HomeMy WebLinkAbout2019 61-017 MICHAEL CORNELL61-017
COMMONWEALTH OF PENNSYLVANIA PENNSYLVANIA STATE ETHICS COMMISSION
SEC-1 REV. 01/20 STATEMENT OF FINANCIAL INTERESTS (717) 783-1610 9 TOLL FREE 1-800-9*32-0936
PLEASE PRINT NEATLY
01 LAST NAME FIRST NAME MI SUFFIX
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02 ADDRESS office (business or governmental) or home City State Zip Code Area Code Phone
-7 7 7Z, (III 15C0(___1zA Dig. Ft IkAMON PtIr L6037 (qJ&)37o
NOTE: IF YOU ARE INCLUDING ATTACHMENTS, DO NOT INCLUDE ANYTHING THAT BEARS YOUR SOCIAL SECURITY NUMBER OR FINANCIAL ACCOUNT NUMBERS.
03 STATUS Check applicable block or blocks, more than one block may be marked. (See instructions on page 2) 0 Check this
A 0 Candidate (including write-in) C Public Official (Current) D 0 Public Employee (Current) E' 0 Check this block block if you
if you are filing are amending
BE] Nominee C 0 Public Official (Former) D El Public Employee (Former) as a solicitor an original filing
04 PUBLIC POSITION OR PUBLIC OFFICE (administrator, member, Commissioner, job title, etc.)0 seeking hold ❑ held
AJ5J-t-f1__J JC�_JC>JtJJ5JdNJe;
C11 I cle- I I I I I I I I I I I I I 1 1 1
1:1 seeking M hold El held
B
05 GOVERNMENTAL ENTITY in which you are/were an Official, Employee, Candidate or Nominee (e.g., dept, agency, authority, borough, board, commission, county, school district, twp, etc.)
AJ(JJA-J�JMJ6JrJJyJ I I I I I I I I
B I I I I I I I I I I I I I I I I
06 OCCUPATION OR PROFESSION (This may be the same as block 4) 07 YEAR SEE INSTRUCTIONS.
Lrr,3 ( ,, Information in Blocks 8 -15 represents 2 0
disclosure for the calendar year listed here: 111 1 C11
08 REAL ESTATE INTERESTS (See instructions on page 2) If NONE, check this box.
Cl)
09 CREDITORS (See instructions on page 2) Creditor (Name and Address) If NONE, check this box.
Interest Rate
7 Name: Address:
ri 7
CA>
146 101 C
10 DIRECT OR INDIRECT SOURCES OF INCOME including (but not limited to) all employment. (See instructions on pg. 2) ONLY I (OFFICIAL USE ONLY)
check t( is I bt ek.
Name: Address:1 s7 fe"-( H y 7
11 GIFTS (See instructions on page 2) If NONE, check this box.
Source of Gift Value of Gift
Address of Source of Gift I Circumstances (including description) of Gift
12 TRANSPORTATION, LODGING, HOSPITALITY (See instructions on page 2) If NONE, check this box. Value
Source (Name and Address)
13 OFFICE, DIRECTORSHIPOR EMPLOYMENT IN ANY BUSINESS (See instructions on page 2) If NONE, check this box. Position Held (i.e., officer, director,
Business Entity (Name and Address) employee, etc.)
5,C>L,,./-n6tAS, 7L Pot,&-f hr--Y PW (6137 Ot A-bAeV_
Name: L Address:
14 FINANCIAL INTEREST IN ANY LEGAL ENTITY IN BUSINESS FOR PROFIT (See instructions on page 2) If NONE, check this box. interest Held (i.e., 5%, 10%, etc.)
Name and Address of Business
15 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) Date Transferred
The undersigned hereby affirms that the foregoing information is true and correct to the best of said person's knowledge, information and belief; said affirmation being made subject
to the penalties prescribed by 18 Pa.C.S. §4904 ( 7worn falsification to authorities) and the Public Official and Employee Ethics Act, 65 Pa.C.S. §1 109(b).
Signature Enter Current Date
THIS FORM IS CONSIDERED DEFICIENT IF ANY BLOCK ABOVE IS NOT COMPLETED. MAKE A COPY FOR YOUR RECORDS.
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