HomeMy WebLinkAboutPacker for Borough Council - 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 110, REPORT FILED 10, 1 I ,
CARD DATE COMMITTEE LOBBYIST
NUMBER ON BEHALF OF
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
P IaZ/K6r '6)// &111/rL OlkilL" 1
STREET ADDRESS
;2/5 W. i3 1191-- St
CITY ° STATE Z DE
'(Arliii) M J t Pk" PI° I I - 6 Cr 10 1
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO, PARTY DA i E OF ELETON
(CHECK ONE) 60r/Alt5h enUrt a/ D MO. DAY YEAR
1. i
6TH'TUESDAY 1" -7 7
PRE-PRIMARY
I FOR OFFICE USE ONLY
MO. DAY YEAR _MO. analYEAR
22. DATES OF
ND FRIDAY
PRE-PRIMARY REPORTING /0 & /7 " 0 2, 17
PERIOD
, (_) 1,...)
3.
30 DAY ' = c
-....
POST-PRIMARY 7..5. --....,
CASH BALANCE AT END 0
CO
4. OF REPORTING PERIOD: $ _ 711 F5
6m TUESDAY "".0 --I
PRE-ELECTION r--
TOTAL AMOUNT OF FILER'S
-----
CA,
0
2i OUTSTANDING DEBTS OR LIABILITIES
V
-.:„.
.....
r4o mow
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ C1
C71 =
8.
30 DAY -,..
P.3
POST-ELECTION AMENDMENT YES NO •.-
REPORT? ...:-
ANNUAL TERMINATION ()
REPORT REPORT? NO
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 KNO EDG,a_AND BELIEF,TRUE,CORREC AND COMPLETE,
SWORN TO AND SUBSCRIBED BEFORE ME THIS „ ,,
iff,
I1761 DAY OF 6c--(zyijcsA._ 2012 SIGNATURE OF PERSON SUBMING.REPORT
f>14, _tE, r 0 be-i4---
PRWTED NAME
MY COMMISSION EXPIRES
ITARI -EAL i/ 737 —/997
MO. Attikiar ercy t"-- AREA CO DAYTIME TELEPHONE NUMBER
DAMP HILL BORO,CUMBERLAND COUNTY
PART II- My Commission Expires Mar 15.2019
If statement is filed on beh-If uf c,C 1dld.1, ALAI—.;,...-1 Oe0,1—Altee,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(Pl.1333,No.320)AS AMENDED. 'i /
/ al
4a-- l----”
SWORN TO AND SUBSCRIBED BEFORE ME THIS /..' (11. -
/ /SD Ono'
IC r• TRE OF CANDIDATE
)I 6 DAY OF 0C17464._ 20 r7 Ali s Cot, fect/ge, .
„/------- r,__----'- ...... PRINTED NAME
.e../ ATURE 570 - ,X5-q - (40 5
MY COMMISSION EXPIRES AREA CODE - DAYTIME TELEPHONE NUMBER
MO. DAY YR.
COMMONWEAL114 OF tiNNSYWAN1P
4 ?WAAL SEAL
: K HOPE
09fla
.0 Public
,
_ MySommission,Expires Mar 15.2019 ,De rtment of State * Bureau of Commissions,Elections and Legislation
DSEB-503
210 N rth Office Building • Harrisburg,PA 17120-0029 • (717)787-5280
CAMP HILL BOROCUMBERLAND COUNTY
_—_, ...... , - -