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Home My WebLink AboutEvans, Mercedes - 2021 2nd Friday Pre-Primary it__/7Pennsylvania 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/cams aignfinance • ra-stcampaignfinancePpa.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 unworn 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. ':Commiittee Candidate;COpbb ist; Mercedes Evans Repo ing @NO Name Eu 0 Cycle 1 lid Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5 6th Tuesday 2nd Friday 30 Day 6th Tuesday 2nd 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 accompanying Campaign Finance Report is true and correct. wpm L dig fi/ tM4' 05-06-2021 Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) Mercedes Evans Camp Hill, PA Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 11 ICI I 11G0GL7 7NIII _IL 1.11111."-VI itI -. Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible.It should be typed) Filer identification Report Filed By Candidate �— Committee —1 Lobbyist Number (MarkX) • X, • , Name of Filing Committee,Candidate or Lobbyist Mercedes Evans Street Address 3001 Beverly Road City i Camp Hill State PA ' Zip Code 17011 Type of Report(Place x under report type) 1-6th Tuesday 2- 2nd Friday 3-30 Day Post 4 6thTuesday 5-2nd Friday 6-30 Day Post 7-Annual Special 2"Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election Date Of Election Year Amendment Termination (MM/DD/YYYY) 05-18-2021 2021 Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 01-01-2021 05-03-2021 A.Amount Brought Forward rom Last Report 8 0 :.Total Monetary Contributions and Receipts 8 (From Schedule!) 250 C.Total Funds Available 8 250 2 v (Sum of Lines A and B) -- D.Total Expenditures 8 Cza - (From Schedule III) 250 r 1-i E.Ending Cash Balance 8 0 › I (Subtract Line 0 from Line C) `-0 -"I F.Value of In-Kind Contributions Received 8 (from Schedule II) 007 - -- CD G.Unpaid Debts and Obligations ' S w 0 (From Schedule IV) a' Affidavit Section Part 1-If this is a Committee report,treasurer sign here.If this is a Candidate report,candidate sign here. I swear(or affirm)that this report,Including the attached schedules on paper,is to the hest of my knowledge and belief true,correct and complete. Sworn to and subscribed before me this 6th day of Ma 20 2021 a� t,��2 Signature of Submitting report /� e/ Mercedes Evans Signature Printed Name • My Commission expires 717 303-3932 MO. DAY YR. Area Code Daytime Telephone Number Part II-It this is a report of a Candidate's Authorized Committee,candidate shall 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.1.1333,N0.320)as amended. Sworn to and subscribed before me this day of 20 Signature of Candidate • Signature Printed Name My Commission expires MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number ' 1.Unitemized Contributions and Receipts4 50.00 or Less per Contributor• Total for the reporting period (1) 8 0 2.Contributions of 8 50.01 to 3250.00(From I Part A and Part B) Contributions Received from Political Committees(Part A) 8 250 All Other Contributions(Part B) 8 0 Total for the reporting period (2) 8 250 I3.Contributions Over 8 250.00(From Part C and Part D) Contributions Received from Political Committees(Part C) 8 0 All Other Contributions(Part D) 8 0 Total for the reporting period (3) 8 0 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) Total for the reporting period (4) 8 0 Total Monetary Contributions and Receipts during this reporting period(Add and 8 enter amount totals from Boxes 1,2,3 and 4;also enter this amount on Page 1,Report Cover Page,Item B) 250 PART A Contributions Received From Political Committees $50.01 TO$250.00 Use this Part to itemize only contributions received from Political Committees with an aggregate value from 350.01 TO$250.00 in the reporting period. IFiler Identification Number \ Amount Full Name of Contributing Date[MM/DD/YYYY] $ Committee Friends of Mercedes Evans 02-23-2021 250-loan repayment House# Street Address Date[MM/DD/YYYY] 8 PO Box 3213 City State Zip Code Date[MM/DD/YYYY] 8 Camp Hill PA 17011 Full Name of Contributing Date[MM/DD/YYYY] 8 Committee House# Street Address Date[MM/DD/YYYY] 8 City State Zip Code Date[MM/DD/YYYY] 8 Full Name of Contributing 1 Date[MM/DD/YYYY] 8 Committee House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S Full Name of Contributing Date[MM/DD/YYYY] 8 Committee House# Street Address Date[MM/DD/YYYY] 8 City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] 8 Committee House# Street Address Date[MM/DD/YYYY] I City State Zip Code Date[MM/DD/YYYY] S Full Name of Contributing Date[MM/DD/YYYY] S Committee House# Street Address Date[MM/DD/YYYY] 8 City State Zip Code Date[MM/DD/YYYY] 8 SCHEDULE III Statement of Expenditures I Filer identification Number: I To Whom Paid . Date[MM/DD/YYYY] 8 Emily Smith Designs 250 01-22-2021 House# Street Address 2002 Columbia Avenue Description of Expenditure •City State Zip Camp Hill -PA Code 17011 Campaign Logo Cost To Whom Paid 1 Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure, City State Zip_ Code To Whom Paid Date[MM/DDIYYYY] 8 House# Street Address Description of Expenditure City State Zip Code . To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure • City State. Zip Code 3 To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code•