HomeMy WebLinkAboutBloom, Stephen - 2016 2nd Friday Pre-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.
FXER roENRFIGnON REPORT FRED CANDIDATE: .1"v
' MDEYTEE 1 LOBBnST ''
NUMBER ON BENAIP OF
NAPE OP RUNG COMMRIEC,CANODATE OR LOBBYIST
BTREET ADDRESS
a100 LONGS GAP 12b.
CRY STATE DP CODE
6-k6IUT-s i- 17013 -
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT N0. PARTY
(CHECK ONE) /SSC-fy�)nL� MO., YM ..
6TH TUESDAY �• IGGO'KG��—��`72VG / I 2; 1,6
P094RTMARY .. . ...
FOR�OfHCE USE ONLY
XDAY I2ND FRIDAY 2. DATES OF
REPOYEA/R.. 1LM0y. DAY YE/A/R
'PRE-PHINARY. ( PERIOD
NG TO
30 DAY S'
POSE-PRIMARY
-- - CASH BALANCE AT END D C o
6TH.nlesoaT A. OF REPORTING PERIOD: $ T
PREELECTION Cr
TOTAL AMOUNT OF FILER'S rnFR
a
5. OUTSTANDING DEBTS OR LIABILITIES
2ND AT THE END OF REPORTING PERIOD: $
_y C
30.o AT
6.
'POSTELECTION. AMENDMENT YES NO x
REPORT? .
T. c w
'ANNUAL - .7'ERMRIAnoN. .s --
REPORT. _ REFORf? YEs NO V 4 V
AFFIDAVIT /�
SECTION
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 sigh here.
I SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR UABnNIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE GEST OF MY KNOWLEDGE AN ,�R ECT AND COMPLETE.
S TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 I(l SIGNATURE OF PERSON SUBMrrTWG REPORT
i �— 1(-1 -1- Ll<-- PRINTED NAME
NOTA —]01 — 1 4-3
dMANI'SALIAR O -7 1-7
COMMISSIONOb
Notary PUDt4o. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
PART 11 My Commission Expires Oct 7,2017
If statement is filed on behalf of a Candidate's Authorized Committee,Candidate must sign here.
1 SWEAR(OR AFFIRM)THAT TO THE BEST OF MY IWOWLEDGE AND BELIEF THIS POLITICAL COMMITTEE HAS NOT VIOLATED ANY PRWISIONS 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 AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
DSEB-503(12-99)