HomeMy WebLinkAboutBosha, John - 2016 Annual Report COMMONWEALTH OF PENNSYLVANIA
CAMPAIGN FINANCE STATEMENT
File this in lieu of a full report only if aggregate receipts, expenditures;or fi ,%
liabilities incurred each did not exceed $250.00 during the reporting period. f`' o
FNUMBER ILER laENTIRCATION 0. ( Q t Z , REPORT FILED .CANDIDATE
ON BEHALF OF / 1[ 'COMMITTEE 2. LOBBYIST: .
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NAME OF FILING COMMITTEE,CANDIDATE OR L ST J.
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STREET ADDRESS
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CITY / STATE ZIP CODE � C I
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TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
!CHECK ONE} Cl 1 !�//(�\\� MO::"' OAY YEAR
'. ,6TH:TUESDAY.
9. V <� I 1 I ' 6 '
v DAY
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:..-P..... ..: '.. FOR OFFICE:USE ONLY...
PRE=PRIMARY:; .�.: - .... .:
MO.- '1 'DAY ;YEAR. ..,MD. DAY YEAR
2. - DATES OF
2ND.�RIDAY.
?RE�PRIMARY REPORTING Q Ip
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PERIOD t I Zi t / l
� ` L 31
30 DAY 31
111 11
POST PRIMARY
CASH BALANCE AT END
4. OF REPORTING PERIOD: $ '7►,+
iiTW TUESDAY
PRE-ELECTION a ..wi
TOTAL AMOUNT OF FILERS "O .. •,,,,
ND FRIDAY 5 OUTSTANDING DEBTS OR LIABILITIES (r l :'71.13' ,C1�" ill
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PRE=ECECTION".: . AT THE END OF REPORTING PERIOD: $ g `" 0
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30 DAY ,AM£ND►EENT:
POST-ELECTIONREPORT?.`:...-: YES NO X 0 'b 4_
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91NNUA1 :7v/ TERMINATION_:.- YES NO '11"'ri '�•. �` 0
REPORT J� REPDRT.: I rn
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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 OF MY KNOWLEDGE AND
D BELIEF,TRUE,/A CORRECT'AND COMPLETE
SWORN TO AND SUBSCRIBED BEFORE ME THIS �0 ff PERSON€1 J
,94hDAY OF ' 20,i SIGNATURE OF N SUBMITTING REPORT
/ (� _ -moo AA P. 6oslea
�` PRINTED NAME
MY COMMISSION EXPIRES. SIGIgA tI�En-\\� 5'7v 9 m..3E/8 7
�MO. DA YR. AREA CODE DAYTIME TELEPHONE NUMBER
PART 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,N .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.
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL Department of State • Bureau of Commissions,Elections and Legislation
e NotaryPublic 210 North Office Building • Harrisburg,PA 17120.0029 • (717)787-5280
D i) o(n`Bo o,Dauphin County
My Commission Expires Dec.2,2018
WEYBER,PENNSYLVANIA,ASSOCIATION OF NOTARIES
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