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[Pages:225]COMMONWEALTH OF PENNSYLVANIA SEC-1 REV. 01/12

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10 P>RECTO? luniRFrtT SOURCES OF INCOME indudino (but not limited to) |H employment TV Nam?: f '

/T/ViMtO^t 0**-

_ Add CO ^ 3 H

J>(0f-FICJSaJSE ONLY)

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11 GIFTS (See instructions on page 2) tf NONE, check this box. Source of Gin

ValuoofGrR

Address of Source or Gift

Ctrajmstances (Including description) of Gift

12 TRANSPORTATION, LODGING, HOSPITALITY (See Instructions on page 2) If NONE, check this box.

Source (Name end Address)

Value

13 OFFICE, DIRECTORSHIP OR EMPLOYMENT IN ANY BUSINESS (See instructions on page 2) If NONE, check this box. Business Entity (Name and Address)

Namo:

Addrwt:

14 FINANCIAL INTEREST IN ANY LEGAL ENTITY IN BUSINESS FOR PROFIT (See Instructions on page 2) If NONE, check this box. Name and Address of Business

Position Hdd

Interest H?W

15 BUSINESS INTERESTS TRANSFERRED TO IMMEDIATE FAMILY MEMBER (See instructions on page 2) If NONE, check thta box. \&[

Business (Name and Address)

Tranifcrea (Name and Address)

The undersigned he> to the penalties pre

I interettHekJ

Relationship Date Transferred

?ald person's knowledge, information and belief; said affirmation being made subject il and Employee Ethics Act, 65 Pa.C.S. 9110,9(6).

Skjna

Enter Current Date

THIS FORM IS CONSIDERED DEFICIENT IF ANY BLOCK ABOVE IS NOT COMPLETED. MAKE A COPY FOR YOURRECORDS.

(3 Of 4)

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COMMONWEALTH OF PENNSYLVANIA SEC-1 REV. 01/12

01 LAST NAME

STATEMENT OF FINANCIAL INTERESTS

PLEASE PRINT NEATLY

FIRST NAME

PENNSYLVANIA STATE ETHICS COMMISSION (717) 783-1610?TOLL FREE 1-800-932-0936

Ml SUFFIX

NOTE: IF YOU ARE INCLUDING ATTACHMENTS, D

03 STATUS Check applicable block or blocks, more than one block may be marked. (See instructions on page 2)

A 1 1 Candidate (including write-in) B 1 1 Nominee

C LJ Public Official (Current) C 1 1 Public Official (Former)

D l--1 Public Employee (Current) D 1 1 Public Employee (Former)

E 0> Check this block

if you are filing as a solicitor

LU Check this

block if you are aTMending an original fillnj

04 PUBLIC POSITION OR PUBLIC OFFICE (administrator, member, Commissioner, job title, etc.) __J seeking

r L / A C^iO

C. 1

0&

seeking

B

J?5. hold

~J held

n hoig-o a ^ .f-\

-/.

r- :> W \T

05 GOVERNMENTAL ENTITY in which you are/were an Official. Employee, Candidate or Nominee (e.g., dept, agency, authority, borough, board, commission. county,schooJ district, twp. etc.)

_ .

.

._

.

^ .--.

--. j---- '

.

?"*?? _. "? _*-**!

o

?A

coM r o

R

O F

06 OCCUPATION OR PROFESSION (This may be the same as block 4)

07 YEAR The information in blocks 8 through 15 below represents financial interests for the PRIOR calendar year indicated:

O

08 REAL ESTATE INTERESTS (See instructions on page 2) If NONE, check this box.

09 CREDITORS (See instructions on page 2). Creditor (Name and Address) If NONE, check this box. LJ Name:

Intarast Rate

10 DIRECT OR INDIRECT SOURCES OF INCOME including (but not limited to) all employment. (See instructions on pg. 2) ONLY IF NONE,

IiLTiQTUT V*\lM Ct TLfO-fLli. Ka&J check this block. I I

Name:

Address: .Suifg

JA- WQI

i

11 GIFTS (See instructions on page 2) If NONE, check this box. Source of Gffl

(OFFICIAL USE ONLY)

Value of Gift

Address or Source of Gift

Circumstances (including description) of Gift

2 TRANSPORTATION, LODGING, HOSPITALITY (See instructions on page 2) If NONE, check this box.

Source (Name and Address^

3 OFFICE, PIRECTORSHIP OR EMPLOYMENT IN ANY BUSINESS (See instructions on page 2) If NONE, check this box.

Business Entity (Name end Address)

HJOil /*llA C'

Name:

Address: ^lil'fa. 2&O}

4 FINANCIAL INTEREST IN ANY LEGAL ENTFTY IN BUSINESS FOR PROFIT (See instructions on page 2) If NONE, check this box.

Name and Address of Business

Position Held Interest Held

BUSINESS INTERESTS TRANSFERRED TO IMMEDIATE FAMILY MEMBER (See instructions on page 2) If NONE, check this box.

Business (Name and Address)

Interest Held Relationship

Transferee (Name and Address)

Dale Transferred

ie undersigned hereby affirms that the foregoing information ts true and correct to the best of said person's knowledge, information and belief; said affirmation being made subject

the penalties presciHHIHHmHHHMHligiM^ritf uthorities) and the Public Official and Employee Ethics Act, 65 Pa.C.S. ?1109(b).

Signature THIS FORM IS CONSIDERS

Enter Current Date LOCK ABOVE IS NOT COMPLETED. MAKE A COPY FOR YOUR RECORDS.

(3 of 4)

COMMONWEALTH OF PENNSYLVANIA sEC-i REV. 01/12

CT ATCftflCMT r\ CIMAMrMAI IMTCDCCTC O IMI CIVIC IN 1 \Jr riiNMINOLML. in 1 Ct\CO ID

PLEASE PRINT NEATLY

PENNSYLVANIA STATE ETHICS COMMISSION (717) 783-1610- TOLL FREE i-aoo-932-0936

01 LAST NAME

4 14 L. 8 (? A. Iv I>7^

FIRST NAME

r? o M -A L "b

MI SUFFIX

W

02 ADDRESS

V

City

Zi Code

NOTE: IF YOU ARE INCLUDING ATTACHMENTS, DO NOT INCLUDE ANYTHING THAT BEARS YOUR SOCIAL SECURITY NUMBER OR FINA

03 STATUS Check applicable block or blocks, more than one block may be marked. (See instructions on page 2)

1 I

A LH Candidate (including write-in) I-,

B LJ Nominee

C LJ Public Official (Current) n

C 1--1 Public Official (Former)

D LX Public Employee (Current)

n

f' ^

'

D 1--I Public Employee (Former)

E LH Check this block if you are filing as a solicitor

block if you are amending an original films

e o *z. V k s ^^ e /e. i T A^V 04 PUBLIC POSITION OR PUBLIC OFFICE (administrator, member, Commissioner,job title, etc.) ,-J seeking

D A

'I ?

C?

4R

- hold

D seeking

hold

J held

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................

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