HomeMy WebLinkAboutGrayson, Lisa - 2020 Annual Report r Pennsylvania Department of State
4;�n
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 Declaration 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), Non-Bid Contract Reporting Form (DSEB-504) 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.
CO AM@ Co mittee, Candidate,cg Lobbyist •
Lisa Grayson
Reporting @orAlb -lame
❑ Cycle 1 ❑ Cycle 2 ❑ Cycle 3 0 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 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 accompanying Campaign Finance Report is true and correct.
Lisa M. Grayson Date:l021.0 .0314:a:31-05son 02/03/2021
Date:2021.02.03 14:06:31-OS'00'
Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY)
Lisa Grayson Carlisle PA USA
Printed Name Location (City/State/Country)
DSEB-502R
Updated 1/22/2021
a
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 IDENTIFICATION , REPORT FILED '1 CANDIDATE I COMMITTEE ri LOBBYIST 3�r
NUMBER ON BEHALF OF
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST L i sa Grayson
STREET ADDRESS 161 S h atto Dr
CRY STATE ZIP CODE
Carlisle PA 17013 —
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE/� �+ DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) Register of Wills ills 21 Rep 11MO 07 DAY YEAR
2017
BTH TUESDAY
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY YEAR
2ND FRIDAY •- 2. DATES OF y
PRE-PRIMARY REPORTING 01 01 20 TO 12 31 20 `
PERIOD
30 DAY 3. r 1 •
POST-PRIMARY 4 CASH BALANCE AT END 0 I
8TN TUESDAY 4. OF REPORTING PERIOD: $ • -
PRE-ELECTION '
TOTAL AMOUNT OF FILER'S ,
OUTSTANDING DEBTS OR LIABILITIES 0 C.
2NDFRIDAY oN AT THE END OF REPORTING PERIOD: $ t.
r..
B. - -. C.1'
30 DAY AMENDMENT YES ❑ NO
POST-ELECTION REPORT?
7.
ANNUAL X TERMINATION YES I I NO Ell
REPORT REPORT? I `
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,TRUE,CORRECT AND COMPLETE.
Date:
signed by Lisa M.Grayson
SWORN TO AND SUBSCRIBED BEFORE ME THIS Lisa M.Grayson Date: 13:59:44
DAY OF 20 SIGNATURE OF PERSON SUBMITTING REPORT
Lisa Grayson
PRINTED NAME
SIGNATURE
717 580-1254
MY COMMISSION EXPIRES
MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
PART II-
If statement is filed on behalf of a Candidate's Authorized Committee,Candidate must 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
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
llSED-503(12-99) 210 North Office Building • Harrisburg,PA 17120.0029 • (717)787-5280
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