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Home My WebLink AboutBert, Martha - 2021 2nd Friday Pre-Primary ififPennsylvania 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-stca mpa ignfina nceP 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 IJ' 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 2"d 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 foregoing is true and correct. y /M 30 A Signat a of Treasurer, Candidate, or Lobbyist Da a (D M/YYYY) /f 7' i/� ,�. /3 e r.f ti e u C 4:1� Printed Name Location (City/State/Country) Usi9 DSEB-502R Updated 6/24/2020 III11uoTit 1 IA III ' visit/v,tea 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 ' Lobbyist Number (Mark X) �l Name of Filing Committee,Candidate or p • ' • Lobbyist Al/9' tLA E • 4 Q�� 'Street Address •.0 yaa I' ,t2 ,9cj eni uE City Aito.) G u 0/ 69-144.,./� %� /%i zip coals !7 0 7 O 'Type of Report(Place x under report type) v ' ' ' " 1-6"Tuesday 2- 2'1.Friday)3-.30 Day Post 4-fitTuesdaY 5;id Frltiay 6-36 Day Post, 7-Annual ' Special 2"°Friday: .Special 30 Day Pre-Primary. Pre-Primary Primary Pre-Section Pre-Election motion Pre-Election Post-Election . - �---i Date Of Election Year Amendment (� Termination , - - 0.-,, (MM/DD/YYYY) O S /g •Z.d 1 Report l I l Report Summary of Receipts and Fro,{ Date To gate For Office Sae On ry ipOnly Expenditures -A.Amount Brought Forward Last Report t ,. .. O 0 c' . B.Total Monetary Contributions and Receipts t •.�- (From Schedule I) 0 -x , C.Total Funds Available 8 • (Sum of lanes A and B) 0 r- c) D.Total Expenditures t . •(From Schedule NI) 6/3- 3'9 E.Ending Cash Balance 8 _ • (Subtract Line D from line C) 0 c : �- F.Value of In-Kind Contributions Received 8 O o (From Schedule II) 01 G.Unpaid Debts and Obligations 8 ' (From Schedule IV) 0 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 D- day of 20 t Signature of P rson Submittin report /"/►AA ikA! .2. . /3�`t Signature Printed Name My Commission expires 7 /7 3 so -0 204( 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 1937(P.L 1333,NO.320)as amended. Sworn to and subscribed before me this Q� day of 20 A.5 . &Ns, Signature of�ndidate. /` ,1A-6' y. Signature Printed Name My Commission expires 7/7 -3 3 c "b g o4' MO. DAY YR. Area Code Daytime Telephone Number . :• SCHEDULE 1 ' . Contributions and Receipts •1 Detailed Suimmry Page ;, Firer Identriication Number 1.Unitemized Contributions and Receipts 850.00 ortess pr*Contributor 0. •' , } t Total for the reporting period (1) t 2.Contn)ptions o1 150 01 to:1250.00(From r :',.,...4 • • i Para:A and Part.0)._. . • .. . - — L .,:�• +j f y 'lit +-t ;.- - ,, -µ, . ,- • . �,. __,:' M. Contributions Received from Political Committees(Part A) . 1 ' . . All Other Contributions(Part'E3) •. S •,., . - Total for the'reporting period ' (2) '1 . . , .. ., d 3.Contributions Over$250.WX0(From Part C and Part D) i. Contributions Received from Political Committees(Part C) _ 1 All Other Contributions(Part D) $ " Total for the reporting period (3) _ 0 I 4.Other Receipts iisfunda,interest Famed,Returned Cheda,ETC.(Prom Qart E)t.it.Via, i r .042-!. k" ? 0 _ + :. Total for the reporting period (4) $ 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 . Cover Page,Item B) 6 SCHEDULE III Statement of Expenditures Filer Identification gumber. . To Whom Paid 'Date:tAM/OD,YY1 T 39 • G.,,r,`� ,gas ZZe,�, ( je a r 1u ,zfes 0 'f o? ?c / 6/(3 , -- House#' Street Addris '.t ,o Expenditure = , • " 743 y Wave 1 Sfte e Y,�R S' r y:as city State . J Tip ,',� h4fi MIA I'4 A Code D / ?a/ To Witr- of Paid Date[IRM/DDIYYYY S 1 House# - !street Address' Description of Expenditure City 1 - State Zip Code . A To 4omPaid Date•[MM/DD/YYYYJ . 3 house it' `Street Address' Description of Expenditure City State. LP h • .•. j ,1.' Code To W om Paid } Date[MM/DD/YYYY] . S House l Street Address" - Description afgendsture City State Zip r .. Code To 1k om Paid DatejMM/DD/YYYY] $ House f Street Address] Description of Expends re City I State Code Code ToW omPaid DateiMM/DD/YYYYJ $ ROWS I. Street Address Description of. , City 1 State t Zip= Code a To W om Paid ' Date[MMIDD/YYYY] 3 House. Street Address Description of Expenditure City State 4 to WEiom Paid Date PA . 3 " r_ House# Street Addres1 Description of Expenditure City State ' zip Code '. SCHEDULE IV Statement of Unpaid Debts "ttse this Section to itemize all unpaid debts and obligations which are outstanding at the end of the repotting period. , Eller identification Number. Name of Creditor Outstanding Balance of Debt House# Street Address DATE INCURRED 1 ,[MM/DD/YYYY] City • State ZIP Zip i• • • Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE D-EB'!INCURRED "' 1 , [MM/DD/YYYY] llty State Zip 'Description of Debt ` Code Name of Creditor Outstanding Balance of Debt x;. t • :v r4 House# Street Address DATE DEBT URRED $ [MM/DD/YYYYI 1 City State , Zip Code ,, Descrfption of Debt Name of Creditor Outstanding Balance of bebt House# eet Address' `- DATE-DEBT INC • •, D " _ [MM/DD/YYYYJ City State -Zip - Code . . Description of Debt ' • . Name of Creditor Outstanding Balance of Debt House# eet Addres1 DATE DEBT iNCIJR D " s [MM/DD/YYYY1 '! City State Zip Code . Description of Debt game of'eret,litor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED ' t `City — State , • Zip . Code Description of Debt .. —.- - . , ,,.. . ,, . . , , ,,,.