HomeMy WebLinkAbout2021 94-006 WILLIAM HARRIS1/1
r/13/2022 3:47,23 PM
COMMON%VrzALTH OF PENNSYLVANIA
SIC-1 (Rev. 01122)
I01 LAST NAME
Harris Funeral Home 8142699658
94-006
STATEMENT OF .FINANCIAL INTERESTS
PLEASE PRINT NEATLY
02 ADDRESS office (business or governmental) or home Chy
S07 r..lhrarry T iant3 Johnstown
PENNSYLVANIA $TATE ETH106 COMM16810N
(717) 783.1010 - TOLL FREE l-eao-932-036
FIRST NAME: SUFFIX '
.W :T L... L ....I ....A... M .. - 4 1
G.... .
stale Zi Coda a Code Phone
PA 1 9904 `i4 ) .241- 386 7
NOTE: IF YOU ARl? INCLUDING ATTACHMENTS, DO NOT INCLUDE ANYTHING
SEARS YOUR SOCIAL. SECURITY NUMBER OR FINANCIAL ACCOUNT NUMBERS•
03 STATUS Check applicable box or boxes, more than one box may be marked. (See Instruclion page) [] Check this
❑ Public Employeebox If you
A El Candidate (Including write-in) C � Pub11c official (Current) D (Current) E El this box are ernonding
If you tire tiling an original filing
13 ❑ Nominee C ❑ Public official. (Former) D ❑ PublIC Employee (Former) 03 a eoGcitor
04 PUBLIC POSITION OR PUBLIC OFFICE (administrator, member, Commissloner, job title, eta.) 0 seoking ❑ hold � held
A
seeking ri hold II,.. ; held
B
06 POLITICAL SUBDIVISION In which you aretwere an Official, Employee, Candidate or Nominee,(e,g., depl, agency, authority, borough, board, commission, county, -school d Wict, twp, etc.)
Fl-
A t; r% A 7i n � u Ti 117 M F R. A L D I R E d T O R S
06 OCCUPATION OR PROFESSION (This may be the some as block 4) 07 YEAR SEE INSTRUCTIONS.
Informellon In blocks 6-15 represents 2 0 2 1
uneral Director disclosure for the calendar year fisted tiara:
06 REAL ESTATE INTEREBTA (gee Instruction pago) 'If NONE, ohaak thla box.
09 CREDITORS (See instruction papa) If NONE check this box. L J
Na 1st Summit Bank
Address: 1,25 Donald Lane
Johnstown, PA 15904
10 DIRECT OR INDIRECT 80URCES OF INCOME Including (but not limiled to) all employmehL (See instruction page) If NONE,
heck this bo�c.
Harris Funeral Horne
See Attached Addendum
11 GIFTS (Sao Instruction page) If NONE, chock this box,]
Source of Glft
Addross of Solace of GIN
.Idoress, 500- Cherry Lane
--
Johnstown I PA 15904
Interest Rate
4%
FICIAL USE ONLY)
T�
- `"9alue at alit
Cy
Cueumslanoes (including d6=1111lorll of GM
13 TRANSPORTATtON, LODGING, imtOSPITALITY (bee Instrudtlon page) If NONE, chock this box. ® VOW
seuroe(Name endAddrvssr
I J
Pcsftbh Hek1(i,e . otr�. Ql►pplor,
13 OFFICE, DIRECTORSHIP, OR EMPLOYMENT IN ANY BU131NEt3$ (Sae Instruction page) If NONE, check this box. I amplvyac, ale.)
Business Entity (Nwm wWAddrs;;) 1257. Scalp Avenue
Richland Cemetery Assn. Addrea� 9 6 o eA 1 XM —
1i FINANCIAL INTEREST -IN ANY LEGAL ENTITY IN BUSINESS FOR PROFIT (See instfuction page) If NONE. *hook
this
this box -
se and Address of Bhrolnesa
Harris Funeral Home 500 Cherry Lane Johnstown, PA 15904
10
BUSINESS INTERESTS TRANSFERRED TO IMMEDIATE FAMILY MEMBER (See Instructlon page) If NONE, check this box. t Hold
Businv** (Name and Address) I Relelionshlp
Transferee (Nome and Address)
The undersigned hereby affirms that the fore
Ip the taonelMeo prooerlbed by Je Pn.0,9: is
information
President
Interest Hell (i.e., 5%.10N, eta)
100%
Bate Transferred
ON ta rr ct tothe d best
OhO Pubka portion's ahQilml pld0ys` Inftump on ae vo�c f said oaKmratlon being made•SubJect
Enter Current Date
Signature CkWAIG -
TMIS FORM 16 CONSIDERED DEFICIENT IF ANY BLOCK ABOVE 13 NOT COMPLETED. MAKE A COPY FOR YOUR RECORDS.