HomeMy WebLinkAboutCentral Cumberland Democrats - 2021 2nd Friday Pre-Primary Pennsylvania Department of State
giji Bureau of Campaign Finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@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 unsworn
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.
cil Committee, Candidate,OP Lobbyist
eiirl d Coifyi k p leeJama c v cils
Reporting @a@( Luim
❑ Cycle 1 ECycle 2 El 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 ❑ Cycle 8 ❑ 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 foregoing is true and correct.
411, -C �' 03 0 5 ca20a J
lirature of Tr a rer, Candidate, or Lobbyist Da a (DD/ M/YYYY)
ria,-M Jesjetoot,"71- itie .A 4P1/CS ihUi' VIY/4/ SA
Printed Name Location (City/Stat ountry)
DSEB-5035
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 IDENTIFICATION ' REPORT FILED 101' ,.CANDIDATE I. COMMITTEE 2. LOBBYIST . 1
NUMBER ON BEHALF OF
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
(r
STREET ADDRESS ff �j /�
c2/,- #&ES7`'Owo --d'�
CITY STATE
ZIP CODE
/mil Pf_44,c 61fCsbud ) PA P4 / ;os-o -
TYPE OF REPORT NAME OF OFFICE SIgHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) MO. DAY YEAR
6TH`TUESDAY'`:.:::
PREPPRfMARY:. FOR OFFICE USE ONLY
MO. DDAY:.. YEAR . :.MO. ...DAY :'YEAR:. .. .. " .
P RID 2V PERREPORTING
3 3 6 o2i/ TO 5- 3 a
PRE-PRNARY DATES OF
30`DAY 3. C
N
Posr.PRlMARY CASH BALANCE AT END p
• OF REPORTING PERIOD: $ 77 0 ii -•<
STH:TUESDAY.; L,.:. r--• I
PREELECTION : ° •
TOTAL AMOUNT OF FILER'S
2NDTRIDAY OUTSTANDING DEBTS OR LIABILITIES -ti
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ ._-'
s. ►V
30 DAY
POST-ELECTION REP YES NO I/ -al
.C"'
7.
ANNUAL TERMINATION.. /
REPORT YES NO
REPORT?
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 P - ,.. •ICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNO ND • EF,TRy 0' -- ND •MPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS 111
•/
DAY OF 20_ J7EONSfG9EPO T
69,
PRINTED NAME
SIGNATURE 71 7G O -3
MY COMMISSION EXPIRES
MO. DAY YR. AREA CODE DAYTIME TELEPHONE INUMBE� R
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.
DSEB-503(12-99)