HomeMy WebLinkAboutMiller, Nicole - 2017 2nd Friday Pre-Primary COMMONWEALTH OF PENNSYLVANIA
CAMPAIGN FINANCE STATEMENT
File this in lieuof a full report only if aggregate receipts, expenditures, or
liabilities incurred each did not exceed $250.00 during the reporting period.
FILER IDENTIFICATION ' REPORT FILED , ':;CANDIDATE COMMITTEE ' LOBBYIST•. '
NUMBER ON BEHALF OF
NAME F FILING COMMITTEE,CANDIDATE OR LOBBYIST
'� )cry\e C` NA ► 1 e_v
STREET ADDRESS
' S\ Gees+ry UJi- S: -r-ee
CITY ST ZIP CODE
On rnp 1I ( a �1 o 1 \ -
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) 5L. M0. ' Oki:
Cv4eriand kik,/ k�, c �'rp� ,/ Af10 Q n 1
oi BTHTUESDAY:" '. 1 UI 1�11t1iX ' \ � � 40( I
PRE-PRIMARY:.!: '. G FOR'OFFICE USE:ONLY'': . :."
. - ..... .MO. : :DAY: ;:.YEAR' ;MO: DAY: ':-YEAR ...
Zi4D' RIDAY<; REPORTING I f '1 ! I-1 TO 5 ( l i C
PREQRIMARY X o/� v --
CO nr
:30 DAY.: . .' '. . m a
:.POST-PRIMARY: ::;. X) -<
CASH BALANCE AT END r— 1
";6TiiTVEsnAr: ; OF REPORTING PERIOD: $ -
PREcELECTION . CI
TOTAL AMOUNT OF FILER'S ��/� C) =
OUTSTANDING DEBTS OR LIABILITIES ,(/J rD
PRE -LECTI AT THE END OF REPORTING PERIOD: $ `� C 7?
FRE=ELECTION 2 N
.. 6 -< ,
::30:1;00 /
AMENDMENT \
POST- LECTION" YES NO
;REPORT?
7.
ANNUAL TERMINATION YES NO'
REPORT; REPORT?^
' 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($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
SW�OfR O AND SUBSCRIBED BEFORE ME THIS c
„/ DAY OF '&. l 20/ ,G51 NATURE OFIERSON SUBMITTING REPORT
PRINTED NAME
Of
slGw►TuA�1TARIA EAL
MY COMMISSION E:PIRES LORIS GEISTWMITE 1 1 42I - '36) -3
Nutbl y gg IIC YR. AREA CODE DAYTIME TELEPHONE NUMBER
CARLISLE"�ORO.CUMSERLAND COUNTY
—my COInmIS$Ion txplres Feb 14,2021
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 BEUEF 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.
DSEB-503(12-99) a