HomeMy WebLinkAbout2021 78-HR3 MICHAEL PACE (2)r
SEC-COM1
01/2 jOFPENNSYLVANIA /93 STATEMEN OF FINANCIAL INTERESTS PENNS)783-1 10eTOLETHICSCOM932-09 6
(717) 783-1610 •TOLL FREE 1-800-932-0936
PLEASE PRINT NEATLY
01 LAST NAME FIRST NAME p MI SUFFIX
P A' � � Vvl 1 C /`I /� EL ❑m
02 ADDRESS office (business or governmental) or home City tate Zip Code Area Code Phone
770 of . %c�1 /v kit-L L Rtl v+b , v A -Taro" r/� lb ytll ( 8>q ) z/(oa -SSS�
NOTE: IF YOU ARE INCLUDING ATTACHMENTS, DO NOT INCLUDE ANYTHING 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) heck this
A (_ y Candidate (including write-in) C ❑ Public Official (Current) D ❑ Public Employee (Current) E ❑ Check this box box if you
if you are filing are amending
B ❑ Nominee C ❑ Public Official (Former) D El Public �E7mplployee (Former) as a solicitor an original filing
s
04 PUBLIC POSITION OR PUBLIC OFFICE (administrator, member, Commissioner, job title, etc.) I� seeking ❑ hold ❑ held 7_1
A R p R-E 5_ Isi I -r Ia I T I i I v I e I I i liv I I -'' H I E
❑ seeking ❑ hold ❑ held
B JC J I F
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.)
A2N� I I L.I EGA S ��IT vF .Di STDI J�T-J
B
06 OCCUPATION OR PROFESSION (This may be the same as block 4) 07 YEAR SEE INSTRUCTIONS.
Information in blocks 8 -15 represents 2 0
disclosure for the calendar year listed here:
08 REAL ESTATE INTERESTS (See instructions on page 2) If NONE, check this box.
r_-1 r
09 CREDITORS (See instructions on page 2) Creditor (Name and Address) If NONE, check this box.
Interest Rate
Name: Address: r°
21
10 DIRECT OR INDIRECT SOURCES OF INCOME including (but not limited to) all employment. (See instructions on page 2) If NO( "' . (OFFICIAL USE ONLY)
�i check2s ob.
Name: TOLL _ 14L L _r/VC . Address: Z� 5 3 r� S I3DT)-1 S r .ccJJ��
11 GIFTS (See instructions on page 2) If NONE, check this box.
Source of Gift Value of Gift
. m
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) employee, etc.)
Name: Address:
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. Moom
Business (Name and Address) 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 118 P�a.C.S. §J,904 lunswrn falsification to authorities) and the Public Official and Employee Ethics Act, 65 Pa.C.S. §1109(b).
Signature /G%LL Enter Current Date -7
THIS FORM IS CONSIDERED DEFICIENT IF ANY BLOCK ABOVE IS NOT COMPLETED. MAKE A COPY FOR YOUR RECORDS.
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