HomeMy WebLinkAbout2019 77-017 DEBORAH FOWLER (2)SEC-1 01/TIH)OFPENNSYLVANIA STATEMENT OF FINANCIAL INTERESTS PENNS)783-1 10eTOLETHICSCOM932-09 6
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�IPLEASE PRINT NEATLY
01 LAST NAME FIRST NAME MI SUFFIX
I o] wl I LLFT I I I I I E ID le,h LL I I F .1 [A]
02 6DDRESS o ice usin ss or governmental) or home City State Zip Code Area Code Phone
it, tv 1-70 717
NOTE: IF YOU ARE INCLUDING ATTACHMENTS, DO NOT INILUDE AN RING THAT BEARS YOUR SOCIAL SECURITY NUMBER OR FINANCIAL ACCOUNT NUMBERS.
03 STATUS Check applicable box or boxes, more than one box may be marked. (See instructions on page 2) � Check this
A ❑ Candidate (including write-in) C ❑ Public Official (Current) D ❑ Public Employee (Current) E ❑ Check this box box if you
are amending
if you are filing
B ❑ Nominee C ❑ Public Official (Former) DIE] Public Employee (Former) as a solicitor an original filing
04 PUBLIC POSITION OR PUBLIC OFFICE (administrator, member, Commissioner, jl b title, etc.) ❑ seeking ❑ hold held
A ! ., ui I �_ I v- , a n n I o I , n e2 I t^
❑ seeking ❑ hold ❑ 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.) ,
A
B
06 OCCUPATION OR PROFESSION (This may be the same as block 4)
IWO, rc 1
07 YEAR SEE INSTRUCTIONS. __
Information in blocks 8 -15 represents F
disclosure for the calendar year listed here: 0
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,
Name: Address:
check this box.
'y
i d.,
';
Interest Rate
10 DIRECT OR INDIRECT SOURCES OF INCOME including (but not limited to) all employment. (See instructions on page 2) If -NO
Check-tF��s:b k.❑
T (I. � J ,ate i
Name: I mi r Add res�� r• m
(OFFICIAL USE ONLY)
2o1a
A M r
15
11 GIFTS (See instructions on page 2) If NONE, check this box. = J
Source of Giftqq Value of Gift
7_1" •r 1 .G' t m
Address of Source of Gift Circumstances (including description) of Gift
12 TRANSPORTATION, LODGING, HOSPITALITY, (See instructions on page 2) If NONE, check this box. Value
Source (Name and Address)
m
13 OFFICE, DIRECTORSHIP,OR EMPLOYMENT IN ANY BUSINESS (See instructions on page 2) If NONE, check this box. �j Position Held (i.e., officer, director,
Business Entity (Name and Address) '''TT I employee, etc.)
Name:
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 eld
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 N18 Pa.C.S. §4904 (unswor falsification to authorities) and the Public Official and Employee Ethics Act, 65 Pa.C.S. §1109(b)..
Signaturevioh� Enter Current Date O
THIS FORM IS CONSIDERED DEFICIENT IF ANY BLOCK ABOVE IS NOT COMPLETED. MAKE A COPY FOR YOUR RECORDS.
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