HomeMy WebLinkAboutFriends of Jim Hertzler - 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.
REPORT FILED 10.
CANDIDATE tCOMMITTEE Nil LOBBYIST
FILER IDENTIFICATION Ilk
ON BEHALF OF I
NUMBER --
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST � ���LE l)/----
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STREET ADDRESS,? 0.
Box
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STATE PR ZiP CODE
CITY l� `III
NAME OF OFFICE^ SOUGHT BY
{ CANDIDATE ''��/� + DISTRICT NO. PARTY , /`� .DATE 1OFF ELECTION
TYPE OF REPQP.I, AY YEAR
COki V ` CLOS l.\_ L S.�.-6NI�g- 2 1 � L/ r I DIV tr l�17
(CHECK ONE)
6TH TUESDAY FOR OFFICE USE ONLY
PRE-PRIMARY
I
MO
i DAY 1 YEAR MO. E GAY 1 YEAR
DATES OF F''(1
PRE-PRIMARY I�.._ REPORTING Q 1 , / f`�(�/7 r0 05'01
5�'0 I i JcI 1 .
I/ PERIOD U(V �.J
30 DAY n f`3
POSTPRIMARY9 0 / --+J
CASH BALANCE AT END �]�J LJL
4. OF REPORTING PERIOD; S ) co
6TH TUESDAY ---C
PRE-ELECTIONC— 1
TOTAL AMOUNT OF FILER'S
s OUTSTANDING DEBTS OR LIABILITIES = '
2ND FRIDAY AT THE END OF REPORTING PERIOD: S ____.-/// C7
PRE-ELECTION
C) 3c
6. Q 30 1
POSTAE ECTlON AMENDMENT YC - 1
REPORT? YES NO N !!
7. ,.,‹
.40
ANNUALTERMINATION 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 :- (oust sign here,
I SWEAR(OR AFFIRM)THAT THE AGGREGATE REC;E:PTS OR CiS_URSEMEN S OR LQ+LIT'ES C tED DUR'NG THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS(5250.00)AND THIS REPORT.S. `>'.E 3R.ti)KNOWLEDGE AND BELIEF,TRUE.CORRECT AND COMPLETE.
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SWORN TO AND SUBSCRIBED BEFORE ME THIS N n,, ! f Q
i
fh y 2 c_,� sri/fi �, - A.
20 1 . w Q Ip z 2 ty SIGNATURE O ERSOP 4SMITTING EPORT
DAY OF ,. 1 Q tau o , �
„4-
h � � u 01�� Q c(3'wK:{ti{� 60D- 669C NAME /�
PAY COMMISSION EXPIRES SIGN 05 DI n/'11 j Zt;._ .o m i l `� 0 D^ 6 6 9 l�
MO. DAY YR. Z m f1?'A.CODE DAYTIME TELEPHONE NUMBER
m T
PART II - € a o 7i' ..
If statement is filed on behalf of a Candidate's Authorizerr r oi�:t, Candidate must sign here.
_,
CT J
I SWEAR(OR AFFIRM)THAT TO THE BEST OF MY KNOWLEDGE,AND SELUEF TH15 POL'-.CAI CCM;,IL 'SE HAS NOT VIOLATED ANY PROVISIONS OF THE ACT OF
JUNE 3, 1937(P.L. 1333,No. 320)AS AMENDED. y�
SWO• TO AND SUBSCRIBED BEFORE ME THIS I /(/4
'g TURE OF CANDIDATE
DAT of Ili.. xd1 (�/ WI /‘-/ 4 -2c--6 k.
G .' 1 ���� . �� PRINTED NAME
\ 011 '
MY COMMISSIO1TAR IttE. - ' AREA CODE DAYTIME TELEPHONE NUMBER
BETHANY SALZARULO MO. LAY YR.
Notary-Public ._._
CARLISLE 80RO;41MRERLANO OM
My immiltliontxpilaact 7,.:' �artm nt of State • Bureau of Commissions.Elections and Legislation
ill Eanrth-1ffice Building • Harrisburg,PA 17120-0029 • (717)787-5280
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