HomeMy WebLinkAboutRothman, Greg - 2016 2nd Friday Pre-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 $250.00 during the reporting period.
FILER IDENTIFICATION ' REPORT FILED ' CANDIDATE I x COMMRTEE i LOBBYIST 3.
NUMBER ON BEHALF OF
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
STREET ADDRESS
l 'unfsoLJ�+� Rat _
CITY STATE ZIP CODE
AA
TYPE OF REPORT NAME OF OFFICE SOUGHTBBf,,Y CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) R�rtiSr.. •-`)yw •12^ '4' MO. DAY YEAR
1. &46,30#44. -(r4-+' AV4-i'.h/ S 7 �Z�,"lr/•�/' /1 G$ 2e/4
6TH'TUESDAY
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY YEAR
2ND FRIDAY 2. DATES OF
REPORTING C TO
PRE-PRIMARY �/
PERIOD 0/ Z,O 20:711- id
Y 7 za/4
30 DAY 3.
POST-PRIMARY n}
CASH BALANCE AT END ' : `°-,
4. OF REPORTING PERIOD: $ C,.•
6TH TUESDAY
PRE-ELECTION
TOTAL AMOUNT OF FILER'S
5OUTSTANDING DEBTS OR LIABILITIES _
PRE-ELECTION
2ND FRIDAY k AT THE END OF REPORTING PERIOD: $
%
6.
30 DAY AMENDMENT
POST-ELECTION
REPORT? YES NO k _,
,;
I�
7. ._
ANNUAL TERMINATION YES NO _le 3
REPORT REPORT? C
. i•
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.
I SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OFCGNATEQNTTING
KN E AN ELIEF,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
Z G��DAY OF Oma t,- - 20 iL SIURF REPORT
Y�\1A� 't • Roil-1M' NI
MM e NW R�F s�iota public PRI TED 3 71 NAME
SIGNATUREG �.�()
MY r•MMISSION EXPIRES 0�7 �"r '/ p,Rps, I �f 3 �{5
MO. *AY S1 rtI p'U>'9,oa Py QUS';•,'"-°I•'' DAYTIME TELEPHONE NUMBER
PART II-
CM in tin ss\O0)Xp
If statement is filed on behalf of a Candi. - = •uthorized Committee,Candidate must sign here.
I SWEAR(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 AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
Department of State • Bureau of Commissions,Elections and Legislation
DSE13-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280