HomeMy WebLinkAboutFriends of Jim Hertzler - 2018 2nd Friday Pre-Primary 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 I 3
CANDIDATE COMMITTEE X LOBBYIST —NUMBER ON BEHALF OF0.
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
-_ y1-'Ij1 tri I(;� 1/
TREET I \1 SS
E N1 OF r \ 1 iE KT I
Y. 0- BOXY
CITY V q L k STATE ^ 1 CODED D5 —
TYPE OF REPOURT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY i`t 1M� DATE OF ELECTION
(CHECK ONE) MO. DAY YEAR
1. CV V Y c O I l l- r65 "MER a l L ETI 7-5 I ( 20 • ..
6TH TUESDAY
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY I YEAR
2ND FRIDAY V DATES OF 0 (J�)
PRE-PRIMARY PER ODTING I 0) poi TO \/a 3D Dula
30 DAY 3'
0
POST-PRIMARY
CASH BALANCE AT ENDmow.
4. OF REPORTING PERIOD:
6TH TUESDAY ��� S
PRE-ELECTION rn
TOTAL AMOUNT OF FILER'S T"' -t
2ND FRIDAY 5. OUTSTANDING DEBTS OR LIABILITIES
PRE-ELECTIONAT THE END OF REPORTING PERIOD: $ 0
30 DAY \
POST-ELECTION AMENDMENT YES NO 'X =="' 0
REPORT
7. CO
ANNUAL TERMINATION YES NO `•4
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 filedonof a Candidate,the Candidate must sign here.
a Contributing Lobbyist,the Lobbyist must sign here.
NOTARVittedIAL IMFy b
EAL
C 1���E�;4 � REGNE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
i, , ..FIPhlihl JflLLAF-S(S250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
MYCOtl7tnl y_.I•'1M:yi;L rAn
� IRE ME THIS 7"P L _ ,
DAY OF ILO, , 20 /F SIGNATUR OF PERSON SU�ITTING -'-ORT
�� t , / ,,i -1 � -Wto F 1 F Ol►� .kct_k
PRINTED NAME
—•IGNAURE
/ii,.., g0 — vV ql:
MY COMMISSION EXPIRES � ®� O`/J Op2.o
MO. DAY YR. AREA COD DAYTIME TELEPHONE NUMBER
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
DSEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280