HomeMy WebLinkAboutDay, Susan - 2015 30-Day Post-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 ' CANDIDATE �/' COMMITTEE 2 LOBBYISTI
Number: Filed ey: /\
Name of Pi lin ommittee, candidate c Lobb ist:
Street Address:
q4s L�
City: State: Zip �eW
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TYPE OF eTH TUESDAY 1. 2ND FRIDAY 2. 30 DAY 3'�( AMENDMENT YES NO
REPORT PRE-PRIMARY PRE-PRIMARY POST PRIMARY �� REPORT?
i TUESDAY. 4' 2ND FRIDAY S. 30 DAY 6' TERMINATION
Iplaee X to
PRE-ELECTION PRE-ELECTION POST ELECTION REPORT? YES NO
the right of ANNUAL 7. YEAR FILING METHOD
report type) REPORT.: ( ) CHECK ONE ® PAPER DISKETTE
Name of Office Sought by Candidate: r . • • District Office Party County
Number Code „CgQe Code
IMO. DAY YEAR
(SEE INSTRUCTIONS FOR CODES)
FOR OFFICE USE ONLY
Summary of Receipts MO. DAY YEAR MO. DAY YEAR
and Expenditures from: To (�
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 III) $
LValue
Balance (Subtract Line D from Line C) $
Kind Contributions Received (From Schedule IU S
s and Obligations (From Schedule IV) $
AFFIDAVIT
PART I - If this is a Committee report, treasurer sign here. If this is a Candidate report candidate sign her
I swear (or affirm) that this report, including the attached schedules, on paper or cc uter diskette, are to the best of my kn ledge and belief true,
correct and complete.
Sworn to,and subscribed before me this
1
dayy of �}.l(SSL 20t.�
Signature of\P son u ' ting Report
n J
NOTARUL EA4 Printed Na a /�/ r
My c mission eYbiNANY SALZARULO / /-�(/(7J� _
Notary PINlpe DAY YR. Area Code Daytime Telephone Number
rAll lei c on
PART I 's Authorized Committee, candidate shall 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
W.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
DSEB-502 17-99)