HomeMy WebLinkAboutMiller, Nicole - 2020 Annual Report 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.
NFILER UMBERENTIFICATION .,CA'7{�Q ry0 C ,^,/�,LI c 3 ON BEHA O ' CANDIDATE REPORT -t�V J COMMITTEE LOBBYIST 3,
NAME OF FILING COMMITTEE,C ANDIDA4TEE OR LOBBYIST
Nh cb C Nlttt C.17
STREET ADDRESS
Uri 40 Ce "itre Ira Y 205-
CITY ST ZIP CODE
(;tlaat i-13FFICE f 1.-70�Z>-
TYPE OF REPORT NAME OF O SOUGHT BY CANDIDATE (DISTlRIICT NO. PARTY DATE OF ELECTION
MO.
(CHECK ONE) 1. L} & o T� `-{ I v 1I 1 DAY 20
STH TUESDAY "iT �I
PRE-PRIMARY FOR OFFICE USE ONLY
MO. ` DAY YEAR / MO. DAY f YEAR.
2N0 FRiDAY- 2. DATES OF + //►� r i
PRE-PRIMARY RP OD INC �� '/" t„i TO 13 t '�_`
30 DAY a. > !�(1
POST-PRIMARY - '"
CASH BALANCE AT END J ':^
a. OF REPORTING PERIOD: $ f-- .'' ) ts:�'�
6TH TUESDAY . (. S,r;;
PsLECTIox TOTAL AMOUNT OF FILER'S C:; ��;� ::;
15• OUTSTANDING DEBTS OR LIABILITIES a ::x•::: •-
2ND PRE-ELECTION
AT THE END OF REPORTING PERIOD: $ 1
PRE-ELECTION. - (Nis :::;.y
30 DAY AMENDMENT
POST-ELECTION REPORT? YES NO
7.
ANNUAL TERMINATION 1
REPORT �/ REPORT? - YES NO V
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.
1 SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST I Y KNOWLEDGE A' BELIEF,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 SIGNATUR OF P SON SUBMITTING REPORT
NItre(v Nit(6.1.---
PRINTED NAME �'��j
SIGNATURE 1 I 4 21 CD- V
MY COMMISSION EXPIRES 1 11
MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
PARTII-
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
DSEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717}787-5280
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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 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
Reporting Cycle Name
❑ Cycle 1 ❑ Cycle 2 0 Cycle 3 ❑ Cycle 4 0 Cycle 5
6t^Tuesday 2nd Friday 30 Day 6t6 Tuesday 2nd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election
❑ Cycle 6 Cycle 7 0 Cycle 8 0 Cycle 9
30 DayPost-Election
Annual Report 2nd Friday Pre-Special Election 30 Day Post-Special Election
Part l- 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.
c I 2-0
Signature o reasurer, Candidate, or Lobbyist Date ( D/MM/YYYY)
cr W(hollysk91 , 141-- Llial4
Printed Name Location (City/Sta Country)
DSE8-502R
Updated 6/24/2020