HomeMy WebLinkAboutAdams, H. Anthony - 2017 2nd Friday Pre-Election 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 po REPORT FILED CANDIDATE:, COMMITTEE . LOBBYIST
NUMBER ON BEHALF OF 0, ' 2 3.
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
I^-1 • 1 N ‘-\-�a IN) JCS.W\ S
STREET ADDRESS
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I5 R @E, e S �cDa. ,
CITY SIATF\ A ZIP CODE l/ C/I 1 V.--- 'TYPE OF REPORT NAME OF OFFICE SOUGHT B ANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) 1 \RC{ I�S'l�J'it... l S (•G' ?���a P• M0. DAY YEAR/
6TH TUESDAY ` �•`V O� C� CJ O� 01 Y�I\ DIb 1 t ' (
PRE-PRIMARY ` FOR OFFICE USE ONLY
. ..
MO. DAY :YEAR: .::MO..'. :'DAY 'YEAR.:.
DATES OF
2ND FRIDAY 2 RE ORTING ,��9I TO r� O
PRE-PRIMARY PERIOD ID v�
30 DAY 3. m E7
POST-PRIMARY O —1
CASH BALANCE AT END �,T� r— -
OF REPORTING PERIOD: $^do D `
6TH TUESDAY
I cc*
PRE-ELECTION C3I
TOTAL AMOUNT OF FILER'S C7 =
21413 FRIDAY X
OUTSTANDING DEBTS OR LIABILITIES AT THE END OF REPORTING PERIOD: $ 0 • O d C co
2.1O
:.:30 DAY. :` 6 -{ CD
AMENDMENT X
POST-ELECTION YES NO
REPORT?
7.
ANNUAL : TERMINATION
REPORT YES NO' X
.
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 AND BELIEF,TRUE,CORRECT ANO COMPLETE.
SWORN.
TAO AND SUBSCRIBED BEFORE ME THIS
L
to DAY OF a C c tQ 20127SIGNATOR • •` SUBMITTING EPORT
4
bit) 20127 14' QIP Qk V.
SIGNATURE Q
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PRINTED
c---1\_MY COMMISSION EXPIRES 1 �� } � '1 Ita3 -- 56 q a
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1
MO. DAY YR. Z d CODE DAYTIME TELEPHONE NUMBER
ffilIEal
PART II- a coo 32 E ' -
If statement is filed on behalf of a Candidate's Authoriz LL it• -"-,Candidate must sign here.
x ct G) OW'.,
I SWEAR(OR AFFIRM)THAT TO THE BEST OF MY KNOWLEDGE AND BELIEIE 8IBF •• COMMITTEE HAS NOT VIOLATED ANY PROVISIONS OF THE ACT OF
JUNE 3, 1937(P.L.1333,No.320)AS AMENDED. Z v,y
z >,•a E z
SWORN TO AND SUBSCRIBED BEFORE ME THIS 2 Y c Q� 4
Y �+ SIGNATURE OF CANDIDATE
DAY OF 20 O C a m
—U t� �
CO w
z PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
DSEB-503(12-99)