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HomeMy WebLinkAboutPeck, Christylee - 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/campaignfinance • ra-stcampaignfinance@pa.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. C Name of Filing Committee, Candidate, or Lobbyist CIv IS 1 Illeporting Cycle Name ❑ Cycle 1 ❑ Cycle 2 ❑ Cycle 3 LI Cycle 4 ® Cycle 5 6th Tuesday 2nd 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 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. 10/22/21 Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) Christylee L. Peck Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 11111 Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible.It should be typed) Filer Identification Report Filed By Candidate Committee Lobbyist Number (Mark X) Name of Filing Committee,Candidate or Lobbyist Christylee Peck Street Address 162 Meadow Lane City Mechanicsburg State PA Zip Code 17055 Type of Report(Place x under report type) 1-6`h Tuesday 2- 2nd Friday 3-30 Day Post 4-6th Tuesday 5-2"d Friday 6-30 Day Post 7-Annual Special 2"Friday Special 30 Day Pre Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election X Date Of Election Year Amendment Termination (MM/DD/YYYY) 11/02/2021 2021 Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 06/08/2021 10/18/2021 A.Amount Brought Forward From Last Report $ B.Total Monetary Contributions and Receipts $ (From Schedule I) C.Total Funds Available $ . . (Sum of Lines A and B) C") D.Total Expenditures $ ^-+ (From Schedule III) 275 o E.Ending Cash Balance $ I":-i c:, (Subtract Line D from Line C) -275 -4 F.Value of In-Kind Contributions Received $ ,. IV (From Schedule II) Iv I G.Unpaid Debts and Obligations $ C C) (From Schedule IV) CD Affidavit Section - '' Part 1-If this is a Committee report,treasurer sign here.If this is a Candidate report,candidate sign here. 1v • 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 ^, P"a`" ChrISt t° t 4 ubmitting report Signature Printed Name My Commission expires 717 979-1559 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 Filer Identification Number: To Whom Paid Date[MM/DD/YYYY] $ Cumberland County Republican Committee 75 10/15/2021 House# Street Address Description of Expenditure 212 N.Hanover Street City State Zip Carlisle PA Code 17013 Fall Dinner ticket To Whom Paid Date[MM/DD/YYYY] $ Friends of Sheryl Delozier 200 10/10/2021 House# Street Address Description of Expenditure P.O.Box 412 City State Zip Harrisburg PA Code 17108 Contribution To Whom Paid Date[MM/DD/YYYY] $ 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/YYYY] $ 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/YYYY] $ 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