HomeMy WebLinkAboutAnthony, John - 2015 2nd Friday Pre-Primary Commonwealth of Pennsylvania
PAGE 1 OF
CAMPAIGN FINANCE REPORT (COVER PAGE)
(NOTE: This report must be clear and legible. It may be typed or printed in blue or black ink.)
all
Filer Identification , Report , t. 2. 3.
Number: Filed By CANDIDATE COMMITTEE LOBBYIST
Name of Filin mfiitt ee Can date o Lo by'st
V v ry
State: illly.)i
Zip Code:
TYPE OF OTH TUESDAY 1. 2ND FRIDAY 2. / 30 DAY 3. AMENDMENT
REPORT
PRE-PRIMARY ' PRE-PRIMARY POSTPRIMARY REPORT? YES NO
OTH'TUESDAY 4. ' 2ND FRIDAY - 5. 30 DAY O' TERMINATION YES NO
(place X to PRE-ELECTION PRE-ELECTION POST ELECTION REPORT?
the right of ANNUAL 7. YEAR FILING`PAETHOD
REPORT
report type) 1 ( i CHECK ONE , PAPER DISKETTE
Name of Office Sought.4x Candidate: I • • District Office I Party Cc my
Number Code I Code Code
(SEE INSTRUCTIONS FOR CODES)
FOR OFFICE USE ONLY.
and Expenditures from:
MO. .DAY YEAR MO.. DAY -YEAR
Summary of Receipts 011, To C
A. Amount Brought Forward From Last Report $
B. Total Monetary Contributions and Receipts (From Schedule 0 $ —
C. Total Funds Available (Sum of Lines A and B) $
D. Total Expenditures (From Schedule III) $ S 2
E. Ending Cash Balance (Subtract Line D from Line C) $
F. Value of In Kind Contributions Received (From Schedule 10 $ 7 (? _ 7
G. Unpaid Debts and Obligations (From Schedule IV) $ -e� _
AFFIDAVIT
PART 1 — If this is a Committee report. treasurer sign here. If this is a Candidatereport candidate sign here.
I swear (or affirm) that this report, including the attached schedules, on p4Are.
, are the best of my knowledge and belief true,
correct and complete.
Sworn to and subscribed before me,, this \\��
+X- day of \ \l���l 20 k5rtur$ pna reMyZAMEMW cammiDAV YR. Daytime Telephone Number
It
PART II — i LPJafb tl Of a Candida 's Authorized Committee, candidate shall sign here.
I we r (or IIyaQlildns�feAetl��If € 0t -k owle ge and belief this political committee has not violated any provisions of the Act of June 3, 1937
Sworn to and subscribed before me this
day of 20
Signature of Candidate
Signature Printed Name
My commission expires
M0. DAY YR. Area Code Daytime Telephone Number
i
Department of State • Bureau of Commissions, Elections and LegislationV,
303 North Office Building • Harrisburg, PA 17120-0029 • (717) 787-5280 _
DSEe-502 (7-99)
PENNSYLVANIA CAMPAIGN FINANCE REPORT
This Report must be typed or printed leaib/v in blue or black ink.
INSTRUCTIONS
This form is intended for the use of candidates, political committees and contributing lobbyists who are required to disclose
contributions and expenditures. Candidates must file separate reports when they make expenditures or receive contributions on their
own behalf and separate from their campaign committee. A candidate's report discloses contributions received and expenditures made
individually by the candidate. A contributing lobbyist's report discloses only expenditures the lobbyist personally made to influence the
outcome of a candidate's election.
Candidates and their authorized political committees file reports in the office where their nomination documents are filed. If the
candidate's reports are filed with the Secretary of the Commonwealth, a copy of the reports filed by the candidate and the authorized
committee must be filed with the County Board of Elections in the county in which the candidate resides.
REPORT COVER PAGE
The Report Cover Page identifies the filer, the type of report and what reporting period is covered. It also summarizes the detailed
contribution and expenditure sections from the body of the report.
Fifer Identification Number- This number is assigned by the Bureau of Commissions, Elections and Legislation to candidates
and committees who register and file with the Secretary of the Commonwealth. A candidate's filer identification number is
assigned by the Bureau when the candidate files nomination petitions. A politica/ committee or lobbyist filer identification
number is assigned when the committee or lobbyist files registration documents in the Bureau.
Report Filed By- Please indicate which type of filer you are by checking the appropriate box on the cover page.
Name of Filing Committee, Candidate or Lobbyist, Street Address, City, State, Zip Code - Please enter appropriate name and
address.
Type of Report- Please place an "X"by the applicable report type.
Amendment Report- Check "Yes"only if the report is being filed to correct, add to, or in some way change a report that has
already been filed.
Termination Report - Check "Yes" only if the filer has no cash balance, no unpaid debts or obligations, and wishes to cease
operation. Contributing lobbyists may file a termination report if they do not anticipate making further contributions to
influence the outcome of a candidate's election.
Filing Method- Indicate whether the complete report is filed on paper, or if the report is filed by diskette accompanied by the
signed and notarized cover sheet.
Name of Office Sought- If filed by a candidate or candidate's committee, indicate office sought.
Date of Election - If this is a pre- or post-primary/election report, indicate the date of the primary or election.
District Number- If filed by a candidate or candidate's committee, indicate district in which candidate is seeking office.
