HomeMy WebLinkAboutDelozier, Sheryl - 2016 2nd Friday Pre-Primary 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 REPORT FILED
NUMBER ON BEHALF OF CANDIDATE COMMITTEE LOBBYIST'
NAME OF FILING CO y
MITTEE,CAN DATE OR LOBBYIST
17,t (b
6TREET AbOREBB
CIT" �� STATE zIF CODE
?A,
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE r DISTRICT NO. PARTY T.
(CHECK ONE) i iC. /�/t 1.1 i�J�.'rl'V nL� MO- YEAR
GTN TUESDAY ( 0' e>5 'IV1F/I O UP
i'RE-PRN,F;Y. - FOR OFFICE USE ONLY
2 GATES OF Mo` DAY YEAR MO. OAY YEAR
2ND
FRIDAY, REPORTING n O tr 1I TO
t 1 I^
PRE=PRIMARY - REPORT
-30 DAY
Posr-pwMAny' C .—
CASH BALANCE AT END
-'.STH TUESDAY a' OF REPORTING PERIOD: $
' PRE+ELSCT(bFl .-'
TOTAL AMOUNT OF FILER'S
2ND FRIDAY - S. OUTSTANDING DEBTS OR LIABILITIES
PR6ELgcnpN. AT THE END OF REPORTING PERIOD: $ >?
B.
y
: 34 DAY
AMENDMEKT \/
POShELECTIbN YES NO JL,
REPQRTZ' CJ
7
ANNUAL TERMINATION CD
REPORT REPORT?' - YES NO X
AFFIDAVIT SECTION,
PARTI-
If statement is filed on behalf of a Political Committee orCandidatees 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 LIAR' TIES INCURR 0 O ING THE REPORTING P0101D INDICATED A80VE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS 0^250.00) ❑THIS REPORT IS,TO THE HEST OF LEDGE A�`D BELIEF,TRUE, CT AN CbMPLETE,
SWORN TO AND SUBSCRIBED BEFORE ME THIOMMON NO�LTHAOLFS ENN V SEL,
DAY O LISA fig$CONE Notary UbIIC SIG))AAT.U,R F PER'SO'N SUB REPORT
V Or Hamsburg, Dauphin Cal [r�K b� ,,, I, cy�
My Commission Expires July 2 2()t7 PRINTED NAME
SIG TU E
MY COMMISSION EXPIRES
(
MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
PART II-
If statement is filed on behalf of a Candidate's Authorized Committee,Candidate must sign here.
(SWEAR(OR AFFIRM)THAT TO THE BEST OF MY KNOWLEDGE AND RELIEF THIS POLITICAL COMMITTEE HAS NOT I+IOLATED ANY PROVISIONS OF THE ACT OF
JUNE 3-,1937(P.L.1333,No.320)AS AMENOED.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
SIGNATURE OF CANDIDATE
DAY OF 20
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
Department of State • Bureau of Commissions,Elections and Legislation
DSEB-503(12-99) 210 North Office Building 0 Harrisburg,PA 1712MO29 • (717)787.5280