Download - Dr. Jeffrey Miller ethics form ( EI Associates)

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Page 1: Dr. Jeffrey Miller ethics form ( EI Associates)

COMMO:'..f\-.JE',LTH 0;: ;:'IEN.NSYLV;\NIASEt;..~ RE\r' OiiC9 STATEMENT OF FINANCIAL INTERESTS PENNSYLVAN!A STAlE EtHICS COMMISSION

(717) 783-16 H). rou, F~EE 1~L\(H-)32·C193{j

LAST NAMEi-~;-'-,-r---'--·-.· -~ _ l~~-'~--j~--':--"-i-' --: - e- ~'

lli: .!_l~j6..L£:.Al--.--;_.~ __.J.__ .~ .... ." .,._...------------------------.-------------------------------------------------------------------_. -01 ~.•-1i

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SUFFIX'-.-,'-1! i{_~"~, ••".:~,~~,_ .•.1

02 ADDRESS . I; , . 1.J~G{ L..1¥l!,'Yl(;.f',

03 STATUS Ch~ck applicable block or blocks. more than one blOG.:'"may co marKed (See inslnlctions on page 2)\---1

!\ L_: Ccndidatc (incfuding 'write-in)

!:3 Nominee

c LJ Pubhc Official (Current)

'-'0 Public Offidal (Former)

D LJ PtJb!ic Eml)!oyc(; {Current}

o C8 Pubilc Employe£: ~FCrm(Jf}

Check this [1block if youare amendingan original filing

Check thisbloc •. if youSri! filing a-e,:

a solicitor

B

or, GOVERNMENTAL ENTfTY in ..•.•ihlc.'-lyou are/were an Offidai, E;r.p!cYef:, Cand;date Of NOij\liIC-'C (t~ 9_.dept. 9gOnGY, ol.ltt1crity. borough. board, cOfl'Yni~;IC?i', county. sr.J'!ocl{ district. tVip, etc.)r-·-~---:--___r_--___y---, --r---T----~ I ' ~ • ----~---·7·--·---~·"-"-.-r-r- .---,...----'---.,~---:'----.........,.- __ ~--r--:--.""!"-- _. ,F'__ j

A V.l;:::i r1 .J-£)J. Ji-r-t/} La]i ,c:,lt:W /1i1:1.., :n!' l?,,'-' /7:1 i~' r ii'L ..tlk::::LJ. .1lzlLLLLJL_l".(_{.~J.. :~_L_.iLl_l_t::·::jt._L L iU.LL_k~_.:.! il"'5..._tL 1.. j .."._.: i. L , ~ _.J

'-."~._.,_...';'_'_._.__<O._._:---, ----'!,.-~"'~T,··-----""T~·-~·---,·-·~-·--,."".~--··~...-·-~·-·--;-----f.,----(-·-----r·! !

-·-··--·----;~--··--..-~~··--r-·----(··'...-···-r--....··'-··{~·---·--··;·~·--·i: Ii -.J8

06 OCCUPATION OR PROFESSION (This may be the same as block 4)-J-y' t?

YEAR The- information in blocxs S through 15.belav! represents financiaJ mlerests (orthe Plil.QR calendar year indicated: r.~:0 iO j 1f--1

, ~. ._.J._L ..

Qs REAL ESTATE INTERESTS (Sa" instructions on paqe Z) if NONE. check this box. ~

09 CREDiTORS is\:0 instructions on pag.: 2) If NONE. check this box.

C,",J,torJli1a'Jl'd;f ~/) {3,;~~Lic K [JU7Q:rJ;)(OFFICIAL USE ONLY)

11 GIFTS (See instructions on paqe 2)Snur.::i.~of GifT

If NONE, check this box. j2£

12 TRANSPORTATION. LODGING. HOSPITALITY (S(>(: instrucnons On page 2) If NONE. check this box. &L I I ! IL ! i I t....,..

i IL. J

13 OFFICE, DIRECTORSHIP OR EMPLOYMENT IN ANY BUSINESS (See instructions on page 2)BUSiness EnMy

If NONE, check this box.

I14 FINANCIAL INTEREST IN ANY LEGAL ENTITY IN 6USt1iESS FOR PROFIT (See instrucuons on page 2) If NONE, check this box. N

Na~ und ACdrt-ss cr Susi~s~ ! (nit"' ' .• .':.

----. ------------------------------------------------------------------------~.---------------15 BUSINESS INTERESTS TRANSFERRED TO IMMEDIATE FAMilY MEMBER (See instrucncns or. pas" 2) If NONE. check this box.

Signature

If!iCfGst i cktr,et.Jlions!,ipD<ite 'rransserrcc'rransteree {l'-JamQ:and AtXlfOSS}

The undersigned hereby offimlS Ihal tho fore'to the penalties prescribed by Hi Pa.C.S. 904 (

~'-'·dperson's knowledgo, iniormntion and belief: said affirmntion bClOg made SUbject~'9l~'Pfj>/'\~~,~~Ic Omcial and Employee EthiCS AC1.65 Pa C S §1109(b)

Current Dale -LJ;t;/t!/ 9ABOVE IS NOT COMPi,ETErI

(3)

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