HomeMy WebLinkAboutSilcox, Nathan - 2020 2nd Friday Pre-Election el 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/campaignf nance • ra-stcampaignfinance@oasov
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 unworn
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
AJ&+M&&i S;'/ .oV
Reporting Cycle Name
o Cycle 1 D Cycle 2 ❑ Cyde 3 ❑ Cycle 4 C-0 Cycle i
6th Tuesday 2"d Friday 30 Day 6th Tuesday 2nd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election
D Cycle 6 Cycle 7 —�.-@yele-8— CI Cycle 9
30 Day Post-Election
Annual Report 2"d Friday Pre-Special Election 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 foregoin is true and correct.
0i27- 20EC�
Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY)
t-�Xr r�.rJ P i L.c 4:Ty v-NN fGN clys.c saorl-C , Pa (v S o
Printed Name Location (City/State/Country)
DSEB-502R
Updated 6/24/2020
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.
FILER IDEN1 iICAT1OM REPORT I'I EO I.1 Il I. +1 Loom
NUMBER CANDIDATE COMM7IEE.. ).
ON BEHALF OF
NAME OF FILING COMWTTEE,CANDIDATE OR LOBBYIST
oeT•IA iA:7 P. I L.. C,p y(
STREET ADDRESS
CITY STATE
ZIP CODE
M.41-era► Icy f3 )12-6 ��, 1-?ot7) —
TYpE OF REPORT NAME OF OFFCE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF EL£C T I O 1:
(CHECK ONE) •NO. DAY • YEAR" •
6TH TUESDAY. C 6 nn can t .3 2-a2A
PRE-PRIMARY
FOR OFFICE USE ONLY•
MO. DAY YEAR MO. DAY YEAR
2ND micaDATES OF
PERIOD (7 O ' i Q 11
REPORTING TO Z
.30 DAY
.. .. .....3
POST-PRIMARY
CASH BALANCE AT END 6
• ern-mesa*. 4. OF REPORTING PERIOD. $
PRE-ELECTOR. ...
• TOTAL AMOUNT OF FILER'S
2ND.FRIDAY
OUTSTANDING DEBTS OR LIABILITIES
'PRE-ELECTION . AT THE END OF REPORTING PERIOD: $
8.
3a DAY:
. POST4LECTION AMENDMENT YES NO
REPORT?
ANNUAL TERMMATION
REPORT YES NO
•
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.
I SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR UABIUTIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TROE,GQ RECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS 1.)
DAY OF 20 SIGMA NG REPORT
Ss L_.I D-e
SIGNATURE PRINTED NAME
MY COMMISSION EXPIRES l q 4.— 2 O��
MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
PART it-
If statement is filed on behalf of a Candidate's Authorized Committee,Candidate must sign here.
1 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(Pl.1333,No.320)As AMENDED.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
. SIGNATURE OF CANDIDATE
DAY OF 20—
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
• Department of State • Bureau of Commissions,Elections and Legislation
DSEB-503(12.99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787.5280