HomeMy WebLinkAboutCamp Hill Democrats - 2020 6th Tuesday Pre-Election ./7)
Pennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
www.dos.oa.gov/camoaignfinance • ra-stcampaignfinancePpa.gov
Unsworn Statement in Lieu of Sworn Statement for
Campaign Finance Reports
Note: Per Act 2020-15, which was signed into law on April 20, 2020 and allows for unsworn
declarations, 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. 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. This form must be signed by hand where a signature is required.
Name of Filing Committee, Candidate, or Lobbyist
C o wt.p i( 4, Ot .0-+S
Reporting Cycle Name
❑ Cycle 1 ❑ Cycle 2 ❑ Cycle 3 X Cycle 4 ❑ Cycle 5
6th Tuesday 2"d Friday 30 Day 6th Tuesday 2"d Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election
❑ Cycle 6
❑ Cycle 7 ❑ Cycle 8 ❑ Cycle 9
30 Day Post-Election
Annual Report 2nd Friday Pre-Special Election 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.
I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania
that the foregoing is true and correct.
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Signature of TreastYrer, Candidate, or Lobbyist Date (DD/MM/YYYY)
It!F AI 'z 2/ 69ineo A//, of
Printed Name Location (City/State/Country)
DSEB-502R
Updated 6/24/2020
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Commonwealth of Pennsylvania-Campaign Finance Report
(Note:This report must be clear and legible.It should be typed)
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Type of Report(Place x under report type)
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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 knowledge and belief true,correct and complete.
Sworn to and subscribed before me this ��
day of 20 ' I 1/47i / '„1/f / G"I' "
Signature of erson Submitting report
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Signature Printed Name
My Commission expires 7/7 a/., _9 Vo 7
MO. DAY YR. 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 ( .
Signature of Candidate
Signature I Printed Name
My Commission expires
MO. DAY YR. Area Code Daytime Telephone Number
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SCHEDULE 1
Contributions and.Receipts
Detailed Summary Page
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Total for the reporting period (1)
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Contributions Received from Political Committees(Part A) $
All Other Contributions(Part B) $
Total for the reporting period (2) $
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Contributions Received from Political Committees(Part C) $
All Other Contributions(Part D) $
Total for the reporting period (3) $
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Total for the reporting period (4) $
Total Monetary Contributions and Receipts during this reporting period(Add and $
{ enter amount totals from Boxes 1,2,3 and 4;also enter this amount on Page 1,Report �1...��� v
Cover Page,Item B) oC
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SCHEDULE III
Statement of Expenditures
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