Office Code, Party Code and County Code- If filed by candidate or candidate's committee, refer to code charts at the back of
this report form. Enter the corresponding code letters for the office sought and the political party of the candidate; enter the
corresponding code number for the county of residence of the candidate. Candidates for,�zyaL f�,ces:wbq,*gwih the
County Board of Elections should enter Office Code OTH for Other Offices.
L..m.-..�:� -•-
Summary of Receipts and Expenditures- Enter the appropriate dates of the reporting period covered
Amount Brought Forward From Last Report (Item Al - The balance, if any, as of the first day of the reportingperiod. _.Por
committees, it is the amount reported as the ending cash balance on the previous report filed, if any:
Items B through G- See detailed instructions on each corresponding schedule.
Affidavit Section - Must be sworn to by the filer acknowledging the accuracy of the report (Part I). On reports filed by a
candidate's authorized committee, the candidate must sign an additional affidavit (Part II).
Page Number- Calculate the total number of pages in the completed report and indicate on top of cover page. Subsequent
pages should be numbered consecutively.
Reports Filed on Diskette: The cover page must accompany all filings, including diskette filings. Diskette filings must also meet the
technical specifications of the Department. These specifications are available at www.dos.state.pa.us or by contacting the Bureau.
SCHEDULE II PAGE OF
IN-KIND CONTRIBUTIONS AND VALUABLE THINGS RECEIVED
USE THIS SCHEDULE TO REPORT ALL IN-KIND CONTRIBUTIONS OF VALUABLE THINGS
DURING THE REPORTING PERIOD.
Detailed Summary Page
Name of Filing Committee or Candidate Reporting Period
From To
1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED - VALUE OF $50.00 OR LESS PER CONTRIBUTOR
TOTAL for the Reporting Period (1) $ _
2. IN-KIND CONTRIBUTIONS RECEIVED - VALUE OF $50.01 TO $250.00 (FROM PART F)
TOTAL for the Reporting Period (2) $ �
3. , IN-KIND CONTRIBUTION RECEIVED - VALUE OVER $250.00 (FROM PART G)
TOTAL for the Reporting Period (3) $ 26> . OU
TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THIS
REPORTING PERIOD (Add and enter amount totals from Boxes t , 2,
and 3; also enter on Page 1 , Report Cover Page, Item F.)
DSEB-502 (7-99)
SCHEDULE II PAGE OF
PART G
IN-KIND CONTRIBUTIONS RECEIVED
VALUE OVER $250.00
Name cN Filing Co mittee r Candid a Reporting Periods \per
From /' I �'To /
DATE AMOUNT
[Emplibyer
Nam f trib o MO. 'DAX YEAR
O rV/^'1T $ �� r QU
ing Adtlress / MO. . DAY YEAR
St a Zip Code P s 4) -M0.' 'DAY YEAR $
1� dos
of Contributor Occupation
Employer Mailing Address/Principal Place of Business Description of Contribution
Full Name of Contributor MO. DAY YEAR
$
Mailing Address MO. DAY. YEAR:: $
City State Zip Code (Plus 4) MO. 'DAY YEAR $
Employer of Contributor Occupation
Employer Mailing Address/Principal Place of Business Description of Contribution
Full Name of Contributor MO. DAY. .YEAR $
Mailing Address MO. DAY NEAR $
City State Zip Code (Plus 4) =MO." DAY YEAR
Employer of Contributor Occupation
Employer Mailing Address/Principal Place of Business Description of Contribution
Full Name of Contributor MO. DAYYEAR
$
Mailing Address MM —.DAY .YEAR $
City State Zip Code (Plus 4) MO. DAY a YEAR
$
Employer of Contributor Occupation
Employer Mailing Address/Principal Place of Business Description of Contribution
Full Name of Contributor -/MO. - 'DAY". YEAR.`
$
Mailing Address MO.. ` DAY YEAR $
City State Zip Code (Plus 4) MO. DAY. YEAR
$
Employer of Contributor Occupation
Employer Mailing Address/Principal Place of Business Description of Contribution
PAGE TOTAL
Enter Grand Total of Part G on Schedule II, In-Kind Contributions Detailed U
Summary Page, Section 3.
DSEB-502 (7-99)
• SCHEDULE III PAGE OF
STATEMENT OF EXPENDITURES
Name SL-EU mmit ee or n idate Reporting rlp�-�j p _
From T / l �To
To Who Pad —U 1.1 \ f^-- - /✓( MO.. 'DAY yEnp mOugL
S
Mailing dr ss Descr' 'on of Expendit re
c , - 'w
City 1 / Q e Z'p Code (Plus 4)
v� I �0ST-
To W om aid MO. I DAY I YEAR moon
Mailing Address D tiop o1 Expen iture
(\ S
City State Zip Code (Plus 4)
To Whom Paid '. MO. "DAY 1 YEAR ..' mount
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
To Whom Paid MO. I DAY I YEARJAmount
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
7o Whom Paid M0. DAV YEAR mount
Mailing Address Description of Expenditure
City State Zip Code (Plus 41
To Whom Paid MO. I }':DAY.,. YEAR Amount
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
To Whom Paid "MO. DAY I YEAR Amount
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
To Whom Paid --MO. I DAY 1 YE4R JAMount
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
PAGE:iQY'/1
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D. $ L
DSEB-502 (7-99)