HomeMy WebLinkAboutFriends of Rick Coplen - 2020 30-Day Post Election i
i
lirPennsylvania 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 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
Fr,e,ri c s a-C R:e-k Cz 11 e-vl •
Reporting Cycle Name
❑ Cycle 1 0 Cycle 2 M Cycle 3 0 Cycle 4 0 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 0 Cycle 7 0 Cycle 8 0 Cycle 9
30 Day Post-Election
Annual Report 2nd 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 foregoing is true and correct.
..-D-r1/4"----- 4,_ mitig,____
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Signature of Treasurer, Candidate, or Lobbyist Oat (DD/MM/YYYY)
Litt 1
D 911 il ck. 1---- ., • - (( 0-14/uc C1 Li S I
Printed Name Location (City/State/Country)
ks
OSEB-502R
• Updated 6/24/2020
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Bureau of Campaign Finance&CivictctfS Engagemet
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
www.dos.pa.eov/campaienfinance • ra-stcampaienfinancePpa.eov
Part II-If this form is submitted with a report by a Candidate's Authorized Committee, the
candidate must sign here.
I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania
that the foregoing is true and correct.
30/11/2020
Si reasurer, Candidate, or Lobbyist Date(DD/MM/YYYY)
2cAarJ
" ek-P Co �ei4 Carlisle, PA, USA
Printed Name Location (City/State/Country)
DSEB-502R
Updated 6/24/2020
1
FIERIDENTIPICATl4N 110, 0.2.4a00i46. REPORT FILED CANDIDATE ;' CO►Wi1TEE z_ tons YfET
3.
NUMHER_-- _ - _ _ _ _ _.. �� ONAE%At5OP
N4MS..OE ACING COMMOir,CANDIDATE O LOEEYfST r,�� j'
f rerlG s v A. 1.A 1l 4
STREET ADDRESS ((�(/fir {J� //A`�,.1 {7�/ ^A /� 1 1 /e
A Sr TI}COOS ..
7
' �1� sly P - i70r
• TYPE OF REPORT ' NAME OF OFFICE SOUGHT BY CANDIDATE
J �d/ 'DISTRICT NO. PARTY GATE OF ELECTION
(CHECK ONE) t./""'� ;A J�n41 o/ J�J,�fn_,'i/ } e'i mo. DAY �fYYEjAR
Gm TUESDAY `` - - - -- - - ---_ J.. -- - -- -
PRE-PRIMARY FOR OFFICE USE ONLY
?_
MO. DAY YEAR MO. ( DAY 1 YEAR 2
2ND FRIDAY REPORTING /0 I 4 0 f0 .Z ��}
PRE-PRIMARY PERIOD J v
30 BAY 3' c�
POST-PRIMARY CASH BALANCE AT END 3 (1 G] 3, 5 7
Ill rr1
6TH-rueso Y a. OF REPORTING PERIOD, ! (")
PRE-ELECTION r—
TOTAL AMOUNT OF FILER'S _
2ND FRIDAY OUTSTANDING DEBTS OR LIABILITIES /5 7 a
PRE-ELEGTON AT'THE END OF REPORTING PERIOD: $ . -
C S
30 DAY 5.Y/ AMENDMENT
POST-ELECTION REPORT? YES NO
Q
7. -a< o-
ANNUAL TERMINATION YES NO 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.
I SWEAR(OR AFFIPLI)TtiAT THE ADDREGATE RECE I".S OR C4SEUREE:.EMTS OR LI.SiLITIES INCURRED survitiG THE REPORTING PER: IS'D!C-AS AEOYE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS(5250.00)AND THIS REPORT IS.TO THE BEST OF ii '`IVLECGE AND E$Lra TA . Co ECT D C LETS.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 H E OF PE VA, SUBMITTING REPORT
P 8 A t CTft
PRINTED NAME
- - SIGNATURE L
Y COMMISSION EXPIRES II .2`f 4 b I 1
MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
PART II-
If statement is filed on behalf of a Candidates Authorized Corn ittee,Candidate must sign here.
'S'.'F-AR(OR AFFIRMS)THAT TO THE BEST 0=MY KNOWLEDGE AND RELIE=THIS PO„T:CAL COMMITLF-F N'S NOT VICLATE•D ANY PnOVISIONS OF THE ACT OF
DUNE 3,1937(P.L.1333.No.320)AS AIetENCED.
—
SWORN TO AND SUBSCRIBED BEFORE ME THIS r
OF C DIDAT
DAY OF 20 /C Q F �, � e�
PRINTED NAM
SIG KATURE
_ Zcf 6 y41 T
MY COMMISSION EXPIRES EA COD DAYTIME TELEPHONE NUMBER
MO, DAY YR.
Department of State I Bureau of Commissions,Elections and Legislation
Ufir11•5cI(12-99) 210 North Office Building • Harrisburg,PA 17120.0929 to (717)787-5280