HomeMy WebLinkAboutMorrow, Douglas - 2021 2nd Friday Pre-Primary / Pennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option
g, � P 4)
. wvw.dos.Pa.gov/cerpaignfinance • ra-stcampaignfinsncef 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.
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❑ Cycle 1 Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5
6th Tuesday 2nd Friday 30 Day 6th Tuesday 2`d Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election
❑ Cycle 6 ❑ Cycle 7 ❑ Cycle 8 ❑ Cycle 9
30 Day Post-Election Annual Report 2'1 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.
NI if( CI
Signature of Treesu1rer, Candidate, or Lobbyist Date (DD/MM/YYYY)
fix Aix
Printed Name Location (City/State/Country)
DSEB-5035
Updated 6/24/2020
•
Pennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
'f 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
t ,,....., ; wvw.dos.pa.gov/camp'aignfinance • ra-stcampaianfinancec pa.gOv
Part II - If this is submitted with a statement in lieu of full report by a Candidate's
Authorized Committee, candidate sign here.
I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania
that the foregoing is true and correct.
7A.0.1.Az*k_f 5-) - l'')(. X I
Sign ture of Candidate Date (DD/MM/YYYY)
DO Imo- L i ��- 5') )v ) a)
Printed Name Location (City/St to/C untry
v � P<
DSEB-503S
Updated 6/24/2020
•
CO;.iMONWEA!T H OF PENT ISYLVANIA .
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.
-...r...
FILER IDENTIFICATION 111, REPORT FlLEO Op.
jjj�AkOCJAI'E. I COM4ltTTGE- 2 L43cY!yT 3 I
NUA`.SER ON EEiALF OF
NAME OF FILING COMM-TEE,GANG ipATE OR LOT.YIST fit,,
STREET ADDRESS 5-/3 A
CITY �p _ /" C W4 t2e r I STATE k 2!?CODS
O/
TYPE OF REPORT NAME OP OFFICE SOUGHT EY CANDIDATE [DISTRICT NO. PARTY DATE OFE.ELECTION
(CHECK ONE) . t . MO. � DAY - .�
'6Tt1 TUESDAY
i. l ,b-vJ () x3, VPv" , 11 /X
PRE-PRIMARY _ . FOR OFFICE USE ONLY
YO. I DAY YEAR ;MO. I DAY t YEAR ' ..
2. GATES OF '
k
PRE-PRlMAP.Y REPORTI,'vu r{�
PE{2IOD 1 - o. I �)
13
30 DAY. r ..,e=
POST-PRIMARY Ffl
CASH BALANCE AT END v—13 '—L
4. OF REPORTING PERIOD; $ r— —
611 TUESDAY > .....
PRE-ELECTION
• _ TOTAL AMOUNT OF FILER'S C7
5 OUTSTANDING DEBTS OR LIABILITIES ...-. -="""
PRE-ELECTION AT THE END OF REPORTING PERIOD: S
CO
8. {
q
• !s1L5cT1oN RE.DRT? `YES NO f .
REPORT, TERMINATIONYES NO ,(3
REPORT REPORT? • �J}.t
• 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 DR DIR?URSET.IS'TS CR LIAE!I.tI:SS IW'IS?.SD DUET 0 THE REPORTING P51 500 IHDiCH'EO ABOVE DID NOT
EXCEED Tr70 HUNDRED AND/FIFTY DOLLARS(S25O.00)Af:C Tws REPORT 15,TO THE EES O.M. IC-IC F.E. •_+EELI`F,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
/ AY OF M 204/ SI 'ATUR OF PERSON SUBMITTING'REPORT
IJ PRINTED NAME
-_� SI-NA I RE ! g ` 8-4 /
MY COMMISSION EXPIRES -7 6 -7 �a-7 3
_______i
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 HE EAST OF MY is O?.N E CE AND Sall'.THIS=,OO ICAA-CC!.'e..,--;FE H S NOT VIOLATED AM'Fr;J'MSiDUS OF h=_ACT OF
JUNE 3.1937(P.L,1333,No,320).:s A,:.s=_Iacs�...
S
SWORN TO AND SUBSCRIBED BEFORe',:,RE TFli�.. ..._..... _a
SIGNATURE OF CANDIDATE
OF 2D
PRINTED NAME
SIGNATURE
My COMMISSION EXPIRES AREA CODE DAYTIME TEEEPNOTE NUMBER
MO. DAY YR.
Department of State • Bureau of Commissions,Elections and Legislation