HomeMy WebLinkAboutHertzler, Jim - 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.)
Filer Identification ► Report , 1. 2. 3.
Number: Filed By: CANDIDATE COMMITTEE :LOBBYIST
Name of Filing C mmittee, Candidate or Lobbyist:
l
Street Address:
City: A IJ V" 1 State: J'1 ,il /p` DoCSr —
IN
TYPE OF 6TH TUESDAY 1. 2ND FRIDAY 2Y 30 DAY [//�/,/�(( 3 AMENDMENT YES NO
REPORT PRE-PRIMARY PRE-PRIMARY J� POST PRIMARY REPORT?
6TH TUESDAY 4. :2NDFRIDAY . 5. 30 DAY 6. TERMINATION
PRE-ELECTION PRE-ELECTION POSTELECTION" -REPORT? YES NO
(place X to
the right of ANNUAL 7. YEAR FILING METHOD
report type) REPORT t l CHECK ONE , PAPER DISKETTE.:
Name of Office Sought by Candidate: rO. •DAYEAR• District Office Party County
Number Code Code Code
Mr /9Y !(?
S ` L �•D/ (SEE INSTRUCTIONS FOR CODES)
FOR.OFFICE USE ONLY
Summary of Receipts Mo. DAY �7vsaR MD. DAY YEAR
and Expenditures from: , �5 �/ To
A. Amount Brought Forward From Last Report $
B. Total Monetary Contributions and Receipts (From Schedule 1) $ O
C. Total Funds Available (Sum of Lines A and B) $ O
D. Total Expenditures (From Schedule III) S 00 • no
E. Ending Cash Balance (Subtract Line D from Line C) $ d J
F. Value of In—Kind Contributions Received (From Schedul711) 7-$ID S Q
G. Unpaid Debts and Obligations (From Schedule IV) S
AFFIDAVIT
PART I — If this is a Committee report, treasurersign here. If this is a Candidate report candidate sign here.
I swear (or affirm) that this report, including the attached schedules, on paper or computE' are to the best of my knowledge and belief true,
correct and complete.
Sworn to,,and
subscribed before me this
Tr,
day of �� \I 20 Ej
.,., ignature of Pe son Submitting qe o
VA_L6 A( 144
L Mi16MLNANIA Pri�ntjed Name
My co mission eyg TARIAL SEAL 7 / ;2
DAY YR. Area Code Daytime Telephone Number
NA01ar Pub is
PART — Qllbidat s Authorized Committee, candidate shall sign,here.
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
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 O Harrisburg, PA 17120-0029 • (717) 787-5280
DSEB-502 (7-99)
PAGE OF
SCHEDULE III
STATEMENT OF EXPENDITURES
Name of Filing Committee or Candidate Reporting Period
From To
To Whom Paid 'MO. ` DAV YEAR mount
Cl
Meiling Adr'
s 13 Description of Expenditure
o. cs
Cityt Zip Code (Plus 4)
L � a0.25 -,Poo
To Whom Paid MO. `✓DAY YEAR mount
G �B tse� .� Y S� o2D� oo• a
Mailing Address Descript' of Expenditure
City I state Zip Code (Plus 4)
To Whom Paid " MO.. "DAY YEAR.]Amount
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
To Whom Paid MOC '.'.DAY YEAR ]Amount
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
To Whom Paid MO. =DAY YEAR mount
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
To Whom Paid MO. DAY r YEAR JAMounl
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
To Whom Paid - MO. ::DAY I YEAR mount
Mailing Address Description of Expenditure
City State Zip Code (Plus 4)
To Whom Paid MO. DAY YEAR Amount
Mailing Address Description of Expenditure
City Statj Zip Code (Plus 4)
PAGE TOTAL
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D. $
DSEB-502 (7-99)