HomeMy WebLinkAbout2021 21-006 Robert GiffingCOMMONWEALTH OF PENNSYLVANIA 21 —006
SEC-1 REV. 01/20 STATEMENT OF FINANCIAL INTERESTS PENNS(71783-1) 783-1 1 STATE ETHICS COMMISSION
610 *TOLL FREE 1-800-932-0936
PLEASE PRINT NEATLY
01 LAST NAME FIRST NAME MI SUFFIX
LG I [R: O B R ITT
E=-
02 ADDRESS office (business or governmental) or home City State Zip Code Area Code Phone
1 12 UNDECAMP LANG PEAQ4 BOTTOM PA 1-756 (71-7 ) 548-31i4
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, morethanone block may be marked. (See instructions on page 2) ❑ Check this
A ❑ Candidate (including write-in) C Q Public Official (Current) D 11 Public Employee (Current) E D Check this block block if you
if you are filing are amending
B ❑ Nominee C ❑ Public Official (Former) D ❑ Public Employee (Former) as a solicitor an original filing
04 PUBLIC POSITION OR PUBLIC OFFICE (administrator, member, Commissioner, job title, etc.) ❑ seeking ® hold ❑ held
r { ❑ seeking ❑ hold 0 held
B I I I- i I I I I
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.)
06 OCCUPATION OR PROFESSION (This may be the same as block 4) 07 YEAR SEE INSTRUCTIONS.
_ Information in Blocks 8 -15 represents .L 0 -�� —�
RE T I R E D CO NST� E disclosure for the calendar year listed here:
08 REAL ESTATE INTERESTS (See instructions on page 2) If NONE, check this box.
C/i r--
r 4
a
09 CREDITORS (See instructions on page 2) Creditor (Name and Address) If NONE, check this box.
+) Interest Rate
Name: Address: ......W
10 DIRECT OR INDIRECT SOURCES OF INCOME including (but not limited to) all employment. (See instructions on pg. 2) ONLY IF this
OOOFFICIAL USE ONLY)
check this bl
P SC 0L__E_�1LOy-RETI�I` rNT 5 f�, 5fi" ST., IiARRtS
Name:_ . Address:_ DURi, 'A
ARM5-MRG 1n cNZ IRD(AsTRE-b PEN50N Po. VS 3" I WCA5 T CR PA lit a q
11 GIFTS (See instructions on page 2) If NONE, check this box.
Source of Gift
Value of Gift
Eli --=- I
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 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) d employee, etc.)
14 FINANCIAL INTEREST IN ANY LEGAL ENTITY IN BUSINESS FOR PROFIT (See instructions on page 2) If NONE, check this box. 0 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. 10
Business (Name and Address) I 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 (unswom falsificatio to authorities) and the Public Official and Employee Ethics Act, 65 Pa.C.S. §1109(b).
Si nature Z
9 Enter Current Date' Z�
THIS FORM IS CONSIDERED DE CIE T F AN LOCK ABOVE IS NOT COMPLETED. MAKE A COPY FOR YOUR RECORDS.
(3 of 4)