Text read by OCR from the pages after the form, as written.
Page 2
STATE ETHICS COMMISSION
Date: 4 2 Lf 202I0 Bates/Batch # 17} IK 3
The PA State Ethics Commission has performed a review of your Statement
of Financial Interests form filed for calendar year 2()25) which was to be
filed in anticipation of the May 1,202 filing deadline. Please be advised
that your form is deficient and needs to be revised because the following
block(s) on the form are blank or otherwise incomplete:
Block 01
Block 02
Block 03 — The amended box is located in this biock on the far right
_X__ Block 04 04 A --Write -— IN “State Representative
X___ Block 5 A—Write IN “PA House OF Representatives
* 05 B
Block 06 --
Block 07 -- Should read (prior calendar year)
Block 08 ~
Block 09 ~
Block 10 -- List any direct or indirect sources of income of $1,300
or more (including but not limited to employers)
Block 11 —
Block 12 --
Block 13 --
Block 14 Fill in informaticn OR Check “NONE” box
Block 15 —
Please sign and enter the current date at the bottom of the form
Your original filing has been retained by the State Ethics Commission. To
correct the above deficiency(ies), please complete the entire enclosed
blank form making all necessary corrections and checking the box in block
3 for amending a filing. If the answer to a block is “none,” check the box
indicating that the answer is “none.” Sign and current date the form and
return it to the PA State Ethics Commission, Finance Building, 613 North
Street, Room 304, Harrisburg, PA 17120-0400. The corrected/amended
form will then be attached to the prior filing we received.
Please also file a copy of the amended form at every other location where
the original form was filed and make a copy for your records.
lf you have any questions regarding this matter, please contact The State
Ethics Commission at 717-783-1610 or toll free at 800-932-0936.
Enclosure(s): A copy of your original form.
Blank form(s) for your corrections
(keep a copy for your records)