HomeMy WebLinkAboutBorder, Zachary - 2017 6th Tuesday 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.
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FILER IDENTIFICATION REPORT FILED GAlmIDATE. /\ .COAINdflEE. 2, LOBBYIST 7.
RINSER ON BEHALF OF ' - J
NAME OP FILM COMMITTEE,Cq►erDMTE OR����
Z 076 "I9f,•
91l¢ti AD/�DRf'ESS 4/q' / / _4' S/
CmL �� Q Yly� STATE Pi ZIP CODE
'c rJ — /12.2_
TYPE OF REPORT ��,E// N,1 OF OFFICE SOUGHT BY CANDIDATE ,DISTRICT NO. PAR/Ty( OA'l C O ELEC,TION}.
(CHECK ONE) �/✓� h / Z'/ i 2 !/ 1 o. I DAY YEAR
PRE'PRIMA'RY'' FOR OFFICE':USE ONLY
MO. ..DAY- . YEAR _MO% DAY - YEAR I
DATES OF )
2ND FRIDAY 2. REPORTM6 a�, i 6 r o z. - i - c..,PRE+RRINTARY. .. PERIOD
' 7
POST=PRMARY.
CASH BALANCE AT END
4. OF REPORTING PERIOD: $ v
8TH TUESDAY.''i'
PRE-ELECTION. -
TOTAL AMOUNT OF FILER'S0 ---. :-.7-..
s OUTSTANDING DEBTS OR LIABILITIES ,
ZND`FRIDAY AT THE END OF REPORTING PERIOD: $ _
PRE-ELECTION — ..
a. -,i
30.DAY ---. OD
AMENDMENT
POS(-ELECTION. - YES NO /t\
7.
ANNUAL TERMINATION.
REPORT REPORT? YES NO �/
..
APFiDAVIT SECTIOI11r.
PART I-
If statement is filed on behalf of a Political Committee or Candidates's_Committee,the Treasurer must sign here. f
If statement is filed on behalf of a Candidate,the Candidate must sign here. c1 z M: o.
If statement is filed on behalf of a Contributing Lobbyist,the Lobbyist must sign here. ,pg
I SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABIUTIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID N
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE.CORRECT AND COMPLETE. , 1 7'
1Qi
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SWORN TO AND SUBSCRIBED BEFO WE THIS -..•1111
_ .
Co. am( �l I VC/L'¢�h :CO A?UPE OP C�: ICRC TING RE TORT/ .s a.
p ria 6/0I (d C��// i u 3 D r
m mi
PRINTED NAME ,Ao p D M
MY COMMISSION EXPIRES SIGNATURE1(/ '10
!0-s-le �'j g O r
20
MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER = C
D
o Z
PART II- io
If statement is filed on behalf of a Candidate's Authorized Committee,Candidate must sign here.
I SWEAR(DR 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
PRINTEDNAME
SIGNATURE
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
DSEB-503(12-99)
CjY)
-1