HomeMy WebLinkAboutEakin, Jackie - 2015 2nd Friday Pre-Primary 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.
"LER IDENTIFICATION , REPORT FILEO , I. 2. i
NUMBER
CANDMATE CONMRTEE
ON BEHALF OF LOBBYIST
NAME OF G COMMITTEEf.6A' NDIDATE O LOBBYIST
-STREET BB p—���) //1nI ' II
CITY � STAT[ ZIP CODE
✓� �, % %ti S d —
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY
(CHECK ONE) MO.• DAY YEAR.
6TH TUESDAY % c} / `D
PRE-PRIMARY. FOR OFFICE USE ONLY
MO. DAY YEAR- M0. DAY 'YEAR:
2ND FRIDAY Z' DATES OF
PttEPmwiRr PERI "G / /S TO / S
30 DAY 3'
' POST-PRIMARY
CASH BALANCE AT END
6TH TUESDAY a OF REPORTING PERIOD: $
PRE-ELECTION
TOTAL AMOUNT OF FILER'S
6. OUTSTANDING DEBTS OR LIABILITIES
PRE-ELECTI
2H0 FRIDAY
AT THE END OF REPORTING PERIOD: $ L
6.
30 DAY
AMENDMENT '
POST-ELECTION YES NO
REPORT?
7.
ANNUAL TERMINATION
REPORT REPORT? YES NO
AFFIDAVIT SECTION
PARTI -
If statement is filed on behalf of a Political Committee orCandidates'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.
S �O AND SUBSCRIBED BEFORE ME THIS
DAY OF \ 20I v SI
/ •JURE OF PERSON SUBMITTING REPORT
_ I/� E%S l<�//t
z
PRINTED NAME
Y COMMISSIL#tNO TA AL / 7 ,.>J/ S - �'b
Notary PublicMo. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
PART - My Commission Expires Oct 7,2017
If statemen IS I e on e a o a an Idate'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 MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
DSEB-503(12-99)