HomeMy WebLinkAboutShultz, Sean - 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 $250.00 during the reporting period.
FILER IDENTIFICATION 0, REPORT FILED AL 2. 3.
CANOtDA'7'E. -- COMMITTEE LOBBYIST
NUMBER ON BEHALF OF
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST` 3e CW
^ 5/1(i ��
STREET ADDRESS `� / S f
S re VA,
CITY STATE ZIP CODE
�r is/2 ��" /70 - BYO$
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) Q � /1 MO. . DAY - YEAR
Car(i Ste_ ,po✓o Il wt4, E
6TH TUESDAY:
PRE-PRIMARY'• FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY YEAR
2ND FRIDAY:' 2. DATES OF
PRE-PRIMARY REPOR NG 0 I of Zoll TO 0 C O1 Zo17
J N
30 DAY 3' r
POST-PRIMARY -.J
- -
CASH BALANCE AT END ° �o A
6TH TUESDAY a• OF REPORTING PERIOD: $ --<
PRE ELECTIOND
TOTAL AMOUNT OF FILER'S _. CI
2ND FRIDAY s. OUTSTANDING DEBTS OR LIABILITIES C�
PRE-ELECTION
AT THE END OF REPORTING PERIOD: $ -ID•, C) -
6.
30 DAY (V
POST-ELECTION AMENDMENT YES NOj W
7
REPORTS
ANNUAL TERMINATION -- _
REPORT REPORT? 'ES 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.
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.
SWORN TO AND SUBS RIBED BEFORE ME THIS S,,y(�t
DAY OF >i L. 20 14 SIGNATURE OF PERSON SUBMITTING REPORT
-11J1!.'"74111117_1RIMINI A !ai PRINTED NAME
►0LLYM.H•C EN; RR S' n-Ir-`•t7.tic
dikerrR :. -Auglbertand Count ' 7 5--. 0—06?Z-
My Commission Expires Septem 4, I .r YR. AREA CODE DAYTIME TELEPHONE 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 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