HomeMy WebLinkAboutBurt, Dwayne - 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 IDENTIFICATION O. REPORT FILED / 2. - 3.
NUMBER
ON BEHALF OF /1111' CANDIDATE: /X` COMMITTEE.. LOBBYIST.:.
NAME OF RUNG COMMITTEE,CANDIDATE OR LOBBYIST
_,PRI> )/IGS "Fel-67--
STREET ADDRESS
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CITYE
cm -, / v� STATE ZIP/7a -
TYPE OF REPORT NAME OF OFFICE
SOUGHT BY CANDIDATE
�/"j ' DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) l'�`- - J��Ij�r/�/i'— MO' DAY. ; -: YEAR
S =.2 /9
GTH TUESDAY
PRE-PRIMARY FOR OFI9CE USE ONLY
MO.. DAY. :YEAR...... .'SMO. DAY ..-:-YEAR
2ND FRIDAY! 2' DATES OF
PRE-PRIMARY REPORTING TO
PERIOD 7 /� 6 to /12
/
3O DAY 33 ` }
POST-PRIMARY +" ,
..to
CASH BALANCE AT END L
Girl TUESDAY 4. OF REPORTING PERIOD: $ k_537 erel 4":1
PRE-ELECTION r
TOTAL AMOUNT OF FILER'S :>> N
CI
5. OUTSTANDING DEBTS OR LIABILITIES "
PRE-ELE TION AT THE END OF REPORTING PERIOD: $2ND FRIDAY _ -,
C) 3'.
B. C)
:3fl DAY : AMENDMENT C
POST-ELECTION :> y....
REPORT?: YES NO �°
7. -G
ANNUAL TERMINATION YES NO REPORT REPORT?
AFFIDAVIT SECTION
PART I-
If statement is filed on behalf of a Political Committee or Candidates's Committee,the Treasurer must sign here.
If statement is filed on behalf of a Candi• - = the Candidate must sign here.
If statement is filed on behalf of a Contr•5%• •bbyist,the Lobbyist must sign here.
I SWEAR(OR AFFIRM)THAT THE AGGREGATE REC TS OR DI ;,IyI- 4 S OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($ •.0O)AND TI 1€#"'P TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT D COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME S 0��jIsG/6P'is,Hyi,,d r
/
v v DAY OF �7rs17 d 0 d p p - SIGNAT f OF PERSON SUBMITTING REPORT
4
' . . _ i� 7Z60jPRINTED NAME
'`AIUR066p1'
Li , D.. 3 / 7 A —,--.j/i9=?
MY COMMISSION EXPIRES
MO. DAY YR. AREA CODE 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.
DSEB-503(12-99)