HomeMy WebLinkAboutFriends of Nate Silcox - 2020 2nd Friday Pre-Primary IfifPennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
www.dos.pa.govicampaignfinance • ra-stcampaignfinance@pa.gov
Unsworn Statement in Lieu of Sworn Statement for
Campaign Finance Reports
Note: Per the temporary waiver granted by the Governor on April 6, 2020, Campaign Finance
Reports (form DSEB-502), Campaign Finance Statements In lieu of full reports (form DSEB-503),
and Independent Expenditure Reports (form DSEB-505) need not be notarized. (See Temporary
Waiver of Notarization Requirement for Campaign Finance Reports and Statements). Instead, the
filer may file with each report or statement the corresponding version of this form signed by the
required individual(s). This particular form is to be used only for Campaign Finance Reports and
only so long as the waiver referenced above is in effect. This form must be signed by hand or by
typing your name where a signature is required. If you type your name, you understand that's
your electronic signature and will constitute the legal equivalent of your signature on this form.
Name of Filing Committee, Candidate, or Lobbyist
0 e- M CA.kc Co)c
Reporting Cycle Name
0 Cycle 1 Cycle 2 0 Cycle 3 0 Cycle 9
6th Tuesday Pre-Primary 2' Friday Pre-Primary 30 Day Post Primary 30-Day Post Special
Election
Part 1- If this form is submitted with a Committee report, the treasurer must sign here. If
this form is submitted with a Candidate report, the candidate must sign here. If this report
is submitted with a report by a contributing lobbyist, the lobbyist must sign here.
By signing or typing my name below, I hereby declare under the penalty of perjury,
pursuant to 18 Pa.C.S. § 4904, that the information contained in the accompanying
Campaign Finance Report is to the best of my knowledge and belief true, correct and
complete.
C4.74u, 5/21/2020
Signature of Treasurer, Candidate, or Lobbyist Date
Craig Mellott
Printed Name
DSEB-502R
T) 2B1uor eNaourtohfofficCampaigneBuilding,Finance H a Harrisburg,
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e71117.787.5280(Option 4)
J www.dos.pa.govicamvianfinance • ra-stcarnoaignfin.pnceOpa.seov
Part II- If this form is submitted with a report by a Candidate's Authorized Committee, the
candidate must sign here.
By signing or typing my name below, I hereby declare under the penalty of perjury,
pursuant to 18 Pa.C.S. § 4904, that the information contained in the accompanying
Campaign Finance Report is to the best of my knowledge and belief true, correct and
complete.
t-- 4-2.. _ --------- s- Ii F. i 7_.
Signature of Candidate Date
-r-1.4-110 P. S"--ii-c-c,"\-
Printed Name
DSEB-502R
4/15/2020
i
I
COMMONWEALTH OF PENNSYLVANIA
CAMPAIGN FINANCE STATEMENT
File this in lieu of a full report only if aggregate receipts, expenditures, or
liabilities incurred each did not exceed $250.00 during the reporting period.
REPORT FILED i }
FILER IDENTIFICATION CANDIDATE COMMITTEE LOBBYIST
NUMBER ON BEHALF OF _
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
t%,2.L f+D IO ON a're SI t c O
STREET ADDRESS
CITY - - STATE ZIP CODE
n — P, V DI I -
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE IDISTRICT NO. PARTY - DATE OF ELECTION
(CHECK ONE) IA'CA ON C il -T'OP MO. I DAY YEAR
6TH TUESDAY
n's IS, tj r =L-Q I Rto -
PRE-PRIMARY FOR OFFICE USE ONLY
MO. I DAY YEAR MO. ( DAY I YEAR
2ND FRIDAY 2. DATES OF
REPORTING .'^ TO
2
I , 0
PRE-PRIMARY PERIOD VE 12-d
30 DAY 3 -
POST-PRIMARY
CASH BALANCE AT END
4 OF REPORTING PERIOD: $ ' • o‘.
6TH TUESDAY
PRE-ELECTION
TOTAL AMOUNT OF FILER'S
5. OUTSTANDING DEBTS OR LIABILITIES
2ND FRIDAY AT THE END OF REPORTING PERIOD: S Q
PRE-ELECTION
A.
30 DAY AMENDMENT
POST-ELECTIONREPORT? YES NC
i.
ANNUAL TERMINATION
YES NO x
REPORT REPORT?
AFFIDAVIT SECTION
PART I-
If statement is filed on behalf of a Political Committee or Candidates's Committee,the Treasurer must sign here.
if statement is filed on behalf of a Candidate,the Candidate must sign here.
If statement is filed on behalf of a Contributing Lobbyist,the Lobbyist must sign here.
SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR=15EURSEMEN T S OR_IME L-TIES INCURRED DUN.:'= S REPCP"NT PERIOD INDICATED ABOVE CID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS(5250.00)AND THE REPORT IS,TO THE FEST OF'Ory KNCV,t'JOE AND EE!EFRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 SIGNATURE OF PERSON SUBMITTING REPORT
Craig Mellott
SIGNATURE 717 234-1431
MY COMMISSION EXPIRES
MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
PART H-
If statement is filed on behalf of a Candidate's Authorized Committee, Candidate must sign here.
I SWEAR(OR AFFIN11)THAT TO THE BEST OF LP KNOV._EDGE A.ND THIS POL'T CAL CDS"::IT EE HcS LIOT VIOLATES'ANY PROVISIONS OF THE ACT OF
JUNE 3. 1937(P.L. 1333,No.320)AS AMENDED.
SWORN TO AND SUBSCRIBED BEFORE ME THIS (T - •
SIGNATURE OF CANDIDATE
DAY OF 20
_ 1--D - -14-1 ,,,,) P. s i L (-p,i
PRINTED NAME
SIC-NATIRE -�_—�-� —T Li
-
^ „r
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO, DAY YR.
Department of State • Bureau of Commissions,Elections and Legislation
DSI:13-=03(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280
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