HomeMy WebLinkAboutFriends of Nate Silcox - 2021 2nd Friday Pre-Election Pennsylvania 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/campaienfinance • ra-stcampaignfinance(alpa.gov
Unsworn Declaration 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 unsworn
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 Reports. This form must be signed
by hand where a signature is required.
Name of Filing Committee, Candidate, or Lobbyist
f r i ends DC Male_ S I CoX
Reporting Cycle Name..
0 Cycle 1 ❑ Cycle 2 0 Cycle 3 0 Cycle 4 14 Cycle 5
6th Tuesday 2nd Friday 30 Day 6th Tuesday 2nd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election
❑ Cycle fi 0 Cycle 7 0 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 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 accompanying Campaign Finance Report is true and correct.
10/20/21
Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY)
Craig Mellott Silver Spring Twp/PA/USA
Printed Name Location (City/State/Country)
DSEB-502R
Updated 1/22/2021
vniPennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
www,dos.0a.gov/camnaignfinance • ra-stcampaignfinancePpa.gov
Part U-If this form is submitted with a report by a Candidate's Authorized Committee, the
candidate must sign here.
I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania
that the accompanying Campaign Finance Report is true and correct.
t U 12-o ( Zo-2..i
Signature of Treasurer, Candidate,or Lobbyist Date (DD/MM/YYYY)
#Jqi-v-z � P. S i,t,c.-o/ oneGN-r,„,tGs.0.us', pry (u&
Printed Name Location (City/State/Country)
DSEB-502R
Updated 1/22/2021
Commonwealth of Pennsylvania...Campaign Finance Report
(Note:This report must be dear and legible.It should be typed)
Filar Identification . Report Filed.By,:;:::' :Candidtit. :, Committee `: ::: I `j ••1vbbyist
Number (Mark X): . •..;.. n
Name of filing.COmmittee iCbndldate:or..:.:-:: ,
Lobbyist Friends of Nate Silcox
Street,Addr!essr.. . .:. ,.._,.. P.O.Box 882 •
City: :'.'.' :.,.: .,'..:,..: :.State:: A :xip°Code:-,.
Camp Hill PA 17011
1 Type of Report(Place x under report type)
i.;6sh,Tuesday. 2- 2i°Friday .3-30 Day Pcst 4 6thTuesday. 5,.2nd Friday 30 Day Post ..7-Annual• ' •SPecael r Friday . .,Spedak .'30.Day .
pre Primary".`, Pre-Pnmary Primary ` ..Pm-Election Pre-Erection 'Fidlen'''` 7►re-Elecdibn Past Election.
n x n
Date:Of Election.:...:.. :. .... .... Y• ear ...` . Amendment:,.. •Tenninetion:.
(MM/DD Y) 11/02/2021 2021 Report Re ❑
ems`.
Summary•of Receipts and.. •From Date •- . ' .TO`Date.( ' ..::`.., •I ... . :. • For Office.Use Only • . ,
Expenditures ..... . . : :'
06/o7/2oz1 10/1s/2021
i ...
A.Amount Brought Forward From:Last Report .:; $
B:Total Monetary Contributions.end Receipts $
(Fro►ii Sd,ediile I): .. 500.00 4..=7-
C.Total Funds Available`. $ 1,263.61 p i CD
of Eines'Aand B) ,
.D:.Total Expenditures $
{rrom.Schedule Ill) 38400 •'" NJ
E:Ending Cash Balance',.:.;.'.. $
Subtract line D from Une`C
F.Value of In-Kind Contributions Received' $ C„•)
(Frain Sotredule II):
0
G..Unpaid Debts end::obligatiorts - •. $' 0 - l
•(Fr - ,=
om sd►edule;IV) I k
Affidavit Section
Part 1-If this is a Committee report,treasurer sign here.If this is a Candidate report,candidate sign here.
I swear(or affirm)that this report,including the attached schedules on paper,is to the best of m owiedge and belief true,correct and complete.
Sworn to and subscribed before me this
day of _ .. 20 f
nature of Person Submitting report
..,,�_ �C�ralg Mellott
Signature Printed Name
My Commission expires _ 717 _ 234-1430
MO. DAY YR. Area Code Daytime Telephone Number
Part II-If this is a report of a Candidate's Authorized Committee,candidate shall 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. t
Sworn to and subscribed before me this .. C>•..e'
day of 20 r
7"- Signature of Candidate
Signature Printed Name
f -1, l
My Commission expires � (9 4 9 — ZOS-t'
MO. DAY YR. Area Code Daytime Telephone Number
PART D
All Other Contributions
Over$250.00
Use this Part to itemize all other contributions with an aggregate value over$250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C)
T
` `L,,, K:,-z Michael G.Musser II o9/27/2021 �•00▪ { •'Y: ..''ram„,m". M IS:tr;� ��S!%✓t +'it
r 1628 4 LYr�,
k "... c ; �,_,vp i Whitley Drive
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"mot Harrisburg r >'A a^4"° ri>a f 17111
R..•' '2 k ,V a, -! Community Networking Resources �.., +. President
. r.,t▪ '�• Lv ���� P.O.Boa 7365,Steelton,PA 17113
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SCHEDULE III
Statement of Expenditures
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a 1117 Country Club Road - *=
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Camp Hill w PA a'Q ,.x '17011 Donation
4:'""' ."'`F`4;. : John freidhoff . � 100.00 '
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441 : Berkshire Lane Y - Ne , s ,,:,-`" . F
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'^ Mechanicsburg PA 17050 Event Sponsorship
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Camp RBI #.- PA ; M 17011 PO Box Renewal
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