HomeMy WebLinkAboutBurt, Dwayne - 2015 2nd Friday Pre-Primary Commonwealth of Pennsylvania PAGE I 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.)
Filer Identification ► Report 2. 3.
Number: Filed By CANDIDATE COMMITTEE .LOBBYIST
Name of Filing Committee, Candidate or Lobbyist:
117u/A ,UE- 1434"1-7—
Street Address:
City: State: Zip Code:
TYPE OF eTH TUESDAY 1. LPRE-ELECTION
2' 30 DAY 3' AMENDMENT YES NO
REPORT PRE-PRIMARY POST PRIMARY REPORT?
STH TUESDAY- a' S' 30 DAY e' TERMINATION
PRE-ELECTION POST ELECTION. REPORT? YES ' NO
(place X tothe right of -ANNUAL 7. FILING METHOD
report type) REPORT { ) CHECK ONE-, PAPER DISKETTE.
Name of Office Sought by Candidate: r • • a District Office I Party I County
7� MO.` DAY YEpp' Number Code Code Code
�
Ad /-t� (SEE INSTRUCTIONS FOR CODES)
FOROFFICE'USE ONLY
MO- DAY :YEAR MO. 'DAY YEAR`.
Summary of Receipts
and Expenditures from: Pho. To
z
A. Amount Brought Forward From Last Report $
B. Total Monetary Contributions and Receipts (From Schedule 1) $
C. Total Funds Available (Sum of Lines A and B) $
D. Total Expenditures (From Schedule 111) $ /"
E. Ending Cash Balance (Subtract Line D from Line C) $ _
F. Value of In—Kind Contributions Received (From Schedule 11) $ 77 --
G. Unpaid Debts and Obligations (From Schedule IV) $
sees
AFFIDAVIT a
PART I — If .this is a Committee :report, treasurer sign here. If this is a Candidate reportcandidate sign here.
I swear lot affirm) that this report, including the attached schedules, on paper or computer diskette, are to the best of my knowledge and belief true,
correct and complete.
Sworn to and subscribed before me this
e ,
day of 'k 20L
Sign a of Person Submitting Report
11 N(TI c _ /X x//41 T
Si nature T Printed Name
C"101 EA 0 PE�IfIS ;6M
My co
BETHANY SA AULO DAY YR. Area Cade Daytime Telephone Number
PART — Nate Authorized Committee, candidateshall sign'. here.
I swear ge 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
day of 20
Signature of Candidate
Signature Printed Name
My commission expires
MO. DAY YR. Area Code Daytime Telephone Number
Department of State • Bureau of Commissions, Elections and Legislation
303 North Office Building • Harrisburg, PA 17120-0029 • (717) 787-5280
DSER-502 (7-99) AO
-_
PAGE OF
SCHEDULE III
STATEMENT OF EXPENDITURES
NamJe�of Filing Committee or Candidate Reporting Period '/
From Z- -/-S To J'" T- /._5
To Wh Paid TAO: DAV YEAR
mount
Mailings,Address Description of Expenditure
City State Zip Code (Plus 4)
A It �iAI II Gr✓�
To Whom Paid `.MO. .:DAY YEAR JAmount
Mailing Address Description of Expenditure
VY�
City State Zip Code (Plus 4)
To Whom Paid MO. 'DAY YEAR " mount
�. 3
Mailing Address Despr iption of Epxp�entl�i
City I State Zip Code (Plus 41
To Whom Paid MO. DAY YEAR. jAmount
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
To Whom Paid `:'MO. -DAY YEARI.; mount
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
To Whom Paid cr MD. -DAYYEARmount
-.
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
To Whom Paid rMO. EDAY : .YEmount
AA
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
To Whom Paid '.MO. :DAY YEAmount
H
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
PAGE TOTAL
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D. $
DSEB-502 (7-99)