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Home My WebLink AboutMartz, Robert - 2021 2nd Friday Pre-Election V:zir Pennsylvania Department of State Bef mganc & vigagem 230ur North auo OCafficepai BuildingnFin HarrisbeurgCi PA cEn 17120 ent 717.787.5280(Option 4) WWW.dos.pa.Rov(campaiRnfinance • ra-stcampaiRnfinance@pa.Rov 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 unsworn 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. , pi Cornrriittee,Candtdate,®lobbyist,}, -Ler+ i *2 Reportin: , . , , ,. ,. . :,,,F, X„ ._ ,..„4.,,,,,:: ;,...:--,-,:. ;> o Cycle 1 0 Cycle 2 0 Cyde 3 0 Cycle 4 0 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 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 t-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 t foregoing is true anc correct. ayle - Signature of Treasurer, ate,or Lobbyist Dat (DD/MM/YYYY) 4k,ed..* )44.44-2__ s.,..4-to,64,,,,, 12• , ac.54 Printed Name Location (City/State/Country) DSEB-502R Updated 6/24/2020 1111 1W-JCl I 1.11111 j 11111 1 VI Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible.It should be typed) Filer Identification Report Filed By Candidate �C, ` Committee I I Lobbyist Number (Mark X) Name of Filing Committee,Candidate or n Lobbyist U b€I1T VV1,, -I Street Address 6&-yAP f�� 2 City C,c S1 fr✓is-Gi.6tate 00/`O 5 ea/ Bp Code Type of Report(Place x under report type) 1-6t°Tuesday 2- 2°d Friday 3-30 Day post 4-6thTuesday 5-2nd Friday 6-30 Day Post 1 7-Annual Special 2na Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election f Pre-Election Post-Election ` I t l ' f Date Of Election Year Amendment Termination (MM/DD/YYYY) Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures e/oiler 07/0,1 �f A.Amount Brought Forward From Last Report $ 0 B.Total Monetary Contributions and Receipts $ (From Schedule 1) 0 '02 I OCT- 5 A I (•5 q C.Total Funds Available $ (Sum of Lines A and B) Liu nit eo2i..Acru Cp L -v1- D.Total Expenditures $ l 2 �� (From Schedule Ill) ,1 v E.Ending Cash Balance $ (Subtract Line D from Line C) !s F.Value of In-Kind Contributions Received $ (From Schedule II) G.Unpaid Debts and Obligations $ (From Schedule IV) 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 my knowledge and belief true,correct and complete. Sworn to and subscribed before me this day of 20 ,`J_J- Signature o Persorf Submitting report iZp14 a/- , Signature Printed Name My Commission expires '7 l2 ,5.VL —t Z C'Z 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. Sworn to and subscribed before me this day of 20 Signature of Candidate • Signature Printed Name My Commission expires MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE III Statement of Expenditures I Filer Identification Number: 1 To Whom Paid Date,[MM/DD/YYYY] $ u Z yla,r--ei-inco- Dc;/4[ /Rda-t o '7.07 House# Street Address v le- Description of Expenditure City State --- Zip 1T'OU'44®� �i�'g Code 769 o'i- To Whom Paid Date![MM/DD/YYYYJ $ Lit. -Z Viar-k-e4;v.-S- O'$ i8.3 bo9f 491:741- , - House# Street Addresso. Description of Expenditure C+tY j / j vv` State ---15 Code Lp 7 7c'Kidd- V& 6°8�5 To Whom Paid ` , Date(MM/DD/YYYJ $ LA ` _ � VT-((,4-I i t t//5fe4o.t 1 f. r House# Street Address 0.� A ,�1.t� n _�Cp Descri on of (�-d+ pti Expenditure 5 aty State ``) Zip gaps-10-- / Q.S Code ,.74f:› OZ ya..0c4 6,8 L`$ To Whom Paid Date,{MM/DD/YYYY( $ House# Street Address . S vit livtek h- q= Description of Expenditure • City �a,l State Met. tth.. Code le, f6� i)tr9r 4p,4i15e/'/AvaG55 C ✓G��o� S To Whom Paid Date[MM/DD/YYYYI $ House# Street Address Description of Expenditure Y State Zap Code To Whom Paid Date(MM/DD/YYYYJ $ House# Street Address Description of Expenditure CitY State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date(MM/DD/YYYYj $ Description House# Street AddressCit of ExpenditureN State Zip Code