HomeMy WebLinkAboutSabadish, Dale - 2021 2nd Friday Pre-Election ., Pennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
kr 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 Statements
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 Statements. This form must be
signed by hand where a signature is required.
IG9MGCOKOK3 Committee, Candidate,07 Lobbyist
PAL SA l$N
'Reportingu]p
❑ Cycle 1 ❑ Cycle 2 ❑ Cycle 3 ❑ Cycle 4 [Xi 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 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 th corn vying ampaign Finance Statement is true and correct.
Signature of Treasure , Candidate, or Lobbyist Date (DD/MM/YYYY)
Phut, Saq pis N Afetf 4MlcSbab, k USA
Printed Name Location (City/State/Country)
DSEB-503S
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 1110,, REPORT FILED - I- L 3.
NUMBER
ON BEHALF OF ' CANDIDATE 1.. COMMITTEE LOBBYIST
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
'Dtc.e ot®gts►sti
STREET ADDRESS
cvasei Civic
CITY STATE ZIP CODE
NtFc twit tc 02.6 PA ii(AC —
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) PlUrrti°P.1.1441 -.CVMakft4 MO. DAY YEAR
6TH TUESDAY; I. 1
PRE-PRIMARY- FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY YEAR
2ND.FRIDAY 2. DATES OF
PRE-PRIMARY REPORTINGPERIOD 6 6 A 2023 TO ID tp lot
30 DAY 3'
POST-PRIMARY.. -
CASH BALANCE AT END �► �-
6TH TUESDAY OF REPORTING PERIOD: $ L[1�,•36
PRE-ELECTION
TOTAL AMOUNT OF FILER'S " n a
2ND FRtDAY 5. OUTSTANDING DEBTS OR LIABILITIES
PRE ELECTION AT THE END OF REPORTING PERIOD: $ € .)
6. ,s C"30 DAY
AMENDMENT.
POST-ELECTION YES Y #;`« fie.?
REPORT? x
ANNUAL -TERMINATION
REPORT REPORT? YES NO Y
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 INCURR_, a ING T REPORTIN ERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF ' 0 ED AND LIEF, UE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 S- ,ATU OF RSO UBMI TING REPO
DO a �aI(S
SIGNATURE 1 / PRINTED NAME
MY COMMISSION EXPIRES MO. DAY YR. AREA
CODE 3 3—O 7 7
DAYTIME TELEPHONE N MBER
PARTII-
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 20_
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
Department of State • Bureau of Commissions,Elections and Legislation
DSEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280
_ .