HomeMy WebLinkAboutMiller, Nicole - 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 , REPORT FILED ► 1. 2. 3.
NUMBER ON BEHALF OF CANDIDATE COMMITTEE LOBBYIST
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
N) ( O 1-e C . MSI )-eY
STREET ADDRESS
3 5 I` CH cs+n w+ J-1--
CITY STATE ZIP CODE ----
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) ( `, l ,rq C I,,,, h 1 MO. DAY YEAR
6m TUESDAY V nibed a✓v) Valk S Jm) Di vata R 5 / b )-7
PRE-PRIMARY / FOR OFFICE USE ONLY
MO. - DAY YEAR MO. DAY YEAR
2ND FRIDAY
2. DATES OF /� In'
PRE-PRIMARY PERIOD REPORTING 5 / )1 TO 5 I =
i- Ts v
30 DAY s m Crl =
POST-PRIMARY .
CASH BALANCE AT END $ r
6TH TUESDAY a. OF REPORTING PERIOD: Z ,p-
PRE-ELECTION 1:::1 a
TOTAL AMOUNT OF FILER'S C) _
2Ho FRIDAY5. OUTSTANDING DEBTS OR LIABILITIES Q
PRE-ELECTION. AT THE END OF REPORTING PERIOD: $ CO
6. M
30 DAY
AMENDMENT
POST-ELECTION REPORT? YES NO
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(S250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
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ATO AND SUBSCRIBED BEFORE ME THIS L4 f - �
DAY OF ,{f/L fL _, 2012 SIGNATURE OF PERSON SUBMITTING REPORT
4 " . . n4.1a_I p 6e Nil 6) IP YY)I1It r�
%I `�( 1�PRoINNTiED NAME
n C [�
MY COMM SIGN Arircea_ I I BJ mmAirsui It I ! 2) ^ 3o S�J
' EGANE &i YR. AREA CODE DAYTIME TELEPHONE NUMBER
Nut fy''INAlik.
-
PART II- CARLISLE 10RO,CUM$tlwo COUNTY
If statement is filed on I. elsg° tlAtd 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
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