HomeMy WebLinkAboutBloom, Stephen - 2016 30-Day Post 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.
FILERIDENTIFICATIONNTffICATION , '�t'(�C.02 REPORT FILED ' CANDIDATE x COMMITTEE .LOBBYIST.-
�.
ON BEHALF OF
NAME OFFILING COMMITTEE,CANDIDATE OR LOBBYIST
5 'Hen) Z LGc i1
STREET ADDRESS
21 )ti L�NQ GA? RUPP
CITY STATE ZIP CODE
C►9RA_isLr PA i-10 13 3 _._._
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
. (CHECK ONE) -) MO. . DAY YEAR..'
i. i.i IN & eg_4_ cssCN13Ly iZrI.
.6TH TUESDAY
II C ZO 1 b
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY YEAR
2
2. DATES OF
NEL PRIDAY.
PRE-PRIMARY' REPOR NG lo 25- it TO (I 2S 16
noo
30 DAY 3.
POST-PRIMARY y •�
• CASH BALANCE AT END
6TH TUESDAY
4. OF REPORTING PERIOD: $ I0. 0 0 . `Y'
PRE-ELECTION
.. TOTAL AMOUNT OF FILER'S
5. OUTSTANDING DEBTS OR LIABILITIES
PRE-FRIDAY AT THE END OF REPORTING PERIOD: $ d' 00
PRE-ELECTION, ._'
6.
36 DAY AMENDMENT .-.
• POSTELECTION AYES NO X t
.. - .. REPORT'F _
ANNUAL : TERMINATION ( )
REPORT - _ REPORT'? YES NO sC 4..
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.
1 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($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLED ANigo*:I '.E, •'RECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS /
.4110
DAY OF Al��// i 20 SIGN• URE OF PERS*' -UBMITTING REPORT.
C �/J St-,e Lr• 'Non
01 1 / I ,t�R "7' ' PRINTED NAME
MYC• � :- *. it.: �1� -7ot ' (43�
_N01'AA14SEAL'.
( Y YR. AREA CODE DAYTIME TELEPHONE NUMBER
BETHANY$AIIIARULD
RAFT II- NotaryPablit
If stBterromltl i6 lbi t @ i ndialate's Authorized Committee, Candidate must sign here.
My 09001ssion Expire;OCt.7,201 i
I SWEAR(OR AFRM4 THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THIS POUTICAL 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
DSEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280