HomeMy WebLinkAboutRothman, Greg - 2016 2nd Friday Pre-Primary i
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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 RSPDRT nom 1 .-
NUL9ER ONOEHAIFOF fANONATE .0 COWMRilE' :4CBaY4TT .
NAME OF FuINO COMNmriv,CANORMYE OR Lw"t ))
•s �o�h M
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aTRevwmpess '
Cm ttwTE LP SOOE
TYPE OF REPORT NAME OF 01, E S CTHT aY CANDIDATE {4� DISTRICT N0. PARTY A
(CHECK ONE) Rl,r�r•N.I+. J/�/w. 91,
uiP��` 0-1/ i L zeiL
6THTUESDAY 1. �yu.rLa..•.L.� AJ,/,P,A��I
FRE-'PPoMARYFOR OFFICE USE ONLY
M0. OAY YEAR M0. DAY RAR C>
2ND FRIDAY, 2' OATS!of C
PRE-PRIM.ARY / REPORTING t0
J� PERIOD Off 7,.OlC C7 �-
..36 DAY S' I )
IPOSYPRIM%,RY
I CASH BALANCE A7 END
8TH TUESDAY A' OF REPORTING PERIOD: $ erU
PRE-ELECTION-'
_ TOTAL AMOUNT OF FILER'S n
2ND FRIDAY OUTSTANDING DEBTS OR LIABILITIES /
' C f J
PRE•FLECRON AT THE END OF REPORTING PERIOD: $
j t`J
I
LO
30 oAY-,F, AATPOVT-SLIECTON
REPORT?
YES NO
ANNUAL - TERMINATION
,REPORT - REPORT? AFFIDAVIT SECTION
YES NO x
1
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 Lobbt,the Lobbyist must sign here.
I SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISSURSEMENrS OR LIABILITIES INCURRED DUFFING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOUR RS($250.00)AND TMS REPOm IS,TO THE DES OFMY NNDWL GM TRUE.CORRECT AND COMPLETE.
,
SWORN TO AND SUBSCRIBED BEFORE ME THIS `
I
�DAY OF ✓�j/ 20/� .SI/GNATVR PERSON SUBMITTING REPORT
SIGNATURE OFSIGNATURE r^ P�SYLTIANIA SPRINTED NAME
MY c SSION EXPIR s O V`L pUb1k .S�/- 33��- 33 r
�O PDS,No C�1fTbf EA CODE DAYTIME TELEPHONE NUMBER
PART 11- p�C11Y of HacT1s�' ITeB X9u
If statement is filed on behalf ap orized Co i le ,Candidate must sign here.
I SWEAR(OR AFFIRM)THAT TO THE BEST OF MY KNOWLEDGE AND SEUEF THIS Po JDCAL COPIMMEE HAS NOT VIOLATED ANY PRROVR9ONS OF THE ACT OF
JUNE 3,1937(P.L. 1333,No.320)AS AMENDED.
I
SWORN TO AND SUBSCRIBED BEFORE ME THIS
1 SIGNATURE OF CANDIDATE
DAY OF 1 20—
I PRINTEO NAME
SIGNATURE
MY COMMISSION EXPIRES MO. DAY YR AREA CODE DAYTME TELEPHONE NUMBER
Department of State • Bureau of Commissions.Elections and Leoislatinn
DSEB-503(12-99) i 27U North Office Building • Harrisburg,PA 17120-0029 • (717)787.6280
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