HomeMy WebLinkAboutMellott, Tami - 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 REPORT FILED 2. 3.
NUMBER ON BEHALF OF , COMMITTEE.. LOBBYIST
NAME OF FANG COMMIE,CANDIDATE OR LOBBYIST GiriC
Toil-NI (V t( b
STREET ADDRESS -
30W c)4+ 5 k-QL4--
CITY
NATE()A ZIP(02-5 — A23 A
NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. ,PARTY '
TYPE OF REPORT D�4'i1���4s~,I�}.�� , 'Fy3Pd
CHECK ONE) �•��.`,, p MD. DAY 'gYEAAR��T.
BIH I1)ESDAY :7 5 C-�'1 0 l`t.ci-b b t t b i Pig
PRE!PRIMARY.' f FOR OFFICE;.USE ONLY •
• Z• DATES OF :WO.' ..DAY•. YFhTt:.. '.IRO. ':OAY YEAR
' .' . �
2ND't7tIDAY REPORTING 1// �� ,�...a7I. *] TO �•, C O
PRE MATtY:: PERIOD UlY- vIJJ i ( tV d 3 096/1` ""j
03
QDAY : .' :• 3. M O
POSTPRIMARY. :" rC
CASH BALANCE AT ENDI c
4• OF REPORTING PERIOD: $ —
FREcELECTiON: • 1=1
TOTAL AMOUNT OF FILER'S n 3L
OUTSTANDING DEBTS OR LIABILITIES
2ND'FRIDAY'• 0 `-� CA
:PRE:ELECiiOR j4 AT THE END OF REPORTING PERIOD: $
Z O
-< ..J
YOST-ELECTTON. AMENDMENT. YES
REPOT NO /`
.. .. T2. ..
7 ` /
'ANNUAL TERMINATION ' YES NO Y
REPORT: REPORT?:: • /�,
•
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''A PH trglit.,SEGT,ON,
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 LIABILmES 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 EDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS / /
.10MMONWvEALTF 9.FEE NNEYLVANIA / ON i
1 D Y O nTA���111it A 20 J 7 �SIjGN"�AyTURE OF P DONj ue G REPORT
risty i,.0 :.ro '' ba;/vLi ! brri/ /V/ /f - 1
n t'=• wp O...-f.,. olanty PRINTED NAME
My .mikritikorseRtwmssion Ex.R ,130, 21 /2/
M . DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
i
PART II-
If statement is filed on behalf of a Candidate's Authorized Committee,Candidate must sign here. i
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
I
SIGNATURE
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
i.
DSEB-503(12-99)
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