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HomeMy WebLinkAboutFriends of Nate Silcox - 2021 2nd Friday Pre-Primary iftPennsylvania Department of State Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.eov/camoaienfinance • ra-stcampaienfinancePpa.eov 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 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 Reports. This form must be signed by hand where a signature is required. Name of Filing Committee, Candidate, or Lobbyist V1AS or Mr .e- Sile-o>C Reporting Cycle Name 0 Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 ® Cycle 5 6th Tuesday 2"d Friday 30 Day 6t 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 1- 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. .s'4 6 J 2-t Signature of TreasurerCandidat..eb, r Lobbyist Date(DD/M M/YYYY) ti7 wc-w-12,..a P S'''- -off rwEc ,csra 00.C- , !SA, vsra Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 Pennsylvania 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-stcampaignfinance@ pa.gov Part!!-!f this form is submitted with a report by a Candidate's Authorized Committee, the candidate 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. 5/7/21 Signature of Treasurer,Candidate,or Lobbyist Date(DD/MM/YYYY) Craig Mellott Hampden Twp/PA/USA Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 • '......r a.x a.v.... 1 ••.w.16*iv.es. Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be dear and legible.It should be typed) Filer Identification Report Filed By Candidate ._______L_ Committee ` Lobbyist Number (Mark X) n Name of Filing Committee,Candidate or Lobbyist Friends of Nate Silcox Street Address P.O.Box 882 aty Camp Hill State PA Zip Code 17011 Type of Report(Place x under report type) 1-6"'Tuesday 2- 2"Friday 3-30 Day Post 4-6th Tuesday 5.2"°Friday 6-30 Day Post 7-Annual Special 2"Frick Acial 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election ?ost-Election Ix — Date Of Election Year Amendment nI Termination (MM/DD/YYYY) 05/18/21 2021 Report Report 1-1 Summary of Receipts and From Date To Date For Office Use Only Expenditures 01/01/21 05/03/21 A.Amount Brought Forward From Last Report $ 5,231.51 C.), B.Total Monetary Contributions and Receipts $ .._.. 0 (From Schedule I) i"7"i �:s. :2:,- C.Total Funds Available $ 5,231.51 r (Sum of LinesAandB) ; . i „I D.Total Expenditures $ 4,467.90 (From Schedule III) E.Ending Cash Balance $ (Subtract Line D from Line C) 7fi3.fii C;.') I C' y F.Value of In-Kind Contributions Received $ 0 " (From Schedule II) -,‹ G.Unpaid Debts and Obligations $ (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 fledge and belief true,correct and complete. Sworn to and subscribed before me this // ,::' 1,0 • y of ___ iiii 20 a i g eIV1A��f 21rsor7 Su omitting report Signature erintteidiName • My Commission expires _ 717 - 234-1430 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 �� dayof 20 L.,. �� • Signature of Candidate Signature Printed Name My Commission expires '1 t'i to' '7 - MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE III Statement of Expenditures Hier WeiiOptaoon rturnbe I To.whorii Paid i Date[MM/OD/YYYYJ'.• .$: . 1 FXG Sign&Labei 04/Sfi/21 4,467.90 House# Street Addnt Description of Expenditure'. 145 l Salem Church Road 'city• 1 I State I .Zip-: 1„ I Mechanicsburg I Ad . i t j,050 Signs :To Whom Paid' : .Date[MM/DD/YYYYJ. $• House.# et Address .Description of Expenditure .. City State •Zip ... Cade To:Whom Paid• , • Date[MM/DD/YYYYj ::$ House# Street Address .Description:of:Expendkure. 'State. ! ip . . , f Code.•':: :To Whom•Paid : Date{MM/DD/yYYYY].• :$ House II 'Street Address` •Description of Expenditure :: • -.City • .State Zip•. . :Code: . •Ta Whom Paid • :Date,{MM/DD/Y,YYyj . S . House.#. Street Address Description.of:Expenditure . :••. PtY. . :State Zip •Code• i To•Whom'Paid Date'[MM/DD/YYYY[: .4 . House# StreetAddress Description of:Expenditure City State• Zip . .Code To Whom Paid.... Date[MM/DDJYYYYJ.. $ House#• Street Address ,Description of Eupendku►e City ' State Zip. 'Cade: •ToWhom Paid DateIMM/DD/YYYYJ $ • House# StreetAddress Desa ipt€on of.Expenditure .City - ,State. Zip..:. Code.