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Home My WebLink AboutPatriots for Perry - 2020 30-Day Post-Primary Pennsylvania Department of State Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.gov/campaignfinance • 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. Candidate, Filing Committee, or Lobbyist Name of . .... Patriots for Perry Reporting Cycle Name ❑ Cycle 1 ❑ Cycle 2 XCycle 3 ❑ Cycle 9 6th Tuesday Pre-Primary 2"d Friday Pre-Primary 30 Day Post Primary 30-Day Post Special Election Part I- 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. I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania that the fore oing is true and correct. Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) [, VAqtb116 ativo (txt R , PA , ( A Printed Name Location (City/State/Country) DSEB-502R Updated 6/23/2020 Pennsylvania Department of State swif Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@pa.gov Part II-If this form is submitted with a report by a Candidate's Authorized Committee, the candidate must sign here. I declare under pen. • •erjur under the law of the Commonwealth of Pennsylvania that the foregoing/s true a d o rect. 7 , [e[14,150/2i Signature of Trea• • • • date, or Lobbyist Date (DD/MM/YYYY) Il wV A ()1P Printed N mme Location Cit /State/Country) ( Y • DSEB-502R Updated 6/23/2020 It . I ._ Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible.It should be typed) Filer Identification Report Filed By Candidate I Committee - , Lobbyist�- Number (Mark X) x Name of.Filing Committee,Candidate or p l 'A Lobbyist �C&XY(o V j(r 'NTT Street Address City State -Zip Code--• Type of Report(Place x under report type) 1-6th Tuesday 2- 2' Friday 3-30 Day Post 4-6th Tuesday 5-2"d Friday 6-30 Day Post 7 Annual Special 2"d Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election '. II Date Ot Election 'Year •Amendment Termination (MM/DD/YYYY) • . li{- 1-' 94) Report • Report. Summary of Receipts and" From Date ' To Date ' For Office Use Only' Expenditures . 61.kLQo2o 0 71-102-' • A.Amount Brought Forward From Last Report $ . (-r41.24 , B.Total Monetary Contributions and Receipts $ 1 , (From Schedule I) ankwt<<? C.Total Funds Available $ ''''11 /n� r-- (Sum of Lines A and'B) " 4 t j 60.4 t D.Total Expenditures $ lit. /+n.A �. ti. (From Schedule ill) l t. 49/1-C y V x`: C-1 E.Ending,Cash Balance• $ r'7 .r (Subtract Line from Line C). V r./1yA-1/' r -- `F.Value of In-Kind Contributions Received • $ -4 . '" I ,(From Schedule 11) 6• G.Unpald,Debts and Obligations., $ (From Sc hedule lV) D'66 Affidavit Section Part 1-If this is a Committee report,treasurer sign here.If this is a Candidate report,candidate sign here. I swear(or affirm)that this report,including the attached schedules on paper,is to the best of my know( ge and belief true,correct and complete. S—wo to and subscribed before me this -Notary Sea\ day 20 2. \vast ?Oa\tC • 'i '�� ` \k o—C— , 1pe, Nary SignFt4r@ c}f Pfsdo Submitting report .�wea -O � co -1 202� A 5U(, ��t 41 nt Signature ' CPR0 • obei\ecl c.A. �s ec•ts6 Printed Name Q �(f,, r�j My Commission expires ommtss�pt\Nu��bet 11 1�� `' tti f MO. D• a' Co % Area Code Daytime Telephone Number Part II-If this is a report of a Candidate's Authorized Committee,candidate shall sign here. I swear(or affirm)that to the best of my knowledge and belief this political committee has not violated any provisions of the Act of June 3,1937(P.L.1333,NO.320)as amended. Sworn to and subscribed before me this day of 20 ipn Ql/f,C�ndidate• Signature lit3Printed`Naame (� My Commission expires 111 7"a "`- 7V6 MO. DAY YR. Area Code Daytime Telephone Number a • SCHEDULE III Statement of Expenditures ' Filer Identification Number: I u u I I �), Date MM/DDIYYYY]"" $ /� , ) Q To Wham Paid lcl,l IU 1�t),A0,,,,,s (kl iq -ts t fi t•0 House# Street Address Description of Expenditure City State ZilY Code rigW6tklektiwi To Whom Paid Date[MM/DD/YYYY] ' $ House# Street Address Description,of Expenditure City State 'Zip Code 'To Whom,Paid, Date[MM/DDJYYYY] $ 4. i •''':i' House# Street Address' Description of Expenditure City State ',:Zip. Code To Whom Paid: •, Date[MM/DD/YYYY] $. . House# Street Address Description of Expenditure City ' State :Zip Code :To Whom Paid. Date.[MM/,DD/YYYY] •$ 'House.# Street Address Description of Expenditure City State- Zip Code To Whom Paid Date[MM/DD/,YYYY] � $ House.# Street Address Description of Expenditu re City State Zip 1Code To:Whom Paid, Date[MM/D_D/YY,YY], $ 'House.# -Street Address Description of Expenditure City 'State . Zip' . Code To Whom Paid Date[MM/DD/YYYY]; $ House# Street Address Description of Expenditure City •State' Zip. .. Code