HomeMy WebLinkAboutFriends of Fedor - 2021 6th Tuesday Pre-Primary ir 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/campaignfinice • ra.stcampaiRnfinance@pa.gov
Unsworn Statement in Lieu of Sworn Statement for
Campaign Finance Statements
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 Statements. This form must be signed by hand where a signature is required.
Name of Filing Committee, Candidate, or Lobbyist
fell ta5 dW ,e./ -aL
Reporting Cycle Name
Cycle 1 0 Cycle 2 0 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
0 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 statement in lieu of full report by a political
committee, the treasurer must sign here. If this form is submitted with a statement in lieu
of a full report by a candidate, the candidate must sign here. If this form is submitted with
a statement in lieu of full 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.
Gc, /0 Z. /Z0Z /
Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY)
cJ � 1-/7�t.. iiJ �c� jct r /74- C/(„v'i//.-. 7e.c
Printed Name Location (City/State/Country)
DSEB-503S
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 ER � ON BEHALF OF ' _CANDIDATE. L COMIBTTEE..1 L f�-LOBBYIST 1
NIBABNAME OP FlU NG COMMITTEE.CANOEISTS OR LOBBYIST !
<le I EN Ds d .- EPDrz—
STREET ADDRESS
/4 g&X &.; '
CITY 2.„VU LA != I'�STATE _
ZIP (/7023 -
TYPE OF REPORT NAME OF OFFICE BOUGHT BY CANDDATE DISTRICT NO. PARTY DATE TTF' El.ECTION
(CHEM ONE) ;' No. ' •'•DAY •*EAR-•.
.- TN YR)ESDAY".:,> !
P'RE?PINMARI!." :: V FON•OFFICE dSE ONLY
` Mo.• . ..DAY•.' !fP.SR:.. :.Tao. OW ...YEAR
•-a,AYfRIDAY.:1,';...2 DATES OF
.1410*MARX; ;._; REEPORTiNG / / 2/ TO 2- U C�
2/ j. ! ,�,
•
la:DAY 3. w1
POST4R10*, ' 'TT
CASH BALANCE AT END /1 t�-t
tirii TUs:sDAil'::
a. OF REPORTING PERIOD: $ CJ es
. PRErELEETTON. .• I
TOTAL AMOUNT OF FILER'S W
OUTSTANDING DEBTS OR LIABILITIES
PRE ELECTI . : AT THE END OF REPORTING PERIOD: $ r 7 `�
�+rTrI�ciioR ---
•30.0.AY: I ....
POST SLEX:TION. - • C)
YES NO / -^I
7.
• ANNUAL'• FERIAE MMTION ` l/ NO
S4PDRT'; 4 'REKiRT.'_. V
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 LIABILITIES INCURRED •THE REPORTING PERIOD INDICATED ABOVE DE)NOT
OICEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY EF. CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 -SIGNATURE OF PERSON SUBMITTING REPORT
SI7r A. "1,:l..:.}
PRINTED NAME
SIGNATURE
ITT COMMISSION EXPIRES 7 2
9. l P O8 — 2-03..?
MO. DAY YR. REA C DAYTIME TELEPHONE NUMBER
PART N-
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 POLMCAL COMMITTEE HAS NOT VIOLATED ANY PROVISIONS OF THE ACT OF
JLRNE 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.
DSEB-503(12-99)