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Home My WebLink AboutLandis, DJ - 2021 2nd Friday Pre-Primary Tir Pennsylvania Department of State tit Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.gov/campaignfinance • ra-stcampaignfina nceP pa.gov_ Unsworn Declaration 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 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 Statements. This form must be signed by hand where a signature is required. Name of Filing Committee, Candidate, or Lobbyist 1).7. Lave o s Reporting Cycle Name ❑ Cycle 1 X Cycle 2 ❑ Cycle 3 ❑ Cycle 4 ❑ 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 ❑ 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 accompanying Campaign Finance Statement is true and correct. 0.6:P-' . .,-/7,c-izei..) a ie - 3751 Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) c.7` 1a4e)d/-S I/ and,r/11J I, 6.,14-/I Printed Name Location (City/State/Country) DSEB-503S Updated 1/22/2020 ll II I, nC3ctrv1111 I s init.voii, Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible.It should be typed) Filer Identification Report Filed By Candidate X Committee Lobbyist Number (Mark X) Name of Filing Committee,Candidate or , AG Lobbyist il. j4 fW f Street Address 111 IA aLkad �J)J City ��,,l n, �� State p& Zip Code j- Type of Report(Place x under report type) 1-6th Tuesday 2_ 2nd Friday 3-30 Day Post 4-6th Tuesday 5-2nd Friday 6-30 Day Post 7-Annual Special 2nd Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election I ,\ Date Of Election _ Year Amendment Termination (MM/DD/YYYY) (a H 192 1 k`2`1 Report Report I Summary of Receipts and From Date % To Date For Office Use Only Expenditures t I/( l�')u 611)la.n-i A.Amount Brought Forward From Last Report $ 61 B.Total Monetary Contributions and Receipts $ /�, r'' U-D t--- (From Schedule I) 1 V .; C.Total Funds Available $ A/} I --< (Sum of Lines A and B) �t��" � 1 ›. ....1D.Total Expenditures $ = (From Schedule III) 0• vo C3 E.Ending Cash Balance $ ff^, C) (Subtract Line D from Line C) OV (� C C) F.Value of In-Kind Contributions Received $' ' - CD (From Schedule II) 0 -.< '.D G.Unpaid Debts and Obligations $ �� (From Schedule IV) 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 best of my knowledge and belief true,correct and complete. Sworn to and subscribed before me this day of 20 Signature of Person Submitting report Signature I Printed Name My Commission expires MO. DAY YR. Area Code Daytime Telephone Number Part II-If 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.L 1333,NO.320)as amended. Sworn to and subscribed before me this day of 20 Ogng kandj,date Signature Printed Name My Commission expires 1l1 114' (.L v`5 MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number �0�� l 1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total for the reporting period (1) $ v- q) 2.Contributions of$50.01 to $250.00(From Part A and Part B) Contributions Received from Political Committees(Part A) $ l6b All Other Contributions(Part B) $ 9-6D- 60 Total for the reporting period (2) $ I3.Contributions Over$250.00(From Part C and Part D) I Contributions Received from Political Committees(Part C) $ All Other Contributions(Part 0) $ Total for the reporting period (3) $ I 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) A Total for the reporting period (4) $ d - 0 Total Monetary Contributions and Receipts during this reporting period(Add and $ enter amount totals from Boxes 1,2,3 and 4;also enter this amount on Page 1,Report ll o fi Cover Page,Item B) �l V lib U PART Gbntributions 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$50.01 TO$250.00 in the reporting period. Filer identification Number Dj. 0 ES Amount Full Name of Contributing Date[MM/DD'YYYYJ $ Committee Rat% heb 1;L V I Y1.t&v- 61(c(21 irk W House# greet Address . Date[MM/DD/YYYYJ $ aty n State �A ZpCode [/ Date[MM/DLYYYYYJ $ Full Name of Contributing`ntiinng !Jt Date[MM/DD/YYYYJ $ Committee L. House# greet Addr Date[M M/DDV YYYYJ $ City gate Zp(ode Date[MM/DD/YYYYJ $ Full Name of Contributing Date[MM/DDVYYYYJ $ Committee House# greet Add Date[MM/DIYYYYYJ $ City gate Zp(ode Date[MM/DQfYYYYJ $ Full Name of Contributing Date[M M/DD/YYYYJ $ Committee House# Street Address Date[M M/DLYYYYYJ... $ City State ZpCode Date[MM/DIYYYYYJ $. Full Name of Contributing Date[M M/DDYYYYYJ $ Committee House# greet Address Date[MM/OD/YYYYJ $ aty gate bp Code Date[MM/DD'YYYYJ $ Fall Name of Contributing Date[MM/DD/YYYYJ $ Convnittee House# greet Address Date[MM/DD/YYYYJ $ City Sate bp Code Date[MM/DD/YYYYJ $ PART B All Other Contributions $50.01 TO$250 Use this Part to itemize all other contributions with an aggregate value from $50.01 TO$250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: DI im v5 Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date'[MM/DD/YYYY] $ rti wwt 0q_ 1,twE City \ n,103 t`, v State pA Zip Code l n VO Date[MM/DD/YYYY] Full Name of Contributor 1 Date[MM/DD/YYYY] $ 0),L1, Vau � 1St( 12( (6b-ro House# Street Address Date[MM/DD/YYYY] $ IV)f 9/ WAY City its v9 State pi‘s Zip Code l .l 1/11) Date[MM/DD/YYYYj $ Full Name of Contributor Date(MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYYj $ City I State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date(MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date]MM/DD/YYYYj $ Full Name of Contributor Date(MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State. Zip Code Date[MM/DD/YYYY] $ 9pi®ULEIV Statement of Unpaid Debts Use this S.ction to itemize all unpaid debts and obligations which are outstanding at the end of the reporting period. flier Identification Number: to (AN(DLS Name of Creditor Q&15 'T rVl�p I f C Outstanding Balance of Debt se Hou # 3reetAddress DATEDEI3rIINWFRED $ Oty istfA Din11 j4/ Sate V• (IV I( Description of Debt Name of Creditor Outstanding Balance of Debt Hose# 3reetAddress DATE Dan INCURRED $ [IVIM/DD+Vor] Oty Sate Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt Ham# street Address DATE DEBT INCURRED $ [MM/DD/WYYJ aty Sate Zp Cade Description of Debt Name of Creditor Outstanding Balance of Debt House# Rreet Addrel DATE DEBT INCUR $ [M M/DD/WYYJ City _.. Sate Zp Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address D4TmDTINCrJRFED $ [M M/Dl 'WYYJ Oty Sate Zp Code Description of Debt Name of Creditor Outstanding Balance of Debt House# 3reetAddress DATE DEBT INCURRED $ [MM/DD/WYYJ aty Sate Zip Ode Description of Debt