HomeMy WebLinkAboutRothman, Greg - 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.
FILER IDENTIFICATION , REPORT FILED ' I. 2
'
NUMBER ON BEHALF OF CANDIDATE COMMITTEE LOBBYIST
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
crZy d-144,an,
STREET ADDRESS '
CIT'• STATE ZIP CODE
/77`Ut N'/G6 v, P.," /70,E
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE ''// DISTRICT NO. PARTY DATE OF ELECTION
/ iY1. T+7...- �� c.�` MO. DAY YEAR
(CHECK ONE) ;?-y��„Lsw"44,'1 o''V'C� } 5� Q v t�
6TH TUESDAY I. -` Gtir�EYob" �,!!�/+J6l r _ f-'4-P // Ce �-o/L
PRE-PRIMARY FOR OFFICE USE ONLY
-
2ND FRIDAY MO. DAY YEAR MO. DAY YEAR
2. DATES OF REPORTING TO
PRE-PRIMARY I v O
PERIOD ?.S '2.0/d // �v livrA C-, fes.,
C_,
30'Day 3. r'-
POST-PRIMARY
CASH BALANCE AT END !
6TH TUESDAY 4. OF REPORTING PERIOD: $
PRE-ELECTIONI
TOTAL AMOUNT OF FILER'S �:,
5, OUTSTANDING DEBTS OR LIABILITIES
2ND FRIDAY
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ ' ...
--
,
, . —.
6. r.....;3O DAY AMENDMENT ''POST-ELECTION REPORT? YES NO x
7.
ANNUAL TERMINATION
YES NO
REPORT REPORT? x
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(5250.00)AND THIS REPORT 15,TO THE BEST OF KN AND BELIEF,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
�7 o 20/ • SIGNATOR O PERSON SUBMITTING REPORT
J DAY OF ji.r-�.0
PENNSY .'. . 6"--e-... ��1i1.r.-a.y
�`� RINTED NAME
SIGNATURE NWtALTI 4 OF
COMMO gEAL
RIAL T_ - S.;/s 7
MY COMMISSION EXPIRES ><�l '= Reg,Nota P 7/
MO. Dt5t)GLAS -'' pauphin Cou>9 A .•E DAYTIME TELEPHONE NUMBER
-- ' burg, ,. 201
PART II - My Commission XpIr "
If statement is filed on behalf of a C. •Date's Authorized 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
u5G[3-S03(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 or (717)787-5280