HomeMy WebLinkAboutBloom, Stephen - 2016 30-Day Post-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 $250.00 during the reporting period.
Fii-ER IDENT4'K;ADON � / t� REPORT fRffi
NUMBER t-{i`I 1fic 0 r, ON RENAtf Of -ATE / CONNOTES
- LO08YIBT
NAME OF HUNG COMMITTEE.CANDIDATE OR LOBBYIST
STREET ADDRESL t' t/V 7^^�
L 100 LL tali "? tZ4�
CITY ^"� } STATE ZIP CODE
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TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT N0. PARTY ! ly
(CHECK ONE) �,t±,p �+ MO. DAY YEAR
6TH TUESDAY ,. 5' tA-GT QCJ �v i'7 W$Lt tt /to
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. OAY YEAR
TES
2ND FRIDAY Z' OF
REPO
PRE-0RBM1ARY REPORTING TO
PERIOD I� D t'V, #
30 DAY 3' --
POST-PRIMARY ^^ C?
l< I CASH BALANCE AT END
.)
678 TUFsanr °. OF REPORTING PERIOD: $ _ rr
PRE-ELECTION
TOTAL AMOUNT OF FILER'S ' --c
2ND PRIORY $ OUTSTANDING DEBTS OR LIABILITIES />J
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ _ t�.
Ga
30 DAY AMENDMENT
POST-ELECTION REPORT? YES NO
ANNUAL TERMINATION ,IES NO .� `•* ('"t
REPORT REPORT?
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 sign here.
EXCEED
R(OR AFFIRM.)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LITHE BES INCURRED DURING THE P RIlEO ED ASOMP DID NOT
E%GEED TbVO HUNDRED AND FIFTY DOLLARS(SZSO.00)AND THIS REPORT 1S,710 THE BEST OF MY KNO4YLEpGE ANO E i E, ORR ,T p COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
ram `
DAY OF ,,'ZQ-&, i SIGNATURE OF PERSON SUBMITTING REPORT
t/Nf/f fX�--'E.•( - J� Y.tLLLf;LL{rG-
PRINTED NAME OiO/r1
SIGNAMWON&WH OF
NU
MY COMMISSION EXPIRE NOTARI&I RvAl
MO. MEW E Q(tra. AREA CODE DAYTIME TELEPHONE NUMBER
"1 11
Ixon.CRt LEiYERDPART it t
If statement is filed anb
mitt e, Candidate must sign here.
I SWEAR(OR AFFIRM)THAT TO THE BEST Oi MY KNOMEDGE AND SEUEF THIS POLFTICAL COMMITTEE HAS NOT VIOLATED ANY PROVISIONS OF THE ACT OF
JUNE 3,4937(P.L. 1333,No.320)As AMENDED.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
SIGNATURE OF CANDIDATE
DAY OF20
PRINTED NAME
SIGNATURE ~—
MY COMMISSION EXPIRESMO, DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
Department of State # Bureau of Commissions,Elections and Legislation ,
DSFB-303(12-99) 210 North Office Building 0 Harrisburg,PA 171.20.0029 Is (71T(787-8280