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HomeMy WebLinkAboutFriends of Jim Hertzler - 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 CANDIDATE COMMITTEE I LOBBYIST NUMBER 111 ON BEHALFLF O OF 10, I \ NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST STREET ADDRESS Q . ©. ?)O ( L3 CITY 0),-- STATE ZIP CODEE p a s TYPE OF REPORT NAME (OF(('��OFFICE SOUGHT BYCANDIDATE C\ DISTRICT NO.1PARTY \��(�\ DATE OF ELECTION (CHECK ONE) 1. CAN1-\ c O\ MSS- " Y - ✓V I \ 05 2\ YEAR 2- 2V 6TH TUESDAY . PRE-PRIMARY FOR OFFICE USE ONLY MO., DAY YEAR MD.. DAY i YEARDATES OF - -- 2ND FRIDAY PRE-PRIMARY 2 PER ODTING 65 O -1t ` TO OG 1 O �OII� g • I 30 DAY / = 4 POST-PRIMARY CASH BALANCE AT END QQQ.c f 6TH TUESDAY 4. OF REPORTING PERIOD: $ C�� VV UU I ' PRE-ELECTION 33 = TOTAL AMOUNT OF FILER'S '. 5• OUTSTANDING DEBTS OR LIABILITIES O 2ND FRIDAY AT THE END OF REPORTING PERIOD: $ .-4.- PRE-ELECTION S. 0 3C 30 DAY POST-ELECTION REPORT? YES NO 7. ---1 N ANNUAL TERMINATION YES NO M 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 LIABILITIES 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. SWORN TO AND SUBSCRIBED BEFORE ME THIS , ,,,,,, d- /4..g.id 20 SIGNATURE OF P RSON "ITTING REPORT r ( ...3:LAGEL PENNSYLVANIA 4,y� i 1 WiI '�� 'T PublicPRINTED NAME t nsboro Twp. i ,,, f 1/ 8a OG MY C•t^ �b4 pilla - Il t', erianr?L. , 4, OZ � ) ( — .G 'Irk• ay30o21)21 YR. AREA CODE DAYTIME TELEPHONE NUMBER MEMBER.PENNSYLVANIAASSOCIArioN or NOTARIES 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