HomeMy WebLinkAboutBirbeck, Jonathan - 2017 30-Day Post 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 FREDCANDIDATE COMMITTEE.. Z LOBBYIST 3
NUMBER ON BEHALF OF Op .....
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
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STREET ADDRESS
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CITY/„. STATE ZIP CODE
IS le r A- 1 70 1
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE /DIISTTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) 1)3" l/l a-Q g/D
MO.. -. DAY YEAR,. t 7 2011
6TH TUESDAY
PRE-PRIMARY FOR OFFICE USE ONLY
-MO.-- -DAY YEAR MO. DAY YEAR
2ND FRIDAY, 2. DATES OF
PRE-PRIMARY : REPORTING 1,1 fl4 ,7 TO 1 1 n 7 1
PERIQD V [i \ L
30 DAY a
POST-PRIMARY:._
CASH BALANCE AT END rjf
6TH TUESDAY a' OF REPORTING PERIOD: $ C)SCJ
PRE-ELECTION o
TOTAL AMOUNT OF FILER'S —..1
2ND FRIDAY s_ OUTSTANDING DEBTS OR LIABILITIES f CD Q
PRE-EL
,LECTION AT THE END OF REPORTING PERIOD: $ MI
7) C'D
s. I I
30 DAY > c_n
AMENDMENT..
POST-ELECTION' 1, YES NO X
REPORTS C
7. -T7
ANNUAL - TERMINATION C)
REPORT REPORT? YES / NO C N
a AFFIDAVIT SECTION
E
.V PAIN-
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If st .ment is filed on behalf of a Political Committee or Candidates's Committee,the Treasurer must sign here.
u, a. If§,teltement is filed on behalf of a Candidate,the Candidate must sign here. J
z a a if Vt5tement is filed on behalf of a Contributing Lobbyist,the Lobbyist must sign here. /
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D. (q O p UPS€ .AR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS CR LIABIUTIES ' - ED DURING E REP'-- I.G PERF II DILA 0 ABOVE DID NOT
I.L. J Z as-f€XimED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BES'OF MY N WLE' :AN. *ELI: ,TRU" 'RR • AND COMPLETE.
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I SWORN TO AND SUBSCRIBED BEFORE ME THIS
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O°C V y DAY OF ;C 1 M Ibe.., ( uL.„D,r- 20 .! • 1 RE OF rN ytr P.vrn G REPORT
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SIGNATURE PRINTED NAME
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2 V>„MY COMMISSION EXPIRES l Q I t C)\ 2_I F. p(a l.Q Vd V '�
O 2 MO. DA YR. - CODE DAYTIME TELEPHONE NUMBER
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PART II-
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
DS.EB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 a (717)787-5280