HomeMy WebLinkAbout2020 93-017 TAMMY FREYD/27/2021 3:09 PM FROM: Staples I TO: +17177870806 P. 2
93-017
COMMONWEALTH OF PENNSYLVANIA STATEMENT OF FINANCIAL INTERESTS PENNSYLVANIA STATE ETHICS COMMISSION
SECA REV. 01120
(717) 783.1610 *TOLL FREE 1-800-932.0936
PLEASE PRINT NEATLY
01 LAST NAMEFIRST NAME MI SUFFIX
IF Cl E=-
02 ADDRESS office business or.governmental) or hom Ci State Zip C de Area Code
NOTE: IF YOU ARE INCLUDING ATTACHMENTS: DO NOT INCLUiiMWW, 't)E WG'F.R-Ai;.lM4RSI'QUR SOCIAL SECURITY NUMBER OR FINANCIAL ACCOUNT. NUMBERS.
03 STATUS Check applicable block or blocks, more than one blob LnaY be; nia5lcedJSnnee iQ1 ructions on page 2) ❑ Check this
A t_E�__J Candidate (including write-fn) C 0Public Official (Current) D I_..1 Public Employee (Current) E I__I Check this block block if you
if you are filing are amending
B Nominee C�ublic Official (Former) O (�u ke Employee (Former) as a solicitor an original filing
04 PUBLIC POSITION OR PUBLIC OFFICE (administrator, member, Commissioner, job title, etc.) L_1 seeking L; hold held
im
i ,
9 � r i seeking I— hold
Ale ' . ❑ s ek g l� ❑ held
B --T�f _1
05 . GOVERNMENTAL ENTITY in wNch you are/were an Official, Employee, Carxlidate 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) 07 YEAR SEE INSTRUCTIONS.
Information in Blocks 8 -15 represents
disclosure for the calendar year listed here:
08 REAL ESTATE I
(See instructions on page 2) If NONE, check this box.
Olt
09 CREDITORS (See instructions on page 2) Creditor (Name and Address) If NONE, check this box. C-
_` InFist Rate
Name: Address:
„ tV
10 DIRECT OR INDIRECT SOURCES OF INCOME including (but not limited to) all employment. (See instructions on pg. 2) ONLY IF NONE, P;
check this block , s�
Name'
Address- I C _3_ _
(OFFICIAL USE ONLY)
11 GIFTS (See instructions on page 2) If NONE, check this box.. -9
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, DIRECTORSHIP,OR EMPL� OYMENT IN ANY BUSINESS (See instructions on page 2) If NONE, check this box. E7 Position Held (i.e., officer, director,
Business Entity(Nameand Address) employee, etc.) ��
&e,•• �'f"
tS tt't C r (v--,- 1)qP- `.611? � / y y
Name: Address: zt7ni �' F l t e !' f`•'l , i 7C7 2, f -- - A:rs/S'�,,% / Cn v k Y re-
14 FINANCIAL INTEREST IN ANY LEGAL ENTITY IN BUSINESS FOR PROFIT (See instructions on page 2) If NONE, check this box. Interest Hold (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) I Interest
Transferee (Name and Address) I Dale 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 (unsworn falsification to authorities) and the Public Official and Employee Ethics Act, 65 Pa.C.S. 91109(b).
f
Signature,, 'i`4•� '1 �T '�l i' /gut • 2
Enter Current Date
THIS F RM 1S CONS I I RED DEFICIEN�1fF ANY BLOCK ABOVE IS NOT COMPLETED. MAKE A COPY FOR YOUR RECORDS.
V (3 or 4)