HomeMy WebLinkAboutScott, Timothy - 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 1111o. REPORT FILED CANDIDATE I- COMMITTEE 2. LOBBYIST 3.
NUMBER ON BEHALF OF ,
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
I 0VAN.,2-1
A- c-Dc_tz.:-k—A
STREET ADDRESS f
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CITY STATE ZIP CODE
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) 1 (I ,CLI/ (A ' A.._,5Vit/
MO. DAY
9- YEAR
6TH TUESDAY L
PRE-PRIMARY FOR 9FFICE ONLY
MO. DAY YEAR MO. DAY YEAR �l U
2ND FRIDAY 2. DATES OF _P.
REPORTINGTO tea.. _
PRE-PRIMARY / I CO
M
PERIOD
iTl
30 DAY 3'
POST-PRIMARY .j„
CASH BALANCE AT ENDOwN
67H TUESDAY 4. OF REPORTING PERIOD: $.4—______ C:) ,.o
PRE-ELECTION C") MC
TOTAL AMOUNT OF FILER'S <J
OUTSTANDING DEBTS OR LIABILITIES
2ND FRIDAY AT THE END OF REPORTING PERIOD: $ O
PRE=ELECTfON / -�-I
6.
30 DAY
POST-ELECTION AMENDMENT YES NO I\
REPORT?
7.
ANNUAL TERMINATION
REPORT REPORT? YES 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 ILITIE'I._� ED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,T HE BSI,g ,g'KNOWLEDGE AND BELIEF,TRUE,/ORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS >- 40 I
'1 /
t�L C M -' 201-7 Z Q Q o NATURE OF - 0• SU=HITTING R-PORT
DAY OF _ C
SIGN URE 0 Q ,,,- CO PRINT Y NAME
gWa
MY COMMISSION EXPIRES = �mJ Fa-.91-i-4 Z �j p C L'-(L-
MO. DAY YR. Z NEly CODE DAYTIME TELEPHONE NUMB R
PART II- 0a, 12a ?
•
If statement is filed on behalf of a Candidate's Authorized ori` m Candidate must sign here.
0 o.c
I SWEAR(OR AFFIRM)THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF Th1 I-ULI I K,ACOMMITTEE 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