HomeMy WebLinkAboutKeystone Taxpayers Unite - 2021 6th Tuesday Pre-Election cifPennsylvania Department of State
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.pov
Unsworn Declaration 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), Non-Bid Contract Reporting Form (DSEB-504) 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.
Name of Filing Committee, Candidate, or Lobbyist
S�n e_ �ax :� Xs f e�
Reporting Cycle Name
❑ Cycle 1 0 Cycle 2 ❑ Cyde 3 CI 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 ❑ Cycle 8 0 Cycle 9
30 Day Post-Election Annual Report 2nd 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 accompanying Campaign Finance Statement is true and correct.
nY1 A It A r4 09/20/2021
Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY)
Sandra M. Newfield Hollidaysburg, PA, USA
Printed Name Location (City/State/Country)
DSEB-5035
Updated 1/22/2020
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 , 20180282 REPORT FILED l CANDIDATE 1' COMMITTEE 2. LOBBYIST 3.
NUMBER ON BEHALF OF I ✓
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
Keystone Taxpayers Unite
STREET ADDRESS
3908 Primrose Road
CITY STATE ZIP CODE
Enola PA 17025
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) N/A
MO. DAY YEAR
1. 11 02 2021
6TH TUESDAY
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY YEAR
2ND FRIDAY 2. DATES OF
PRE-PRIMARY PERIOD REPORTING 06 08 2021 TO 09 13 2021
30 DAY 3.
POST-PRIMARY
CASH BALANCE AT END -
"=
6TH TUESDAY 4. OF REPORTING FIELD: $ 1095.04 q`; s
PRE-ELECTION r'n(
TOTAL AMOUNT OF FILER'S X)
2ND FRIDAY 5. OUTSTANDING DEBTS OR LIABILITIES
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ 0.00
30 DAY 6.
POST-ELECTION AMENDMENT YES NO 1I C
REPORT? C)
7.
REPORT TERMINATION YES NO ✓
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
11:611616.114"Pf14DAY OF 20 _ SIGNATURE OF PERSON SUBMITTI EPORT
Sandra M. Newfield
SIGNATURE PRINTED NAME
MY COMMISSION EXPIRES 814 207-4570
MO. DAY YEAR 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
PRINTED NAME
IGPRE
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YEAR
DSEB.503(12.99)