HomeMy WebLinkAboutCapozzi, Shelly - 2019 2nd Friday Pre-Election 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 loo. REPORT FILEDL� 2. L O 3.
NUMBER
ON BEHALF OF O. :CANDIDATE. ' COMMITTEE`.' 'LOBBYIST`.
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
‘S> t^ Ck,10072t
STREET ADDRES
i; P ike_,
CITY STATE ZIP CODE
C64—Lisle OA /7a/. —
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) MO DAY: YEAR
717— YDS Pc 4, - 11 65-- z01 g
G7H TUESDAY
PRE-PRIMARY FOR OFFICE USE ONLY
MO... .; :.DAY YEAR> : ':MO. -:'DAY :.YEAR.:. ..:...:.... .. :: ..
2ND FRIDAY: 2' DATES OF
PRE-PRIMARY REREPORTING / I) TO 0 ?....i Z-019 n, ♦a
l!? / CO
30 DAY ' rn "-4
POST-PRIMARY
CASH BALANCE AT END yam„ N
6TH TUESDAY 4' OF REPORTING PERIOD: $ 0 CI
PRE-ELECTION -'a
TOTAL AMOUNT OF FILER'S C7 Z
OUTSTANDING DEBTS OR LIABILITIES
PND FRIDAY ✓ AT THE END OF REPORTING PERIOD: $ 0 C
PRE-ELECTION —4 N
6. -< X'
30 DAY AMENDMENT
IO
POST-ELECTN YES NO
REPORT?': :
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 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($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
swo
S TO
DAY OFUB$QRED BEFOREME THIS 20� SIGNAT R N U RTING REPORT
(! /moo, +d �tRE OF PE
� M
co •ennsylvania-Notary Seal PRI ED NAME
SIGNATURE N ORRIS-Notary Public
MY COMMISSION EXPIRES Cumberland County I 1 ''-7 / -7 Zo C-i •
MO. DA) My("emission Expires Jan 14,2023AREA CODE DAYTIME TELEPHONE NUMBER
Commission Number 1260066
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) 8