HomeMy WebLinkAboutHertzler, Jim - 2015 30-Day Post 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.
FRER NEXIFICATKIN
NUMBER BON RTFILED CANDIDATE. t. CDMMIITEE:' ). :LOBBYIST ).
NAME OF FILING COMMITTEE,CAN NATE OR LOBBYIST
STNEET ADDREES
0
cm & ^ STATE,,n /I ZIP/CODE
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`/x/\/11 ,V '
TYPE OF REPORT NAME OF OFFICE SOUGHT B CANDIDATE DISTRICT NO. PARTY
(CHECK ONE) ��GI^� MD. . .DAY YEAR ..
I j /0 A-P
BiH TVEsonr
PRE-PRIMARY FOR OFFICE USE ONLY
MO. I DAY I YEAR.. `MO: DAY YEAR
2ND FRIDAY `2' DATES OF t''� /
PRE-PRIMARY PERIOD a.NG n /r TO (J A✓-( 7 L�JJJ
�.:.. N
REPORTI
30 DAY . . 3. 7 / �
.'POST-PRIMARY - I=
CASH BALANCE AT END d Mr--
BTH TOESOAr -4' OF REPORTING PERIOD: $ A
PRE-ELECTION I
TOTAL AMOUNT OF FILER'S ^'— W
2i.D'FMAY s_ OUTSTANDING DEBTS OR LIABILITIES /� - -p
PRE-ELECTION. AT THE END OF REPORTING PERIOD: $ y 0
C
30DAY: e '
PORT-ELECTION - ET
YES NO �
7.
ANNUAL _ A/'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 Lobbyist,the Lobbyist must sign here.
I SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCU RED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF KNOWLEDGE AN F,TRUE,
CORRVCT AND COMPLETE.
SW RN OAND SUBSCRIBED BEFORE M/E THIS � ^7/iE, I�
DAY OF�(237](�L� 1Q�� S NATUREOFPERSON U[BM��.I--ffTING REPORT
gil
} .�oltt.-. PRINTED NAME �y
cISSION�IO NUIleANIA /7
COMMISSION MATAft11L '
BETHANY SALZARY[0 DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
PART CARLISLE BORO;,CUMBERLAND CNTY
My Commlisbn EI Ir 7. 017
If stat 's Authorized Committee,Candidate must sign here.
I EA
SWR(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 VR. AREA CODE DAYTIME TELEPHONE NUMBER
DSEB-503(12-99)