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HomeMy WebLinkAboutCamp Hill Democrats - 2021 30-Day Post-Primary Pennsylvania Department of State gL, Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 •717.787.5280(Option 4) www.dos.na.eov/campaignfinance • ra-stcampaignfinancePoa.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 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 Reports. This form must be signed by hand where a signature is required. Commi`-ee(§a-v i av t t (,ct vU.,� {-H I 4wi.o e ra* ❑ Cycle 1 ❑ Cycle 2 Ig 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 ❑ 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. A2Q;( / 4>/:<,-/-Pr7,1-( 6//"7 t Signature of reasurer,Candidate,or Lobbyist Date(DD/MM/YYYY) • 7 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 ' REPORT FILED CANDIDATE COMMITTEE j/ _1 LOBBYIST NUMBER ON BENALF OF NAME,OF FILING,CAOMMITTEE,CANDIDATE OR LOBBYIST C;c�.rr. WI t' 1D e-eV\o C„(04.5 STREET ADDRESS P D 6d,e_ lilt 5 CITY STATE ZIP CODE i✓0.v61 P kt'il1 e1\ lin<:ai _ TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE 'DISTRICT NO. PARTY DATE OF ELECTION (CHECK ONE) I MO. DAY YEAR .5 : I% ja(.)o21 6TH TUESDAY PRE-PRIMARY FOR OFFICE USE ONLY 12 OATES OF MO. DAY YEAR MO. , DAY ! YEAR ✓ PRE-PRIMARY PERIOD REPORTING • 1 i g,f TO 6 7 2..i `PO DAY `f POST-P-PRIMARY 'Jt` �f� C.) N. CASH BALANCE AT END / /vim 0 C.:: T..a, — 6TH TUESDAY ° OF REPORTING PERIOD: S / 'V _ PRE-ELECTION rri TOTAL AMOUNT OF FILER'S -,-, 5. OUTSTANDING DEBTS OR LIABILITIES r"- --- PND EE-ELECTI FRIDAY ON AT THE END OF REPORTING PERIOD: S © .- . d 6. CI - 30 DAY AMENDMENT C) POST-ELECTION YES YES NO ANNUAL TERMINATION YES NO +�-{ REPORT REPORT? '-'C s,.) AFFIDAVIT SECTION PART I- If statement is filed on behalf of a Political Committee or Candidates's Committee.the Treasure r 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 S,.:EAR(OR,*.FIR'.")THAT TI-E AGGREGATE RECE P 5 OTZ_:SJRS5i,_..S�R_yg;-ES N.:-RRES_JR I._ 5 RE R^Iv.zER'u..:'IO;C.ATEO ABOVE DO NOT .S RER ' EF.TRUE.CAR?ECT ANO COMPLETE. EXCEED TWO HUPiDF!EO AND FIFTY DOLLARS(S250.00)..�.-.'... .. - 5.-.." E_eS- _° .._..__..__-•._BE_ SWORN TO AND SUBSCRIBED BEFORE ME THIS L'e. -J. c y DAY OF 20 SIGNA E OF PERSON SUBMITTING REPORT P t- r 77 i eiwI _ PRINTED NAME SIGNATURE �f j C� MY COMMISSION EXPIRES 1 i 7 Z ` J .r✓7 0v 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 THE BEST O'.... riV:.:.E_'w_+•._nc_n°T-;S -..-_ - -7=S NC .OLATEC 4,4Y_.O.TS,ONS O -'-E'CT or JU!NE 3. 1937(P.L. 1333.N .320)As A^E;,:SC. 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. Department of State • Bureau of Commissions,Elections and Legislation LN LIJ-_II3 I I olI I 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280 I