HomeMy WebLinkAboutFriends of Jim Hertzler - 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" I.
1111„ llo, CANDIDATE COMMITTEE LOBBYIST
NUMBER ON BEHALF OF
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
-Fy,- N bS c 3-rn4E g-
STREET ADDRESS
PO 80X �-3
CITY IDLfiFF._ 1 CODE
STATE zP1705 —004-3
TYPE OF REPORT
NAME
yyOF1nnOFFICE SOUGHT BY CANDIDATE p DISTRICTST1NO. PARTY M
DATE OFFELECTION(CHECK ONE) CO1 I /NK `21 MO. AY YEAR
6TH TUESDAY
PRE-PRIMARY FOR OFFICE.USE ONLY-
MO. DAY YEAR MO. DAY YEAR "
2ND FRIDAY 2. DATES OF
PRE-PRIMARY REPORTING 0n L�a/�IC TO I I ,8 a)16PERIOD p(til V
30 DAY 3.
POST-PRIMARY ��l. �� �
CASH BALANCE AT END c.
6TH TUESDAY 4• OF REPORTING PERIOD:
PRE-ELECTION iv/
TOTAL AMOUNT OF FILER'S
2ND FRIDAY e. OUTSTANDING DEBTS OR LIABILITIES `//')
PRE-ELECTION AT THE END OF REPORTING PERIOD: $
i7
30 DAY
AMENDMENT
POST-ELECTION YES NO ...
rr.
REPORT? - / _
7. C.)ANNUAL TERMINATION YES NO X
1"'
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. mn
If statement is filed on behalf of a Candidate, the Candidate must sign here. i4 s
If statement is filed on behalf of a Contributing Lobbyist, the Lobbyist must sign here. _.f r a o
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 OF MY KNOWLEDGE AND BELIEF,T-UE,CORREC AND COMPLETE. < ,e m
SWORN TO AND SUBSCRIBED BEFORE ME THIS Ir > 'a
kms-,
� DA,r%F \ Q 20�� SIGNATURE OF PERSON SUB NG REPORT = O
/ _ Ol c� 5� 2
/ SIG"/TURF �� P NTED NAME o v.
r 'Z z
MY COMMISSION EXPIRES �' 26 i% W 0 a- OG q�' z
.i r
MO. DAY YR. AR A CO DAYTIME TELEPHONE NUMBER 7 4.' y
PART II - o_ r
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 COMM' EE HAS NOT VIOLATED •NY PROVISIONS OF THE ACT OF
JUNE 3, 1937(P.L. 1333,No.320)AS AMENDED.
SWORN TO AND SUBSCRIBED BEFORE ME THIS �I /
i4i��
q k . n,^ , ,0, ._ 'n/ SIGNATURE 0 CANDIDATE
o DAY OF L� ��V` 20 l - /J 1//V�( y/; ` -2 le
ALV A 1.1-044} A IL- t`// PRIN FNALMIE
SIGNATU-E A( ) 7)
A CODE DAME TELEPHONE NUMBER
''TAR MO. DAY YR.
MEGAN E ORRIS'
Wary Public
Department of State • Bureau of Commissions,Elections and Le islation
CARLISLE 90Rt),CUMBEItt#i1D"C9UN�► P 9
MyICOttnldlslgtlixptf r Jan 14.2019 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280