HomeMy WebLinkAboutFriends of Jim Hertzler - 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 Illil REPORT FILEDI- 3.
' CANDIDATE COMMITTEE ! I t LOBBYIST
ON BEHALF OF
NUMBER �/
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYRIENPS OF M HE1SLER
STREET ADDRESS oX /�3
D '/�"J[J /LTZIP CODE
CITY �+�Dt� STATE 7�'l7' 17425-_
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT/ NO. PARTY DATE OF ELECTION
(CHECK ONE)
1. 1 C)001Y COMMI55TOI S
!�!
{{77 DAY� ZO6
�
6TH TUESDAY
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY YEAR
2ND FRIDAY 2. DATES OF �+
PRE-PRIMARY REPORTING i 28 4 TO 1O A/�ie
PERIOD J 4/�I�1
30 DAY 3' I- r,.s
POST-PRIMARY (---,�� . G
CASH BALANCE AT END - cr.
4. OF REPORTING PERIOD: $ ,.i
6TH TUESDAY
PRE-ELECTION `F 1 —I
TOTAL AMOUNT OF FILER'Sr ti3
2ND FRIDAY OUTSTANDING DEBTS OR LIABILITIES0 . �-�w,
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ C-M
6. �.
30 DAY r ,
POST-ELECTION AMENDMENT YES NO C_
REPORT?
7.
ANNUAL _TERMINATION YES NO ��
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.
,t Dement is filed on behalf of a Candidate,the Candidate must sign here.
a l atelement is filed on behalf of a Contributing Lobbyist,the Lobbyist must sign here.
d al EAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
Z L, ci ED TWO HUNDRED AND FIFTY DOLLARS(S250.O0)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
Z
_ ^ i SWORN TO AND SUBSCRIBED BEFORE ME THIS 4""Vr- i '
0— C a� DAY OF /air. ' 20,& SIGNATURE OF PER= UBM—"nr-P.'EPOIRT
qJ Z W 4-2 o ‘ PRINTED NAME
ui 11 SIGNATURE /y
Z y E = MY COMMISSION EXPIRES
di' awe � 6a /L
z 0 p d MO. DAY YR. AR COD DAYTIME TELEPHONE NUMBER
Z 8
x W
o _ >. z
U o' _'f II -
If statement is filed on behalf of a Candidate'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. i
1.
SWC- TO AND SUBSCRIBED BEFORE ME THIS , G�,
SI NATUR OF CANDIDATE
it. IIP DAY OF a�/(� / 20 JAM /
1,./ .1.16-,.. _v-La .y \ 47/� r- PRINTED NAME
*SIGNATURE
, :• 1•• ,!j ^: LVAN1A 7'7 97 -0Z g(D
AREA CODE DAY IME TELEPHONE NUMBER
NOTARIAL WE MO. Y YR.
BETHANY SALZARULO
Notary Public
CARLISLE SORO;,CUMBERLANDIONI tm t of State • Bureau of Commissions,Elections and Legislation
DSEJ ,a-503(' riinission Expires Oct 141Z01Nbrth Ice Building • Harrisburg,PA 17120-0029 • (717)787-5280