HomeMy WebLinkAboutPA Assoc. of Ambulatory Surgical Centers - 2019 Annual Report 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 10. 2 0 0 7 0 1 7 REPORT FILED 110.
CANDIDATE I 2..,
COMMITTEE A LOBBYIST 3.
NUMBER ON BEHALF OF
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
Pennsylvania Association of Ambulatory Surgical Centers
STREET ADDRESS
423 North 21st Street, Suite 104, American Office Center
CITY STATE ZIP CODE
Camp Hill PA 17011
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF.ELECTION
(CHECK ONE) MO, DAY YEAR
1.
6TH TUESDAY
PRE-PRIMARY FOR OFFICE USE ONLY
MO. I DAY YEAR MO, DAY I YEAR
2. DATES OF
2ND FRIDAY
REPORTING
PRE-PRIMARY 01 01 2019 TO 03 31 6019
PERIOD
0'
3.
30 DAY
POST-PRIMARY
CASH BALANCE AT END 0. 00 CA
4. OF REPORTING PERIOD: $ 61 7
6TH TUESDAY
PRE-ELECTION 7.7
TOTAL AMOUNT OF FILER'S
s. OUTSTANDING DEBTS OR LIABILITIES 7>000
2ND FRIDAY
PRE-ELECTION . t N
AT THE END OF REPORTING PERIOD: $
Cir
6,
AMENDMENT
POST-ELECTION
30 DAY YES NO X (41) I 3
REPORT?
7,
ANNUAL TERMINATION
REPORT X wig g to
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 LIABILITIES INCURRED DURIN- -- -.", '-•- "P 100 INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE . E, ‘ORRECT AND COMPLETE.
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SWORN TO AND SUBSCRIBED BEFORE ME THIS
.00111111111".- - •
...___
SIGNATURE OF PERSON SUBMITTING REPORT *
DAY OF Ape, 20 i q
F. Wilson Jackson, M. D.
PRINTED NAME % b0
c(00... ---..."--1,1: IGNAT(URE. C",$1' .%
MY MISSION EXPIRES 001— '?,5— ?{)).() 717 761-0930 -Cs' - % 0 ol•-
MO. DAY YR. AREA CODE DAYTIME TELEPI-It,. 7.4*4.7.0.i:7 k‘z,
.4.." 41 eibt‘,A,CZ‘Z . ,
PART II-
\cc.e; 430C tA
If statement is filed on behalf of a Candidate's Authorized Committee, Candidate must sign h- ep..°.,R.,40_40,•40)
ccfr c5r-
I SWEAR(OR AFFIRM)THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THIS POLITICAL COMMITTEE HAS NOT VIOLATED ANY PRO "k's• 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
210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280
DSEE3-503(12-9))
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