HomeMy WebLinkAboutScott, Timothy - 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 10,. REPORT FILED I- 2 3.
NUMBER ON BEHALF OF 110, CANDIDATE X. COMMITTEE LOBBYIST
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
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STREET ADDRESS �7 /�
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CITY STATE ZIP CODE
C51(2- <sQ. ,?4_ \-70(3 —
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) MO. DAY YEAR .
6TH TUESDAY 1 Ma-16Q 4` �r e c(f�S -Dep-, ..S.-..S.- I
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PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY YEAR
2ND FRIDAY. 2`' DATES OF
PRE-PRIMARY - x PERIOD REPORTING i l (� TO 1. C) ',
,` ` 1 rly
30 DAY 3.
POST-PRIMARY O
CASH BALANCE AT END rn -'
6m TuesoAv
4. OF REPORTING PERIOD: $___4___ I ,
PRE-ELECTION : CA,
TOTAL AMOUNT OF FILER'S
2ND FRIDAY 5. OUTSTANDING DEBTS OR LIABILITIES
PRE-ELECTION AT THE END OF REPORTING PERIOD: $
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6. a cri
30 DAY AMENDMENT l ` (J1
POST-ELECTION YES NO ,
REPORT?
ANNUAL TERMINATION
REPORT REPORT? YES NO
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.
OaR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
Z L TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE •AND BELIEF,TRUE, ,,ARRECT AND COMPLETE.
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WORN TO AND SUBSCRIBED BEFORE ME THIS
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Z 4J Z DAY OF 20 SIGNATURE PERS� �fTTING REPORT
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PRINTED NAME f= i �{
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COMMISSION EXPIRES (RE /10CD r?( 1 2 J e (s ` t
QH Q f- c Z DAYTIME TELEPHONE NUM R
< C O MO. DAY YR. AREA CODE
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2 iftttt Client is filed on behalf of a Candidate's Authorized Committee, Candidate must sign here.
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(1) `'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.
Department of State • Bureau of Commissions,Elections and Legislation
DSEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280 a