HomeMy WebLinkAboutMiller, Jake - 2019 30-Day Post-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 IDENTIFICATIONREPORT FILED I. L B - • 3.
NUMBER 100, ON BEHALF OF 0, CANDIDATE 'COMMITTEE LOBBYIST
NAME OF FILL G COMMITTEE,CANDIDATE OR LOBBYIST
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STREET ADDRESS
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CITE'() ` �/ STATE ZIP CODE
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TYPE O NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) � . MO. DAY' YEAR::
6TH TUESDAY •. A ✓ t
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO, DAY YEAR
: • 2' DATES OF �C
)
-2ND:FRIDAY G
REPORTING TOPRE-PRIMARY .: PERODU✓ 07 ^_ ? 0 rA ?oil
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30 DAY-.• 3-. / __ '."r' =
POST- PRIMARY' V ® 33CASH BALANCE AT END GJ
6TH TUESDAY ' OF REPORTING PERIOD: $ ! .. .:.
• PRE-ELECTION- :
TOTAL AMOUNT OF FILER'S C)
OUTSTANDING DEBTS OR LIABILITIES Q 00 0
2ND ELIDAY AT THE END OF REPORTING PERIOD: $ (/v r'"3
PRE-ELECTION. Z Go
8. 'PO
30 DAY AMENDMENT
. POST ELECTION YES NO
REPORT?
7. - --
ANNUAL:. TERMINATION ,
REPORT.:.` . :.REPORT? YES NO ;Y]�`
AFFIDAVIT SECTION
PART 1 -
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°URI.- H REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY ^\-•- 0 .A I BELIEF,TRUE,CORRECT AND COMPLETE.
SWOR/JV�--TO AND SUBSCRIBED BEFORE ME THIS
.46,1 ANIL
i 3 •DAY OF (LA 12J� ?o (1 NATURE OF PERSON SUBMITTING REPORT
-
Commonwealth of Pennsylvania•Notary Seal J �f�j T P
.//�? MEGAN ORRIS•Notary Public G C oL b c
v�/ SIGNATURE Cumberland Cearty PRINTED NAME
My m si Expires Jan 14,2023 1
MY COMMISSION EXPIRESs.j&A• I a ' Number 1260066 .. 7- L{ s1- 3
61 -
MO. DAY YR. AREA CODE lL DAYTIME TELEPHONE NUMBER
PART I1-
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(EL.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