HomeMy WebLinkAboutBirbeck, Jonathan - 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 10, REPORT FILED CANDIDATE. COMMITTEE LOBBYIST- 3
NUMBER ON BEHALF OF ..
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
Jo nc fto. rx c,k-
STREET ADDRESS
1 f9 S. 12,'-/t S-Ircc-
CETY^a/ 11 5 I�r STATE �� ZIP 70 I -
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE 'DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) M V `J d^ /D MO...: DAY .. •YEAR
I 7 Da i-.
6TH-TUESDAY
PRE-PRIMARY FOR OFFICE USE ONLY
MO." - DAY YEAR MO. DAY YEAR
2ND FRIDAY, 2' DATES OF --7
PRE-PRIMARY PERIOD NG / I I TO 1O a3 I ( O_
.;30 DAY 3. �(� to
"„ -ted
CO C
` POST-PRIMARY
CASH BALANCE AT END _ S6 «�(Jb frT c,6Tri:TUESDAY 4 OF REPORTING PERIOD: $ I r- N
. PRE-ELECTION Ol
TOTAL AMOUNT OF FILER'S
2ND PR10AY • 6' OUTSTANDING DEBTS OR LIABILITIES n 3C
PRE-ELECTION /� AT THE END OF REPORTING PERIOD: $
s. ` C fV
30 DAY O
AMENDMENT ---1
POST-ELECTION 7
REPORTS YES NO Y -< en
. �l
ANNUAL TERMINATION
REPORT ..REPORT? . YES NO
a
Z . AFFIDAVIT SECTION
PART l-
N a If2latement is filed on behalf of a Political Committee or Candidates's Committee,the Treasurer must sign here.
z � >. itiatement is filed on behalf of a Candidate,the Candidate must sign here.
W wiiio statement is filed on behalf of a Contributing Lobbyist,the Lobbyist must sign here.
O- In o oU
'
LL J Z CO.0a,c''�WEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCU O DURING THE REPOR , PERIOD INDICATED ABOVE DID NOT
O < O N C tQ CEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF IY OWLEDGE AND BE F, RUE,CORRECT AND COMPLETE.
S FE m N`
Q la-�-.- • N SWORN��//-- TO AND SUBSCRIBED BEFORE ME THIS in
"
w O >. Ern 2 O DAY OF 4 it IP !" 201. ATURE *; PE-. ON SUBMITTING R -ORT
Z E 7JCS)kf 4 &(-12C ,/
P NTED NAME
2 �V SIGNATURE
/�
o X 2 MY COMMISSION EXPIRES 10 l 0 2' 1. .. a '
U Mo. DAY YR. AREA• ODE *T` IME TELEPHONE NUMBER
PARTII-
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 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