HomeMy WebLinkAboutMorrow, Douglas - 2021 30-Day Post-Primary Pennsylvania Department of State
Bureau of Campaign Finance&Ovic Engagement
210 North Office Building,Harrisburg,PA 17120 •717.787.5280(Option 4)
www.dos_pa.eovlcampainnfinance • ra-stcampaianfinance@paaov
Unsworn Declaration in Lieu of Sworn Statement for
Campaign Finance Reports
Nate:Per Act 2020-15, which was signed into law on April 20, 2020 and allows for unswvm
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 DSE8-505)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 Lobb ist
0 , I&l.S L. MOY- ►' DEN
`deporting Cycle
,Name
o Cycle 1 0 Cycle 2 Jyde 3 0 Cycle 4 0 Cycle 5
6th Tuesday 2"d Friday ` �3'0 Day 6th Tuesday 2'd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election
Cycle 6 0 Cycle T 0 Cycle 8 0 Cycle 9
30 Day Post-Election
Annual Report 2"d Friday Pre-CpPriai Election 30 Day Post-Special Election
Part!-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 accompany' Campaign Finance Report is true and correct.
(elf
0-01 I
Signat of Treasur nd or Lobbyist flat (DD/MM/YYYY)
5• 1 ., Mi')Uagi MAri Co4dmik ?Pc vtA
Printed Name Location (City/State/Country)
DSE8-502R
Updated 1/22/2021
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 Ilpo REPORT FILED CANDIDATE ,/13 ( 7EE. 2. T3NUMBER ON BEHALF OFO. NN
NAME OF FILING COMMITTEE1,�fr DIDAI DE R LOBBYIST
00u GL4_5* L _ VDRRb( )
b,HFtT ADDRESS
5- 13 -PA - IL. 4v.e .
CITY STATE ZIP CODE
'V Cu-, ,, I-,,--10--gc - f I _ i 70
TYPE OF REPORT NAMEOF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) p,� '\p� �� / n'� Q
BTH TUESDAY AY YEAR
I.
- r 10 tL b V' •)3 CQV Y\V 6 t4y�► 1 ' O /.'
PRE-PRIMARY . .FOR OFFICE USE,ONLY
MO. DAY YEAR MO. DAY YEAR - ..
FRIDAY
PRE-PRIMARY 2 PERIOD G 5- LA )..' TO 6 1 d.
i".r,l
...30 DAY '°-"
POST-PRIMARY
CASH BALANCE AT END .
BTH TUESDAY 4. OF REPORTING PERIOD: $
PRE-ELECTION
TOTAL AMOUNT OF FILER'S t j
2ND FRIDAY 5' OUTSTANDING DEBTS OR LIABILITIES7.7
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ ,7';:
8.
30 DAY
POST-ELECTION R AMENDMENT YES
REPORTEPORT?
7.
ANNUAL- TERMINATION
REPORT REPORT? YES
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 UABIUTIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS(S250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 SIGNATURE OF PERSON SUBMITTING REPORT
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES
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 OF MY KNOWLEDGE AND BELIEF THIS POLITICAL TTEE ID-WED ANY PROVISIONS OF THE ACT OF
JUNE 3,1937(P.L.1333,No.320)AS AMENDED.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
NATO E 0 CANDIDATE
vi V N""
DAY OF 20_ rX 0 1 1 L+n 6 ,i v y Y,l 1.
r�`'V fPIRINTED NAME 1 V
SIGNATURE v
MY COMMISSION EXPIRES AR ��IIM O �Em
AREA CODE DAYTIME TE PHON UMBER
MO. DAY YR.
Department of State • Bureau of Commissions,Elections and Legislation
DSEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280