
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D OF ,\\I-.w` 2011 • GNATURE OF PERSON SUBMITTING REPORT
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SIGNATURE 17TARIAL S AL PRINTED NAME
MY COMMISSION EXPI ES LORIE GEISTWHITE 7/7
w� s� 94L7
Nv' ub1iC AREA CODE / DAYTIME TELEPHONE NUMBER
CARLIM BORO,CUMBERLAND COUNTY
My Commission txplres rev 14.ZUZI
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 SUBSCRIBED BEFORE ME THIS
SIGNATURE OF CANDIDATE
DAY OF 20^
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
6 DSEB-503(12-99)