HomeMy WebLinkAboutAdams, H. Anthony - 2017 30-Day Post-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 Ow REPORT FILED I. b
NUMBER ON BEHALF OF
01, CANDIDATE COMMITTEE' LOBBYIST
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST f^\ `^\\j(Jp
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STREET ADDRESS
15 We..._ \e S ccs
CITY STATE ZIP CODE
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TYPE OF REPORT iN\NAMEA�,w, OF OFFICE SOUGH DIDATE , DISTRICT NO. PARTY DATE OF ELECTION�
(CHECK ONE) C\CSL\ 1 " $ oct- 5— .
• t. .4 \-) � O
` cl ( R e MO. DAY YEAR
6TH TUESDAY
PRE-PRIMARY C�
F.._. CE uaE ONLY
MO, DAY YEAR MO. l.DAY YEAR '-'-� �
2ND FRIDAY Z' DATES OF `] co c_.
PRE-PRIMARY• • PERIOD 2 .REPORTI7
5 /, l TO cj C 1 7 m C
O1 J 1
r .—
30 DAY
XPOST-PRIMARY: .. .-
CASH
CASH BALANCE.AT END
0� F� o z,,,
6TH TUESDAY 4' OF REPORTING PERIOD: , 1 �-y
PILE-ELECTION a =
TOTAL AMOUNT OF FILER'S C
2ND KRloav 5- OUTSTANDING DEBTS OR LIABILITIES h� �„`t - -
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ n , ...< :�-
6
30 DAY. `
POSELECTION AMENDMENT
TYES NO y
REPORT? �\
7. L s
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, IO i HAlib i a,MY'. NOWLEDGE AND BELIEF,TRUE.CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS Z ==-t N ,_ .4011111111111111111111
'�14.
DAY OFlk 20 l -3 0 • SIGNATURE OF PERSON SUBMITTING REPORT
---..0,F)1. `SIGNATURE / W W a LL PRINTED NAME
MY COMMISSION EXPIRES ly �A) I J.Z ° t I-1 (40. -3 - 5 yam`
MO. DAY YR. O Q x 111EA CODE DAYTIME TELEPHONE NUMBER
PART II-
W I-
If statement is filed on behalf of a Candidate's Authoril FC8rialftie,Candidate must sign here.
o — 0o D to
I SWEAR(OR AFFIRM)THAT TO THE BEST OF MY KNOWLEDGE AND BE 'TNlS VAG/6.COMMITTEE HAS NOT VIOLATED ANY PROVISIONS OF THE ACT OF
.JUNE 3, 1937(P.L. 1333,No.320)AS AMENDED. 0 _a�"m
o to co w
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 s Bureau of Commissions,Elections and Legislation
DSE3S(13(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280
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