HomeMy WebLinkAboutCrampsie, Sean - 2015 2nd Friday Pre-Election 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.
BIER IDENTIFICATION ' REPORT FILED ' 1 ).
NUMBER
ON BEHALF OF CANOIDATE COMMRTEE LOBBYIST
NAME OF FILING DOMMIREE,DANDIDAW OR LOBBYIST
✓b
STREET ADD/RE/BB /1 t(' '
lll5 71!.11 TG d Nlr.
Cm 9 STATE ZIP CODE
6151 l1yI /W/3
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. i PARTY
(CHECK ONE) 1 M0. DAY YEAR'
�fL-5le �0 rLyr� (c,L104-i
STH TUESDAY
PRE-PRIMARY FOR OFFICE.USE ONLY
MO. DAY YEAR MO. DAY YEAR
2ND FRIDAY 2. DATES OF
PRE-PRIMARY REPORTING TO
PERIOD n ,--a
3. C o
3PriAY C=)
LLLI
POSM1PRIMARV /1 q
CASH BALANCE AT END l) !-�•g �
6TH TUESDAY 4. OF REPORTING PERIOD: $
PRE-ELECTION1V
TOTAL AMOUNT OF FILER'S
2ND FRIDAY 5. OUTSTANDING DEBTS OR LIABILITIES
PREELEcnoN AT THE END OF REPORTING PERIOD:
6. C
30 DAY
POST-ELECTION. AMENDMENT' C3
REPORT? YES NO Cr%
7,
ANNUAL TERMINATION
REPORT REPORT?- YES 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 Lobb,the Lobbyist must sign here.
I SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR (TIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPO TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
SWORN NO SUBSCRIBED BEFORE ME THIS
P"
DAY OF 20 �c SIGNATURE OF PERSON SUBMITTING REPORT
PRINTED NAME
SIGNATURE
MY COMMIS EXPIRES
/ MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
PARTII -
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 BB,E1FOORE�ME
THIS c
C�D DAY OF 20 SIGNATURE OF CANDIDATE i
PRINTED
NAME'
AE' (,
�I.IIv
S'ME N E ORRIS
MY COMMLSSIpN EXPIRES REA CODE DAYTIME TELEPHONE NUMBER
'.nRLISLE BOMOCUMBERQAND COUNF9
9
DSEB-503(12-99)