HomeMy WebLinkAboutRogers, David - 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.
FRIER IDENTIFICATION plo. REPORT FLED t 2 .
ON BEHALF OF101' :CANDIDATE::' .COMMITTEE;.: ::LOBBYIST.,::
NUMBER ..,
NAME OF RUNG COM ,CANDIDATE OR LOBBT1ST��� R5CyA
S,eatI ADDRESS_ ,
`(� M€ , Or
.
CRY STA ZIP CODE .........
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE t-1-6
CT NO. PARTY DATE
DATE OF ELECTION
(CHECK ONE) �4 �, J` '1 MO: DAY'' YEAR?':... 1• \ '-I k'� rw-P 1 �;S'� S4
;PRE-PRIMARY.::: ..:
FOR'OFFICE:USE ONLY i':.i;!::"
.. MO:'> :DAY :.YEAR .:MO:. '.:'DAY:',.YEAR.'.;.
DATES OF
:PRO''FRIDARY]-:": •
REPORTING �(�' tl TO 6 S 11 PRE�fRIMARY '';;:; PERIOD J
30.bAY .::. 3. C 4=11
:..POST=ARIMARY: :':: M
CASH BALANCE AT END 03 C
Orli:TUESDAY' '%:.. OF REPORTING PERIOD: $---SXI
PREcELECTION . r
TOTAL AMOUNT OF FILER'S ,J Z .f~
5 OUTSTANDING DEBTS OR LIABILITIES l/..'{N
ZNOFRIDAY.:: :.:: c,
`PRE.'EI:EcnoN'; < AT THE END OF REPORTING PERIOD: $ n mi.
=
C ,—
30 DAY
POST-EI ECTION � YES NO V • .,,,I CO
/� ..< On
: .ANNUAL.:;':.:::- TERMINATION YES NO xx
: 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,TO THE BEST OF MY KNOWLEDGE 0 BELIE TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBEDTRIBEFORE ME THIS
ln
' 'DAY OF �J �A e- 20L1./ SIGNATURE OF N SUB NG REPORT
ZoCIvS
I�'s'r° 3' ,,t•.r 1!•'•+ ' v;NI ,n u . I,
PRINTEDgNAME
Ci b y L. ro, k�ertary - c ' I' (6 lj ^d(o t k
•
MY COM ISs�Oerr�eIR166ro�al�ibertatt� ,•olin
My Commission Expdses Oct.DAB; 202' '. AREA CODE DAYTIME TELEPHONE NUMBER
MGR,PiNNSYLVANIA ASSOCIATION OF NOTARIE
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
MO. DAY YR. DAYTIME TELEPHONE NUMBER
•
DSEB-503(12-99)