HomeMy WebLinkAboutFulham-Winston, Deb - 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 IDENTIFICATIONI.
NUMBER ' REPORT FILED
ON BEHALF OF 10, CANDIDATE. .I.
COMMITTEE 2. LOBBYIST
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
STREET ADDRESS '
1(( 2, U3N,AtL V C-4-'
CITY STATE
CM \i s 1 ZIP CODE�- ( Q/ — 3733
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) CAP-`isS. a '( (^�J C.6-tumU'L MO. -' DAY YEAR Z
6TH'TUESDAY' 1. ( U 7 Z(�I I
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR: . MO. -.DAY "YEAR. .. .
2• DATES OF FRIDAY -- p_
PRE-PRIMARY REPORTING 1 o Z t( 2c. \' TO 1( 21 ZO(7 La.. -"r
PERIOD l 1
30 DAY . . . 3' 70 C-")
POST-PRIMARY I'-- I
CASH BALANCE AT END D >0 Q,
4. OF REPORTING PERIOD: --
6TH TUESDAY". CI -•,0
PRE-ELECTION
TOTAL AMOUNT OF FILER'S C
5• OUTSTANDING DEBTS OR LIABILITIES N
2ND FRIDAY AT THE END OF REPORTING PERIOD: $ d 2
PRE-ELECTION G0
6 i/// 1� C!1
3O DAY
POST ELECTION. AMENDMENT YES NO /
REPORT?
ANNUAL TERMINATION... YES NO (//'REPORT' REPORT
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 UABILITIES 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 KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
SWPRN[O AND SUBSCRIBED BEFORE ME THIS f I/� i, \' C ( r
`t r/\DAY OF�, 0 v 20 �{`J 1/SIIGGNATURE OF PERSON lSUBMITTING REPORT
it I u I. , tis - 1\1(11-716/i
1 %,A K-cG P-m-03 ins i49Ar\
,.::A'RR;ej sa14X3 uolsslwwo3 Ally PRINTED NAME
MY COMMISSION EXF RESuNnOO ONV1I131aWn10'01109 31SIl1IV3 `711 ZSR - I('t
MO. •IIUII4,1p¢EIUN YR. AREA CODE DAYTIME TELEPHONE NUMBER
311HM1S139 31801
1V3S 1VIHYION
PART II- 41101/01s a..4n unvllur, w o� .
If statement is filed on behallf a Candidate s Sutllorized 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.
DSEB-503(12-99)