HomeMy WebLinkAboutHertzler, Jim - 2015 30-Day Post-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 IDENTIFICATION REPORT FILED CANDIDATE: I COMMITTEE LOBBYIST I
NUMBER ON SEKALF OF ,
NAME OF RUT COMMITTEE,CAN NATE OR LOBBYIST
I 2C
STREET ADDRESS
CITY STATE ZIP CODE
D r� 714 / 70-R s- -
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY
(CHECK ONE) T]T�� MD.• DAY YEAR
.6TH TUESDAY 1 �oGNYr �t*-t/I'1/Sf/O.✓fj2 Iv /
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY -YEAR MO. DqV YEAR..
2ND FRIDAY 2 DATES OF C-,
REPORTING TO
PRE-PRIMARY
PERIOD YYrr
30 DAY ' =�
POST-PRIMARY n �-
CASH BALANCE AT END ^ ti
6TH.TUESDAY- -`4. OF REPORTING PERIOD: $
PRE-ELECTION '. _J
TOTAL AMOUNT OF FILER'S —i7
i�
2ND FRIDAY B. OUTSTANDING DEBTS OR LIABILITIES
PREELECTION
AT THE END OF REPORTING PERIOD: $
30 Dar -• N
POST-ELECTION AMENDMENT j YES NO
REPORT?
7.
LNUAL TERMINATION
PORT REPORT?- YES
AFFIDAVITSECTION
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 Contributina Lobbyist, the Lobbyist must sign here.
I SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED D ING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNO EDGE AND BELIEF TRUE CORRECT COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OFA, 20NATU E OFPERSON
SUBMITTING�RJEP(ORT�/p
V-1144/144
ARE PRINTED NAME
OF PE ?AMA I l _ y
NOTA DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
BETHANY SALIARULO
NDtuy PuElk
PART I - CARLISLE 00R0c.CUM1IERLANO CNTY
If state ent*06edWIiI:1 dAfldfD87C�118idat '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) ~ '