HomeMy WebLinkAboutGrayson, Lisa - 2021 2nd Friday Pre-Primary ilfifPennsylvania 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-stcampaignfinancePpa.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
Lisa Grayson
I Reporting Cycle Name
0 Cycle 1 0 Cycle 2 ❑ Cycle 3 ❑ 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 0 Cycle 7 0 Cycle 8 0 Cycle 9
30 Day Post-Election Annual Report 2"d 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.
05/07/2021
ig an Lure of Treasurer, Can I i e, or Lobbyist Date (DD/MM/YYYY)
Lisa M. Grayson Carlisle PA USA
Printed Name Location (City/State/Country)
DSEB-503S
Updated 1/22/2020
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 IDENTIFICATION , REPORT FILED ' I 3�
NUMBER ON BEHALF OF CANDIDATE ✓ COMMITTEE LOBBYIST
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST L.sa Grayson
STREET ADDRESS
161 Shatto Dr
CITY STATE ZIP CODE
Carlisle PA 17013 ---
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT ND. PARTY DATE OF ELECTION
(CHECK ONE) Register of Wills 21 Rep 11MO. 02 DAY
YEAR
2021
1.
6TH TUESDAY -- - ------ - -PRE-PRIMARY FOR(AcFICE USE ONLY
MO. DAY YEAR MO. OAY YEAR - ---
2ND FRIDAY 2. DATES OF - TEA
PRE-PRIMARY X REPORTING 01 01 21 TO 05 03 21 - 1:10
PERIOD
rn
30 DAY 3. .`"r1 ""‹
POST-PRIMARY F'— I
CASH BALANCE AT END 0 J —..1
6TH TUESDAY 4. OF REPORTING PERIOD: $ C7
PRE-ELECTION C) ,-.
TOTAL AMOUNT OF FILER'S
5• OUTSTANDING DEBTS OR LIABILITIES 0 fV
ZND FRIDAY AT THE END OF REPORTING PERIOD:
PRE-ELECTION CII
6. "C -•.J
30 DAY AMENDMENT
POST-ELECTION REPORT?
7. 1 YES ri NO n
ANNUAL EROINATION YES El NO
REPORTREPORT?
111
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 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.
SWORN TO AND SUBSCRIBED BEFORE ME THIS Lisa M. Grayson Digitally signed by Lisa M.Grayson
Y Dale:2021.05.0712:56:00-oncr
DAY OF 20 SIGNATURE OF PERSON SUBMITTING REPORT
Lisa Grayson
SIGNATURE PRINTED NAME
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
DSEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280