Commonwealth of Pennsylvania-Campaign Finance Report. (Note: This report should be clear and legible. It should be typed) Candidate. Pfi.

Transcription

1 Reset Form Print Form Filer Identification Number Name of Filing, Candidate or Lobbyist Street Address Type of Report (Place x to the right of report type) Pre-Primary Date Of Election (MM/DD/YYYY) 6"1 Tuesday Pre- Election Commonwealth of Pennsylvania-Campaign Finance Report (Note: This report should be clear and legible. It should be typed) 2na Friday Pre-Primary Report Filed By (Mark X) <Vr"? 2na Friday Pre- Election Year o Candidate 30 Day post Primary Pfi 30 Day Post Election X Amendment Report Annual Special 2 Friday Pre-Election Termination Report Special 30 Day Post-Election II Summary of Receipts and Expenditures From Date To Date For Office Use only A. Amount Brought Forward From Last Report B. Total Monetary Contributions and Receipts (From Schedule II) 10, 6%,-7 3 C. Total Funds Available (Sum of Lines A and B) D. Total Expenditures (From Schedule III) E. Ending Cash Balance (Subtract Line D from Line C) F. Value of In-Kind Contributions Received {From Schedule 11} G. Unpaid Debts and Obligations (From Schedule IV) Part 1- If this is a committee I swear (or affirm) that thit report, inclu^ihg, O O FTlO I en D.cr en m () m Affidavit Section, candidate sign here. er, is to the best of my knowledge and belief true, correct and complete. Sworn to and Signature of Person Submitting report Signature Printed Name My Commission expires Mo. Day YR. Area Code Daytime Telephone Number Part II- If this is a report of a Cafldidates Authorized, candidate shall sign here. I swear (or affirm) that to ttj,i;jx)litical committee has not violated any provisions of the Act of June 3,1937 (P.L. 1333, NO.320) as amended. "WA Sworn to and subscribed Signature My Commission expires, Mo. IL Printed Name Day YR. Area Code Daytime Telephone Number

2 SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number 0 l.unitemized Contributions and Receipts-SSO.OO or Less per Contributor 2. Contributions Over (From A and Part B) Jftief Contributions Received from Political s (Part A) p All Other Contributions (Part V) 3. Contributions Over (From C and Part D) Contributions Received from Political s (Part C) All Other Contributions (Part D) Total for the reporting period (!) Total for the reporting period (2) Total for the reporting period (3) 4. Other Receipts-Refunds, Interested Earned, Returned Checks, ETC. (from Part E) Total for the reporting period (4) Total Monetary Contributions and Receipts during this reporting period (add and enter amount totals from Boxes 1,2,3 and 4; also enter this amount on page 1, report cover page, item b) i> S i> S :? ^ * -o -o- <&fy8fr *t^ -0- v^& && -O~ -* & /o/sfr-o- - o 1O, 5ZH5 -OO <\(tr*^> 10 j b^ 6 '1^

3 PART A Contributions Received From Political s TO Use Part A to itemize only contributions received from Political s with an aggregate value from TO in the reporting period. Filer Identification Number fri-frtd* of TOS./J Sy^r'^ ' ^00~^"7tf? i> S -o-

4 PARTB All Other Contributions TO 250 Use this Part to itemize all other contribution with an aggregate value from TO 250 in the reporting period. (Exclude contribution from political committee reported in Part A.) patehm iyi/oo/.xyjtj? ^ - Date,[M M/Dp/XXXW? ' s;iii, Date [MM/pp/YYYYl? Date :[MM/DD/XY>T]^ i IV f pate;; pate j[.

5 PARTC Contributions Received From Political s Over Use this Part to itemize only contributions received from Political s with an aggregate value over in the reporting period. jfilerldentification Number " of aoo fulljnameg! icontributingsgorrrrniwee1!: ; MaillrigiAtJdress; S; o

6 PARTD All Other Contributions Over Use this Part to itemize all other contributions with an aggregate value over in the reporting period. (Exclude contributions from political committees reported in Part C) :j-iler-ldentificatiori!:numbfer::k-' ' ' ' ' ' of

7 PARTE Other Receipts REFUNDS, INTREST INCOME, RETURNED CHECKS, ETC. Use this Part to report refunds received, interest earned, returned checks and prior expenditures that were returned to the filer. of 35s./) fo ^ Zip Code Zip, Code V^.^a Codec,.V>uK.»"-'; '-Zip «"->;? oatev[m M/Dp/mnry 1 ^

8 SCHEDULE II PARTF In-Kind Contributions Received VALUE OF TO 250 Filer Identification Number: : - '.v ' :.' A^'j.v1..,"^1;^;.1';^,^ -.'. *,' V 5 -;,.. r' Date ;[MM/DD/infyYl Description; -of Contribution Date; Descriptionjof, Gontn bution '1 'i«;v;;j*-6i'-i. thelcontrjbutorife,,,.. ' ' ' - " ' 1 :Zip; odesi!>' '.'.- a-v''t.'^-vfl" Date -, Date [M M/DD/YY^YJ ' ;

9 SCHEDULE It PartG In-Kind Contributions Received VALUE OVER 250,pccupationpsH Erhplpver4MaHirig;Address-/iPrincipal! a^*(j ^i*bw*!i*s>«afe ^^^^^^^^^^^^^ Zip-Code ^t^m^p^w^. :^h^contnbutoi;^^^^: pate; ;:. i idescri ptibn

10 SCHEDULE 111 ment of Expenditures Filer Identification Number ^* i***1' H 'To;Whbm! Raid PA- Zip Code patei[mm/dd/yyyy^ '.f^i'ifefti Mailing^Address1 l^'s.*^:-'ku«:ii?siws^il-- - H 'i ;^ h-^'' '7:^>U Si- -^\ -' PO JosX S>iW//-o *^:! >!*:: ' Zip,; ~Cbde Zip Code Description of Expenditure v.l-tf;-}1 '" «*- " pate; u Zip :MailirigjA"ddress ^4- // Date Ifr]M/DQ/YYYYl>* fmaili ngva'ddi:ess s: Zip Code - SV^^- < Code,j t^fci^

11 SCHEDULE IV ment of Unpaid Debts Use this Section to itemize all unpaid debts and obligations which are outstanding at the end of the reporting period. Filer;ident"rficatipn'<Number:.-i1^ ^:^!^^V'j^1^;ft^i^^\^jn^;Lj^'*v^1-''. '!.';-"V'''':;w -*&r.*f-i'.'a-'.** >-r,.*.-".rt'-'.ij. "- '^>'<J>rv-^*>;.>c*\^/,J.;'NLJ-,A\V-'JiVV'' ^ DATE^PEB; i'outstandmg;baiance-or-ueoti frj^&g^te^^^^ DATEiDEBiy NCU RREDM^ Jk 1 *- ^.^-^AftS^Tfi&WwF.^gffi ^ [MM/Pp^OT^S state - ^OUtstandihgiBialanceof^D :