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HomeMy WebLinkAboutHertzler, Jim - 2015 2nd Friday Pre-Election Commonwealth of Pennsylvania PAGE 1 OF Z 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 LOBBYIST 3 Number: Filed By: - Name 01 Filing Committee, LandidJo or Lobbyist 1 et^c1 ,, Street Address:_ 11 City: StW& Zip Code: / CXi O TYPE OF 8TH TUESDAY 1. E2NDFRIDAY 2. 30 DAY 3' AMENDMENT YES, NO REPORT PRE-PRIMARY POST PRIMARY ";REPORT? - - YES 8TH TUESDAY 4' 30 DAY e- TERMINATION PRE-ELECTION POST ELECTION - REPORT] YES 'NO (place X tothe right Of ANNUAL 7. FILING METHOD PAPER DISKETTE report type) REPORT ( 1 CHECK ONE , Name of Office Sought by /Candidate: r • ilDistrict Office Party County - C, M0. DAY nyEAp Number Code 1 ode Code I /h� (SEE INSTRUCTIONS FOR CODES) '�l.E 111"`R FOR OFFICE USE ONLY MO. DAY YEAR MO. DAY YEAR Summary Receipts , 015 To {� and Expenditures from: C') o A Amount Brought Forward From Last Report $ c.n B. Total Monetary Contributions and Receipts (From Schedule 1) $ m ,;;m Ill O C. Total Funds Available (Sum of Lines A and B) $ 'O '< r— 1 D. Total Expenditures (From Schedule III) fV $ DDD 0 C-) O E. Ending Cash Balance (Subtract Line D from Line C) $ C) CIV F. Value of In Kind Contributions Received (From Schedule 10 $ (7 771 ?_' N G. Unpaid Debts and Obligations (From Schedule IV) $ C:) AFFIDAVIT a PART I – If this is a Committee report. treasurer sign here. If this is a Candidate report candidate sign here. I swear for affirm) that this report, including the attached schedules, on paper or computer diskette, are to the best of my knowledge and belief true, correct and complete. Sworn to aryd subscribed before me this /� 1 ,n Ln]/Y11, day of 'C 20� (/////G/ //L/// Signature of Person Submitting R¢pon NW Y If& 1 O�1 OTAR BA2ture ' ' Printed Name n My ca is ion a Ores BETHANY LZARULO pq CARLISLE 8:0.C EflLAND C QAY YR. Area Code Daytime Telephone Number PART 11 – If this is a reporto a an 1 a e 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. 3201 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 Coda Daytime Telephone Number Department of State • Bureau of Commissions, Elections and Legislation 303 North Office Building 0 Harrisburg, PA 17120-0029 • (717) 787-5280 DSES-502 (7-99) PAGE OF SCHEDULE III STATEMENT OF EXPENDITURES Name of Filing Committee or C/a�ndid]ate1 Reporting Per ond, / From % [ To /()h2 LJ To Whom Paid `.MO. DAY YEAR mount C atCO D / 7IDT�_ d Mailing Address Description of Expenditure / C7-/O/Sl City ate Zip Code (Plus 4) L /?o.2s- MMMM To Whom Paid MO -,13AY- -YEARmount 3; Mailing Address Description of Expenditure City State Zip Code (Plus 4) To Whom Paid =r`MM 1, SAY - YEAR.- mount Mailing Address Description of Expenditure city State Zip Code (Plus 4) To Whom Paid L' MO.; '.OAY. - YEAR" mount Mailing Address Description of Expenditure City State Zip Code (Plus 4) To Whom Paid Mo."°. : .DAY': yEAR?q mount Mailing Address Description of Expenditure City State Zip Code (Plus 4) To Whom Paid ^;-MO. _. .,,+OAY:b YEAR i; mount Mailing Address Description of Expenditure City State Zip Code (Plus 4) To Whom Paid c 'Moi` '"DAY}1YEAR Amount Mailing Address Description of Expenditure City State Zip Code (Plus 4) To Whom Paid M0: .'SHAY= '.YEAR - Amount Mailing Address Description of Expenditure City State Zip Code (Plus 4) PAGE TOTAL Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D. $ j DOD, ail i DSEB-502 17-99) 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. FILM IDENTIFICATION REPORT FILED - I 3. >. NUMBER ON BEHALP OF , 'CANDIDATE COYYIREE.' :.LOBBYKT- NAME OF Fl COMMITTEE,CANDIDATE OR LOBBYIST OFT STREET ADDRESS C P't�tcz e ' CITY © STATE ZIP CODE � � / 7d2s'- - TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY (CHECK ONE) fllld MO.• " VAY YEAR " 6TH TUESDAY ."':1. V ! �PI' •(MI/SIIJN� f 3 D/S� PRE-PRIMARY FOR OFFICE USE ONLY MO. DAY YEAR-.. 'MO. DAY YEAR 2ND FRIDAY - 2' DATES OF PREPBd RARY . REPofRING TO PERIOD LC� r/ .3D DAY 3. POT-PRIMARY CASH BALANCE AT END GTH.TUESDAY 4' OF REPORTING PERIOD: $ `' n '� <_- Cr'1 'PREELECTION CL7 O TOTAL AMOUNT OF FILER'S r7T C-) 2ND FRIDAY 6. OUTSTANDING DEBTS OR LIABILITIES N .PRE-ELECTION AT THE END OF REPORTING PERIOD: $ ? W 6. C7 POST-ELECTION .AMENDMENT YES NO C- _ REPORT'T Cr 7. ANNUAL TERMINATION'.' REPORT? YES REPORT .. -� IV AFFIB . 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. 1 SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOIfiLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE. SWORN TO AND SUBSCRIBED BEFORE ME THIS yiEA- . NEON SUBMITTING REPORTDAY OF 2Q� S OFPE . . _ _ PRINTED NAME NOTARI SEA _ 7 I '7 - 91 -e2-510) LT OMMI�"�C�R�>IANULO NOlery Public MO. V YR. AREA CODE DAYTIME TELEPHONE NUMBER PAyCommission ExPlres ODI t,2017fss tiled on behalf of a Candidate's Authorized Committee, Candidate must sign here. 1 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 M. AREA CODE DAYTIME TELEPHONE NUMBER DSFB-503(12-99) -