HomeMy WebLinkAboutWarner, Brock - 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.
FILER IDENDFICATKIN ' REPORT FILED ' CANDIDATE. IX c.
OTEE... 2
MLI .LOBBYIST
7-1
NUMBER ON BEHALF OF
NAME OPDNG COMMITTEE,CANDIDATE OR LOBBYIST
STREET ADDRESS
1��L'�1 Sc�✓ t
C BIATE nn 21P CODE _ _
TYPE OF REPORT NAME OF OFFICE souGFfr BY CANDIDATE DISTRICT NO. PARTY T
(CHECK ONE) r (1 MD. DAY YEAR
��L✓4 1�� 'r�i 5(j r I �h(i[an
6TH TUESDAY y I• �/
PRE-PRIMARY FOR OFFICE'.USE ONLY
MO. DAY YEAR MO. DAY YEAR.;
TND FRIDAY ?' DATES OF
PRE-PRIMARY A�,( REPORTING TO
PERN]D
30 DAY
POST-PRIMARY
CASH BALANCE AT END L�
6TH.TUESDAY °' OF REPORTING PERIOD: $
PRE-ELECTION
TOTAL AMOUNT OF FILER'S
5. OUTSTANDING DEBTS OR LIABILITIES C)
PRE-ELECTION
FRIDAY AT THE END OF REPORTING PERIOD: $
PRE-ELECTION
6.
30 DAY
POST-ELECTION. ' .AMENDMENT YES NO -'
REPORT?
ANNUAL TERMINATION-TERMINATION
REPORT REPORT?. '•' NO
AFFIDAVIT -
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 AGGREGAZ C IPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOL I q I '�In mwslnBELAtSSYLO�NILR.BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
Notarial Seal
SWORN TO AND SUBSCRIBED FORE IA(a��HIESteT,Notary PUbIIC
`` SIIYeT Sptlny Twp.,Cu COUD[y j SIGNATURE OF PERSON SUBMITTING REPORT
DAY OF 1 'r i -F, 5,2017 i ,^SI j / ' /_ -
PFNNSYLVPN[A-S:MI:-TpN r-:ynTgRIFF l✓C/ L'tz / '[e—r—
SIGNATURE 7 PRINTED NAME Q' }/
MY COMMISSION EXPIRES TI_1J 5 �7 l / ��7— !C/l
MO. DAY YR. AREA CODE DAYTIME TEL PHONE NUMBER
PART 11-
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 MO. DAY AREA CODE DAYTIME TELEPHONE NUMBER
YR.
DSEB-503(12-99)