HomeMy WebLinkAboutThomas, John - 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 $250.00 during the reporting period.
FILER IDENTIFICATION NEPDRT FAED , CANDRM7E I / COMMITTEE �- LOBBYIST �-
NUMBER ON BEHALF OF
NAME OF FILING COMMITTEE,CANDIDATE W LOSSYIFI
STREET ADDRESS
X107 AaLJn/F-F .D
Cltt STATE ZIP cooE
Ec/a An//cs3u A o
TYPE OF REPORT. NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY
(CHECK ONE) '$'dW^/S�I)� Co MM 1.55!O A/E Mo.• DAY YEAR
6TH TUESDAY 1 NFIM/JD EN "rWP •T �� // 3 a�/✓`�
PRE-PRIMARY FOR OFFICE USE ONLY
YO, DAY YEAR IAO. DAY YEAR
2N0 FRIDAY 2' GATES OF
PRE-PRIMARY REPORTING TO p
PERIOD •j0/,5 LQ
30 DAY S' /
POST-PRMARY
CASH BALANCE AT END
6TH TUESDAY 4. OF REPORTING PERIOD: $ C7
PRE-ELECTION
TOTAL AMOUNT OF FILER'S
6. OUTSTANDING DEBTS OR LIABILITIES
2ND FRIDAY
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ 0
6.
30 DAV AMENDMENT
POST-ELECTION REPORT? YES NO
7.
ANNUAL TERMINATION
REPORT REPORT? YES V NO
AFFIDAVIT
I-
S If st ment is filed on behalf of a Political Committee or Candidates's Committee,the Treasurer must sign here.
zd Aft ment is filed on behalf of a Candidate,the Candidate must sign here.
&f ( ment is filed on behalf of a Contributing Lobbyist,the Lobbyist must sign here.
ZR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR UABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
W m y TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
-g C $WORN TQ AND SUBSCRIBED BEFORE ME THIS __-_(
Tj c O DA OF �/ 20 IS SIGNATURE OF PERSON SUBMITTING REPORT
>$E ,� SIGNANRE PRINTED NAME
E rq
COMMISSION EXPU V� 211 �� 1 7/7
8 W 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 SEUEF 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.
Department of State • Bureau of Commissions,Elections and Legislation ,[t,
DSEB-503(12-99) 210 North Office Building 0 Harrisburg,PA 17120-0029 • (717)787-5280 �K./