HomeMy WebLinkAboutMiller, Jake - 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 1110, REPORT FILED CANDIDATE t f/' 9 COMMnTEE' 2, -"LOBBYIST •
NUMBER ON BEHALF OF V 1 __•
_
r NAME OFLING COMMITTEE,CANDIDATE OR LOBBYIST
dui AAIIL
STREET 3Aran &S `
C 61/YttpSTATE ZIP CODE
Muf Tfr / -7b / I
^_
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) �l \ F' MO. DAY YEAR •.
t•. ✓LJA . siA.Per ...,11-M 1/ os a '
p7
6TH TUESDAY'
PRE-PRIMARY FOR OFFICE USE ONLY
.. .-- .MO.. DAY YEAR MO. DAY YEAR
*,i:FR10AYCr;:f:•. 2. DATES OF 11
PRE PitiMARY" RNG upq TO j " e21 /
�2 =F
7L;30 OAY .., 3. m
''::POST=PRIMARY •; Cal -.-.
CASH BALANCE AT END 6 A 1
a. OF REPORTING PERIOD: $ r tt
;:tiYli TtIESDAY: >. fV
:-:PRE-ELECTION;'' ••:
':`: TOTAL AMOUNT OF FILER'S
OUTSTANDING DEBTS OR LIABILITIES -1,
v AT THE END OF REPORTING PERIOD: '$ Of I
. PRE=ELECTION 0
'c3O.DAY.h.:;�.' ,. AMENDMENT • ..�
POST ELECTION YES NO ,"
'. REPORT?
.
'..ANP/IJ) : `;TERMINATIONV
REPORT 'REPORT? YES NO
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 :EPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS(S250.00)AND THIS REPORT IS,TO THE BEST OF MY KN• 'LE.GE f BELIEF,TRUE,CORRECT,AND COMPLETE.
SWORN r AND SUBSCRIBED BEFORE ME THIS ,
*....0,r , C
PERSO UBMITTING REPORT
Croix • 1.-1�(f.e.r
- .�1!_T' �-' NAME
S ,:::,:l., !q �40�oonwealth of Pennsylvania-Notary Seal
MY COMM +N EXPIRESMEGAN ORRIS-Notary Public
MO. DAY YR. Iounty DAY'IME TELEPHONE NUMBER
Py Com^II0on Expires Jai 14,1021
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.
Department of State • Bureau of Commissions,Elections and Legislation
DSE13-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280