HomeMy WebLinkAboutGossert, Michael - 2021 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 - I.
' REPORT FILED
ON BEHALF OF '. :CANDIDATE COMMITTEE 2. LOBBYIST O•
NUMBER
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
/11.1 c-4 e ( Gs.s E. s"{—
STREET ADDRESS
67Q CA�vlc.4../ I(ea_ k 3 c-
CRY (_ STATE ZIP CODE
✓ .' t_ ' c_4aCC . 7 V4- ( ?U(-t —
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) / ,
' r. /� MO. DAY YEAR
1. �.�CAULL la H Li `cLy ���
6TH'7UESDAY` ';i
PRE-PRIMARY'' FOR OFFICE?USE ONLY
:.. :MO. •DAY:. YEAR .MO.
No FRIDAY 2. DATES OF
PRE`PRIMARY PERIOD NG f TO ID / ('-' Off'
30'DAY 3. .1., ".
POST-PRIMARY h c
CASH BALANCE AT END "-'.
6TH TuesuaY...;: 4' OF REPORTING PERIOD: $ F..- I.
PRE-ELECTION Cil
TOTAL AMOUNT OF FILER'S M
2ero'FrRmi►r OUTSTANDING DEBTS OR LIABILITIES lj
PREELECTION, AT THE END OF REPORTING PERIOD: $ /I
s.
4w N
30 DAY \, , c>
POST-ELECTION AMENDMENT YES NO -\ CD
REPGRT�
REPORT TERMINATION. YES
REPORT? 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 DISSURS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND TH EPO 0I TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CO ND COMPLETE.
4.
SWO1:11/71...O AND SUBSCRIBED BEFORE ME THIS t NI$ /,
DAY OF r iroJ NATURE OF PERSON SUBMITTING REPORT
Cr6ONATuR—LiA-A-/-A----
t'ti c d2.`�i'a /1/f CLO, l /4 GCC;C'-- jam`-/ ��a�� Vg„ .94x,1, ~ PRINTED NAME
MY COMMISSION EXPIRES d 1 - L ) �j��91 c 7 3o 3 - 6 S/6S
MO. DAY vol. 66�C? A 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)