HomeMy WebLinkAboutArgot, Ryan - 2021 30-Day Post-Primary tiPennsylvania Department of State
v 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@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
GI h r
Reporting Cycle Name
❑ Cycle 1 0 Cycle 2 i Cycle 3 ❑ 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 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.
(.////2 c L
Sig re of Treas r, Candidate, or Lobbyist Date(DD/MM/YYYY)
l Printed Name Location (City/State/Country)
DSEB-502R
Updated 6/24/2020
wr
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 - 2. ?
NUMBER ' ON BEHALF OF ` CANDIDATE �I COMMITTEE LDDBnsf
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST r
Kyan i7g1
STREET ADDRESS
rd 3g (hcf i.•,/ g-e*- *-
Cm' ...�{{,,,, STATE ZIP CODE
t1/1eCClan.eS 4.a� F i7C,
TYPE OF REPORT NAME OF OFFICE SOUGHT BY INDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) // MO.- I DAY - YEAR
6TH TUESDAY .I. Ce ert N1•f rf i e'IJ P/ 0 e,.'t ! I i 2. 202 /�
PRE-PRIMARY FOR OFFICE USE ONLY
MO, DAY YEAR MO. j-DAY YEAR
2ND FRIDAY 2. DATES OF
PRE-PRIMARY REPORTING
r/^ s 6 L 2 / TO 7 ^ t
P
C"1
30 DAY 3' G,„..',
POST-PRIMARY X �",'--m
CASH BALANCE AT END O e (_
4• OF REPORTING PERIOD: $ ;r i z c
sm TUESDAY .� ,
PRE-ELECTION
TOTAL AMOUNT OF FILER'S
2ND FRIDAY 5' OUTSTANDING DEBTS OR LIABILITIES d ...lePRE-ELECTION AT THE END OF REPORTING PERIOD: $ C) '
B. '""`
30 DAY
POST-ELECTION AMENDMENT YES NO v
REPORT? J`
ANNUAL
7 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 Contributincl 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(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 R SIGNATURE 0 SON SUBMITTING REPORT
{/Di
I� E p p f
SIGNATURE '—t7 PRINTED NAME
MY COMMISSION EXPIRES 7 f 9 6 /2 o 7 —
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 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
DSEI3-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280
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