HomeMy WebLinkAboutSmith, Emily - 2021 30-Day Post-Primary i'1 Pennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
t 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
www.dos.pa.Rov/campaignfinance • ra-stcampaienfinancePpa.gov
Unsworn Statement in Lieu of Sworn Statement for
Campaign Finance Statements
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 Statements. This form must be signed by hand where a signature is required.
GIEED CQ[ Committee, Candidate,07 Lobbyist
Emily Smith
r Reporting Rai g9Eim
❑ Cycle 1 ❑ Cycle 2 CI Cycle 3 ❑ Cycle 4 ❑ 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 ❑ Cycle 7 ❑ Cycle 8 ❑ 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 statement in lieu of full report by a political
committee, the treasurer must sign here. If this form is submitted with a statement in lieu
of a full report by a candidate, the candidate must sign here. If this form is submitted with
a statement in lieu of full 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.
,(32/04 .- 6/14/2021
Signature o Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY)
Emily Smith Camp Hill, PA
Printed Name Location (City/State/Country)
DSEB-503S
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 CANDIDATEI" COMMITTEE 2. LOBBYIST
NUMBER , ON BEHALF OF ' 3.
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
Emily Smith _
STREET ADDRESS
2002 Columbia Ave
CITY _ --- STATE ZIP CODE
Camp Hill PA 17011 __._
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) Borough Council - Camp Hill D MO. DAY YEAR
1. 11 3 2021
6TH TUESDAY - - -
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. OAY YEAR - _-- -
2ND FRIDAY 2. DATES OF
PRE-PRIMARYREPOR PERIOD
5 18 21 TO 6 7 21 �' ;e_
C.: 1,
F.a
3. K
30 DAY w —
POST-PRIMARY X - 03 C.....
CASH BALANCE AT END rn C
6TH TUESDAY 4. OF REPORTING PERIOD: $ 0 X
--
PRE-ELECTION
TOTAL_AMOUNT OF FILER'S
2NDFIiIDAY 5. OUTSTANDING DEBTS OR LIABILITIES Q —0
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ 0 1) :.
C)
6. Ce
30 DAY Z:
AMENDMENT ---4
POST-ELECTION REPORT? YES NO X
7. `,,`
ANNUAL TERMINATION YES NO 7C
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 LIABIUTIES 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 KNOWLE E AND BELT ,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 SIGNA JR OF PERSON SUBMITTING REPORT
Emily Smith
SIGNATURE PRINTED NAME
MY COMMISSION EXPIRES 71 7 421-3789
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
DSE13-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280