Commonwealth of Pennsylvania
PAGE
FINANCE REPORT ~NOTE;
This report must be clear and legible. It may be typed or printed in blue or black ink.)
City:
TYPE OF REPORT (plJilCe X to
the right of report type)
Summary of Receipts and Expenditures from:
and Receipts {From
Funds AvaHab\e (Sum of Lines A and 8) Expenditures {From Schedule m}
Cl
Ending Cash Balance {Subtract Line D from Une
Value of In-Kind Contributions Received (From Schedule
I "'"""" lor af!!.m) tin"
cortect
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this r~pnrt, lnclurllflg the attached scne4ules, on "aper e( cemputernkette, are to the best 01 my know1edge and belIef true,
completa, 1~
Sworn to a11d subscribed be10re me tl\,s
d. cr
_ _ _ _~ _ _ _:,_,,.-____::__------.. -.-.-..- - - -
N
day of
1)-c,.vMl:. s
r, .~.C--A,-,-:tJ=-",,>E~_ _ Printed Neme
I swear lor "fnrm) that to the hest of my Imowiedg" lind belief !hls rolit;",,! committee has 110t vioillted "ny proVisions of the Ac( of June 3, 1937
u~:d
(p.L. 1333, No. 32tll as amended. Swom to and subscribed befors me this
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7
JUDY I JEHU
't~~~~73~~~t;;GrnUJnrARl~No~t~a~ry;;;PU;b~lIiFCIHIN' 7. RISSuRG, DAuPHIN COU
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Signature of Candidate
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YR.
of State ~ 210 North Office Building
Area Cod"
Bureau of Commissions, Eleetiol'ls and Harrisburg, PA 11110-0029 iI
*
Daytime Telephone Nlnnbe,