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}

Ending Cash Balance {Subtract Line D from Une Cl

Value of In-Kind Contributions Received (From Schedule m

I "'"""" lor af!!.m) tin" this r~pnrt, lnclurllflg the attached scne4ules, on "aper e( cemputernkette, are to the best 01 my know1edge and belIef true,
cortect ""d completa,
Sworn to a11d subscribed be10re me tl\,s 1~

d. cr day of N _ _ _ _~
_ _ _:,_,,.-____::__------.. -.-.-..- - - -
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
(p.L. 1333, No. 32tll as amended. u~:d
Swom to and subscribed befors me this

.........::'::;#~~~~~.2N~O~TAR~IA~L SEM.QL
JUDY I JEHU 7 Signature of Candidate

't~~~~73~~~t;;GrnUJnrARl~No~t~a~ry;;;PU;b~lIiFCIHIN'
7. RISSuRG, DAuPHIN COU __~-
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OA Y YR. Area Cod" Daytime Telephone Nlnnbe,

of State ~ Bureau of Commissions, Eleetiol'ls and

210 North Office Building * Harrisburg, PA 11110-0029 iI