Commonwealth of Pennsylvania PAGE 5 OF
CAMPAIGN FINANCE REPORT (NOTE:
(COVER PAG&
This report must be clear and legible. It may be typed or printed in blue or black ink,;
Filer Identification Number:
TYPE OF REPORT (place X to the right of report type)
6TH TUESDAY PRE-PRIMARY
2ND FRIDAY PRE-PHIMARY
BTH TUESDAY PRE-ELECTION
2ND FRIDAY PRE-ELECTION
30 DAY POST ELECTION
FILING METHOD IVI CHECK ONE
Name of Office Sought by Candidate
(SEE INSTRUCTIONS FOR CODES! FOR OFFICE USE ONLY Summary of Receipts and Expenditures from: A. Amount Brought Forward From Last Report 3- Total Monetary Contributions and Receipts (From Schedule I) C. Total Funds Available (Sum of Lines A and B) Total Expenditures (From Schedule III) E Ending Cash Balance (Subtract Line D from Line C) F. Value of In-Kind Contributions Received (From Schedule II) G. Unpaid Debts and Obligations (From Schedule IV)
PART I - If this is a Committee report treasurer sign here.
If this is l Candidate report fjndldM sisnn«rr
I awear {or affirm) that this report, including the attached schedule, on paper or compvt«r tfickme, are to «.« beat of my KMOWIMB* «m belief true, correct and complete.
Daytime Teiep-hone r.ymbor PART H - If this is a report of a Candidate's Aathonzad Committon, cy.did.rta sKatl sign hare. I sweat (or affirm) that to the best erf my knowledge and belief this political committee ham not violated any previsions of tha Act of June 3, 1937 {P.L. 1333, No. 320) as amended. Sworn to and tubseribed before m« thii day of
tfi
Signature of Candidet* Printed Name My commission axpjras Daytime Telephone Number
Department of State • Bureau of Commissions, Elections and Legislation 303 North Office Building • Harrlsburg, PA 17120-0029 • (717) 787-5280 DSEB-592 (7-99I
PAGE
"2- OF
SCHEDULE Hi
STATEMENT OF EXPENDITURES Nwne of Filing Committee or Candidate
To Whom Paid
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Mailing Addr«=a
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Reporting Period
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Description of Expenditure
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1 Amount
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MO.
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DAY | YEAR
Description of
|AfTlQum
1 |f Exparsditur*
City
To Whom Paid
MO.
Mailing Address City
Y E A H l '••'"•"
Description of Expenditure State
«0.
Mailing Address
DAY
YEAR
Description of ExpenditlQ'* State
f
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Zip Cod* (Pint 4)
To Whom Paid
City
DAY
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•
|AmOUnt
Zip Cod* (Pius 4}
I
PAGE TOTAL
5
S
2\(2~ f 1 8
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
^
ON BEHALF OF NAME OF FILING COMMITTEE, CANDIDATE OR LOBBYIST
f\
( ^ C?^AA4 STREET ADDRESS
<
? rl
fff r
CA»D».TE
^|
COMMITTEE
1.
2ND FRIDAY PRE-PRIMARY
30 DAY POST-PRIMARY
/
2.
X
GTH TUESDAY PRE-ELECTION 5. 2ND FRIDAY PREELECTION
Ce£mAjcM DATES OF REPORTING PERIOD
£r Xr=r
T^V-EI J-e-rtsvi \\e.
j^naei ZIP
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DISTRICT NO.
••BiESESi^^uESBHH
PARTY
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^ .— ^
TO
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ir. r
$
TOTAL AMOUNT OF FILER'S OUTSTANDING D -:BTS OR LIABILITIES
AT THE END OF REPORTING PERIOD:
YEAR ^CXJ
$
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5pl
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5
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POST-ELECTION
AMENDMENT REPORT?
YES
NO
X
ANNUAL REPORT
TERMINATION REPORT?
YES
NO
x^
.
DAY 1^
g 09
6
CASH BALANCE VT END OF REPORTING F ERIOD:
MO. JT
FOR OFFICE USE ONLY
' 30 DAY
1
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6TH TUESDAY PRE-PRIMARY
A
/ T e h * S4W&.
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STATE
NAME OF OFFICE SOUGHT BY CANDIDATE
LOBBYIST
1
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TYPE OF REPORT (CHECK ONE)
1\/
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 ASOVE DID NOT EXCEED TWO HUNDRED AND FIFTY DOLLARS ($250.00) AND THIS REPORT IS, TO THE BEST OF MY KNOWLEDGE AND BELIEF, TRUE, CORRECT AND COMPLETE.
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, No. 320) AS AMENDED. SWORN TO AND SUBSCRIBED BEFORE ME THIS SIGNATURE OF CANDIDATE
PRINTED NAME
DAYTIME TELEPHONE
DSEB-503 (12-99)
Department of State • Bureau of Commissions, Elections and Legislation 303 North Office Building • Harrisburg, PA 17120-0029 • (717)787-5280
NUMBER
.:;-,
SCHEDULE IV
STATEMENT OF UNPAID DEBTS Use this Section to itemize all unpaid debts and obligations which are outstanding at the end of the reporting period. Reporting Persoc
• Name of Filing Committee or Candidate S
.jL^l£££fcjbLl3lllCl!E— Niame of Cred'tor
,
$—™A§..c Z™JS ?K*3
~
^5*.5~|. ^ City
°"
Outstanding b5;ar;ce of DetJt
p A
MsiNng Address
cript
Sitf TT A
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JN v^iecJ^os \)i i [
Kpoxi-
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-
-YEAR
l
\ C fi v^^rn &.V\A. \D TD v1
NST-S o j Crec:tor
DAY
MO--
INCURRED
Sf
\totrj-
\p^
Meiling Address
Outstanding Baiance of Debt
$
DATE DSBT INCURRED
WO,
'
YEAR
DAY
City -
Descriotion of Debt J-utstar-.ding Ba.ance or DeDt
Narns of Crecitor
$ Ma, ling Acdress
WO-
-
Y"EA?1 . -
DAY
INCURRED
-' 'Y
S:ate
Z,p Cede Pius 4:
Description of Debt
Name of
-j,..«..Bo ra«^ s
editor
Msiling Aaoress DS5T
P/IC.
i.a.e
C,,V
YEAR
DAY
^tp
ra
_ccs
Vi^s
4!
Description of Debt Name of Creditor
Cj-.stanaing Balance of Eebt
S " !"9
DATE DEBT INCJ^StD
MO.
i.i.e
"V
DAY
Y^AR
-
i,p ^ c o e
""'*
Description of Debt Name of Creditor
Cutstanaing Balance of Debt
S Mailing Address
DATE DEBT
WO-
YEAR
GAY
City
PL i ! 5
4:
_
f________^ PAGE TOTAL
Enter Grand Total of Unpaid Debts on Page 1, Report Cover Page, Item G,