HomeMy WebLinkAboutShultz, Sean - 2021 30-Day Post-Primary 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 10,
I COMMITTEE Z LOBBYIST ;
NUMBER ' ON BEHALF OF x
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYISTpp, 'i ,
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LGM1
STREET ADDRESS
5-3 F Strte_-1-
CITY C r STATE ZIP CODE7 O 1-J ..--- I T W.
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) �f C/' MO. 'DAY YEAR
1. /UA 0r oS r113/2 golra-L5L Dem 5- 'r - --
6TH'TUESDAY
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY YEAR
2ND FRIDAY Z' DATES OF
PRE-PRIMARY REPORTINGr (� to t 1 TO /L► '7- zoz( (') �,.-,
PERIOD y
30 DAY
POST-PRIMARY X t"-%
CASH BALANCE AT END 4 `1 C-
F
4. OF REPORTING PERIOD: $ ----
6TH'TUESDAY' T""
PRE-ELECTION --1*;'" --
TOTAL AMOUNT OF FILER'S ''j
2NDFRIDAY e' OUTSTANDING DEBTS OR LIABILITIESAC
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ CD .,.
B.
30 DAY 27
POST-ELECTION AMENDMENT YES NO X "--'l IN)REPORT? -< C::'
7.
ANNUAL TERMINATION YES NO
REPORT 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 PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS � —‘ _
AY OF 202J SIGNATURE OF PERSON SUBMITTING REPORT
Commo en yl
DOLLY M OC No POI b yl k /l/1/J ✓'e�"s PRINTEDAMU f -
SIG A R.-.• �'l �/ l/
My Commission Expires e 24, 022 2 f r 2a 2 7(? 5-50- 75 Z7
C�9n 9A444hs�l}rflbiMM-42 '7
M . 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 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.
Department of State • Bureau of Commissions,Elections and Legislation
DSEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 a (717)787-5280