HomeMy WebLinkAbout2021 15-007 Caitlin Chasar15-007
1COM(MONWEALTH) of PENNSYtVANIA STATEMENT OF FINANCIAL INTERESTS PENNSYLVANIA STATE ETHICS COMMISSION
(717) 783.1810 • TOLL FREE 1-80M32-0038
PLEASE PRINT NEATLY
01 LAST NAME FIRST NAME MI SUFFIX
•C:H.A;SSA R, C AA T L IN E__--
02 ADDRESS office (business or governmeretal) or home City • '• State Zip Code Area Code Phone
361 Moyer Blvd North Wales PA 19454 (215) 8961652
03 STATUS Check applicable box or boxes, more than one box may be marked. (See instruction page) .'
Check this
A Candidate (including write-in C Public Official Current D Public Employee box if you
( 9 ) (Current) ployee (Current) E Check this box an amending
�/ if you am fling g
B Nominee C X Public Official (Former) D Public Employee (Former) as a solicitor an original filling
04 PU13UC POSITION OR PUBLIC OFFICE (administrator, member, Commissioner, job title, eta) r seeking ; hold lX held
A
seeking F hold i -^ held
05 POLITICAL SUBDIVISION in which you areAvere an Official, Employee, Candidate or Nominee (e.g., dept, agency, authoft borough, board, cornrnission, county. school district, twp, eta.)
A
8 - _..__....
00 OCCUPATION OR PROFESSION (This may be the same as block 4) 07 YEAR SEE INSTRUCTIONS.
Grants and Policy Development Coordinator Information in blocks 8-15 represents disclosure
O 2 ; }
disclosure for the calendar year listed here:
08 REAL ESTATE INTERESTS (See instruction page) If NONE, check this box. X
09 CREDITORS (See instruction page) If NONE, check this box. X
Interest Rate
Nsme: Address:
10 DIRECT OR INDIRECT SOURCES OF INCOME including (but not limited to) all employment. (See instruction page) N NONE, (OFFICIAL USE ONLY)
cc c ` - 7 * p� %1 , �j». chec this box.
Name LIBEL E.J OIA RCI45 Ad : � 12 M D S I SuZ , WO
i jaJelphicu A lG1101
-11
11 GIFTS (See instruction page) If NONE, check this box. X
Source of Gift Value of Gift
Address of Source of Gift ( Cmumatenkxs (including description) of Gift
12 TRANSPORTATION, LODGING, HOSPITALITY (See instruction page) If NONE, check this box. X Velue ^��
Source (Manus srtd Atldress)
13 OFFICE, DIRECTORSHIP, OR EMPLOYMENT IN ANY BUSINESS (See instruction page) If NONE, check this box ' Position Had (i.e„ omoer• dkedor,
Business Entity (Name and Address)
employee etc
"arm Address: zz 0"1
14 FINANCIAL INTEREST IN ANY LEGAL ENTITY IN BUSINESS FOR PROFIT (See instruction page) If NOW cho"WljC . X Interest Held (i.e.. 5%, 10%, etc.)
Name and Address of Business 0 ,
15 BUSINESS INTERIESTg TRANSFERRED TO IMMEDIATE FAMILY MEMBER (See instruction page) If NONE, check"box.
Business (Name and Address) Interest Held
Tm(Name and (Naend Address) Relationship
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.14904 (unsworn falsification to authorities) and the Public Official and Employee Ethics Act. a Pa. 0.S. f I I09(b).
Signature Caitlin E Chasar Enter Current Date 04/06/2022
THIS FORM 13 CONSIDERED DEFICIENT IF ANY BLOCK ABOVE IS NOT COMPLETED. MAKE A COPY FOR YOUR RECORDS.