HomeMy WebLinkAboutFriends of Jim Hertzler - 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 0,. REPORT FILEDI _\. 3
CANDIDATE COMMITTEE LOBBYIST
NUMBER ON BEHALF OF 1110,
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST _
F-R. 6' )0 OF `\ N\ V �I . R_
STREET ADDRESS
p. o_ P,OX 3
CITY E )0 L STATEPA- \P CODE —
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) 1 ► ou"Tr co 1 \FIT SS�"V ME. ell t�./ E1 l /`�� DAYMO, YEAR
s I�7
6TH TUESDAY lll��� (J
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY 1 YEAR - -
DATES OF
2ND FRIDAY
PRE-PRIMARY 2. PERIOREPORTING 05 oa MAli TO OG 65 \I
30 DAY �j I Ip V
POST-PRIMARY - ,.•,A n
CASH BALANCE AT END IG� (1 o
4. OF REPORTING PERIOD: $ I �' --.4
6TH TUESDAY CO C....
PRE-ELECTION
TOTAL AMOUNT OF FILER'S :
2ND FRIDAY 5. OUTSTANDING DEBTS OR LIABILITIES r--
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ C l'1
C/
6. —p
30 DAY n
AMENDMENT
POST-ELECTION REPORT? YES NO C
7. .., E
2 ..
ANNUAL - TERMINATION ^--I .4"
REPORT REPORT? YES NO "< taxt
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. p
If statement is filed on behalf of a Contributing Lobbyist,the Lobbyist must sign here. P E g, ;
1 SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NO v 3= 3 Z
EXCEED TWO HUNDRED AND FIFTY DOLLARS(S250.O0)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE. 3,= Ip z
mZ
SWORN TO AND SUBSCRIBED BEFORE ME THIS // u, II • dr4...,_,_, o C D
)L1 DAY OF _ ale. 20 11 SIGNATURE OF PERSON UBMITTMG REPORT 5 c ea—D A O
mi
SI NATURE�'] /J/j //�� PRINTED NAME s -n n O m m
MY COMMISSION EXPIRES V - t3 2021 ri I� gO �O6 q 1 2 N .D Z
n r
vi
MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER " W Cps C
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PART II- g ��o z
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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 CO M' EE HAS NOT VIOLATED ANY PROVISIONS OF THE ACT OF
JUNE 3, 1937(P.L. 1333,No.320)AS AMENDED.
SWORN TO AND SUBS RIBED BEFORE ME THIS AIL / .....111,
iA SIGNATU' O CA='ATE
DAY OF _. A. t 20 110V
I-�L // PRINTED NAME
.._. .?,s.we as.•r_,.
NOTARIAL: AL,' '11 - 1 7 J
MY COMMIllt �i A m AREA CODE CILE TELEPHONE NUMBER
NOtafyfPubliC •MO. D Y YR.
CARLISLE BONO.,ttlilNIep11; 1 C 1'tt
My CoMili►i3t11on$plr*ASCI,70artmirit of State • Bureau of Commissions,Elections and Legislation
DSEI3-503(12-99) ' 'o - ice Building • Harrisburg,PA 17120-0029 • (717)787-5280
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