HomeMy WebLinkAboutFriends of Dr. Ryan Argot - 2021 30-Day Post-Primary iiryPennsylvania 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(a'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 i res./ e. (/i. r /'T,f/
e-
Reporting Cycle Name
❑ Cycle 1 0 Cycle 2 tg Cycle 3 0 Cycle 4 0 Cycle 5
6th Tuesday 2"d 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"a 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 fore 'no,is true and correct.
- 2 66 / H
Signature of Treasurer, Candidate,or Lobbyist Date (DD/M /YYYY)
5:I'? L ► li 4v15 el ii6442 P U 542
Printed Name Location (City/State/ untry)
DSEB-502R
Updated 6/24/2020
`x 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-stcampaignfinancePpa.gov
Part II-If 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 foregoing is true and correct.
„ow" t(7///2 4-1
ature of Treasu r, Candidate, or Lobbyist Date (DD/MM/YYYY)
yew N !'/i p", filifee 44*inkl?w.y� �/7 +�f
Printed Name Location (City/State/Country)
DSEB-502R
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 D /♦< 3 / O I s 3 -7 ORN BERHALF OF p CANDIDATE I CONMRTEE 2 X LOBBYIST 3
NUMBER (23
NAME OF FlUNG COMMITTEE,CANDIDATE OR LOBBYIST t /� /� �J
ri : e..di ai £ . k AA /� I04
STREET ADDRESS ) t /
I o 3 t C It e. t � 'F�' a.- Gr
CITY STATE ZIP CODE
tM 1► ckA„rcf bAI Y,r� A l7GJV
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY CM@ CO
(CHECK ONE) MO. DAY YEAR
I. ( rir)tMrtf:cote/ Pe WA l/ 2 2e21
6TH TUESDAY -
PRE-PRIMARY FOR OFFICE USE ONLY
NO. DAY YEAR MO. I DAY YEAR --
2ND FRIDAY 5- !(
2. OATES OF -
PRE-PRIMARY REPOR PERIOD TING 2. TO �'}
It
•
PO DAY
POST-PRIMARY (X,
CASH BALANCE AT END i I V, 7 2
6TH TUESDAY 4. OF REPORTING PERIOD; $ C?
PRE-ELECTION 1,...1
TOTAL AMOUNT OF FILER'S
2ND FRIDAY 5" OUTSTANDING DEBTS OR LIABILITIES 1 Q'(`j, U rT'1
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ 1 �+ D ,I,
r-- _
6.
30 DAY AMENDMENT
POST-ELECTION REPORT? YES NO /]L` Q
7. C, =
ANNUAL TERMINATION _
REPORT REPORT? YES NO % d
c
I AFFIDAVIT SECTION x ui
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 OUR REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TW2 HUNDRED AND FIFTY DOLLARS(S250.00)AND THIS REPORT IS.TO THE BEST OF MY KNO` 'BELIEF,TRUE,CORRECT AND COMPLETE.
see IArFiir,....ly f As A MAP e-
SWORN TO AND SUBSCRIBED BEFORE ME THIS P f/ 1 - - �.
DAY OF 20 SIG RE OF PERSON SUBMITTING REPO71%
T
1 A I,tiv1 �; q'SIGNATURE ^ PRINTED NAME
MY COMMISSION EXPIRES v
MO. DAY YR. AREA CODE DAYTIME TELEPHONE BER
PART It-
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 0 THE ACT OF
JUNE 3,1937(P.L.1333,No.320)AS AMENDED.
Oa ket44-.mow 8d^wle moo 0 F
SWORN TO AND SUBSCRIBED BEFORE ME THIS
SIGNATUR C NDIDATE
DAY OF 20
PRINTED NA'M(
SIGNATURE '" 61 Z G 7 `2
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
Department of State o Bureau of Commissions,Elections and Legislation
DSEt3-503(I2-97) 210 North Office Building o Harrisburg,PA 17120-0029 o (717)787-5280
.-