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HomeMy WebLinkAboutFish, David - 2021 2nd Friday Pre-Election (3) lir PennsyflCampaignvania Department Engagement of State Bureau o 210 North Office Building.Harrisburg,PA 17120 • 717.787.5280(Option 4) w w:.dos.pa,nov/can)oairnfinance • ra-stcanipaignfinancePoa.p,ov Unsworn Declaration in Lieu of Sworn Statement for Campaign Finance Reports Note: Per Act 2020-15, which was signed into low 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 ©SEB-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 David J. Fish Re•ortin: Cycle Name © Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 El Cycle 5 6111 Tuesday 2"'Friday 30 Day 6N Tuesday 2ntl Friday Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election 0 Cycle 6 0 Cycle 7 © Cycle 8 0 Cycle 9 30 Day Post-Election Annual Report 2"a Friday Pre-Special Election 30 Day Post-Special section 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 .. .. ::- .-_ .'=. 7 , n rep ny n conrrimurFr?, !copyist, Ioe locaylst 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. 7) --i f ..�/ 1 0/2( /2021 . Signature of 'reasurer,Candidate, or Lobbyist Date(DD/MM/YYYY) David J. Fish Camp bill, PA, USA Printed Name Location (City/State/Country) DS£4.502k Updated 1/27/7021 i Coi,'.ttA•'wEALTH of PENNSYLVANIA CAMPAIGN FINANCE STATEMENT File this in lieu of a full report only ifaggregate receipts, expenditures, or liabilities incurred each did not exceed S250.00 during the reporting period, citDCNTIrICArIaH RETORT MED ut VID11�-- ---- _---- - - HfliC I _ __ -- --- M ON&HMI Or . co�eum[r4. moans* 3 wAMr Or fIUYE C0117MITTtt„w‘DIDAn:OR I:os8Y$r - - ___----- -- STRUT ADDRESS -- - - - -- - -- illd L P PUS-(- Lev STATE n_r CODE TYPE OF REPORT NAM!OF ORTC2 SOUGHT BY IC CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION(CHECK ,. . TOW rJ).HI P (d,146,W1dAle( 'I JN1 I I DAY r�Y[AR fiTH TUI'ADAY t L s 7 f PRE-PRIMARY P.A$OFFICE USE ONLY W. DAY { YEAR ' NO. j DAY i YtA I - t , o+ - - - i 2Nb(it16_a!V PR&PRIMARY RCPOR:' - OATES OF ` - r � TNNG C' y PERIOD 0 6 O /�oa i TO j ) u ? c 30 DAY 3. PDST-AgnuoW I, . CASH BALANCE AT END0 t)rH mcaDAY4. OF REPORTING PERIOD: S l „� PRSi-iI.CCTION � s ��^I TOTAL AMOUNT OF FILERS 2ND FRIDAY a OUTSTANDING DEBTS OR'UABILfTIES 0 v PRLI•ELECTION AT THE END OF REPORTING 'PERIOD: S w. IN,..) FO T t AIAENOCACNT PDCT•ZLLCjIOId REPORT? YESNO ANNUAL T RMWAA`.TGN REPORT lIVOR YEST� NO e' AFFIDAVIT SECTION PART!- 1f statement is filed on behalf of a Politic?l Committee orCandiclates'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 CQntjlbutino Lobbyist,the Lobbyist must sign here. I s:I.,EAR(on Arx1RA/)THAT THE ALCREGATE RECEIPTS OR DanuRtItigrrs OR LIAIMITas tura.Fsmia DUR:nG PIE'PPPCRFWIG PERIOD CIDICATLO ABOVE OIO NOT EXCEED TWO HUNDRED AND FIFTY DOLLARS.(S2.50.00)Ara,:I-zs REPORT r,:o THE MST a�:itGEro BELL.T}tAiEI,CORRECT AND COMP>_IrTE_ SWORN TO Aft)Sllt3,•,GRIBF,O BEFORE YE THIS DAY OF 20 SIGNATURE PERSON Sumurrtuo REPORT 1)kuI Q .— 1 S 1-{- PRINTED NAME. - SIGFiAT'URF 7 t / ,r? —GC 3,s MY commsioN CXPIR.Cs _ MO. DAY YR. AREA CODE DAYTIME TLLEPHONE NUMBER PART it- If statement,is filed on behalf of a CanOidate's Authorized omrnittee,Candidate must sign here. I evvtAR(OR AFfRM)THAT TO TFtl BEST Q:_Li?KNQWLErj3c kID SEUEF TH5 POLITICAL CEX.7I.GTTtE IwvS NOT VIOLATED ANY PROVISIONS OF:l• ACT OF Junc 3,1937(P.L. 1333,No.320)A8 AUSENC . SWORN TO AND SUBSCRIBED BEFORE ME THIS SIGNATURE OF CANDIDATE DAY OF 20 _ PRMrw•D NAME 1GNATURE MY COMMISSION EXPIRES - AREA CODE DAYTIME TELEPHONE NUMBER MO. OAY YR. Department of State • Bureau of Commissions,Elections and Legislation ml:wAnt#I5.,nnt 210 North Office Building • Harrisburg.PA 17120.0029 • (7471.707-5280