HomeMy WebLinkAboutShaffner, Harold Bud - 2021 2nd Friday Pre-Election ylvania Department of State
i irBureauPenns of Campaign Finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787,5280(Option 4)
www.dos.pa.gov/carnpainnfinance • ra•stcamp nfinance pa.2av
Unsworn Statement 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), 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.
Name of Filing Committee, Candidate, or Lobbyist
Bud Sho,c c1e.x
Reporting Cycle Name
❑ Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5
i 6th Tuesday 2nd Friday 30 Day 6th Tuesday 2nd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election
❑ Cycle 6 0 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 the foregoing is true and correct.
CiscrhcS,o-'1 !
- __,5- l/ 0 /fie* (
Signature ofTreasu Candidate, or Lobbyist Date (DD/MM/YYYY)
0 ‘k. SA)44-0AlgiL—
Printed Name Location (City/State/Country)
DSEB-5035
Updated 6/24/2020
1 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.
IDENTIFICATIONSO. REPORT FILED CANDIDATE I JL.v COMMITTEE 2 LOBBYIST
FILER ,'
NUMBER ON BEHALF OF ®v
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST - -
I-day-o 1 cI I TEGcol S ka_PCn ex
STREET ADDRESS //j/J Q {/--}�y
9 f mover e.3I `� r)
CITY STATE ZIP CODE
1 1MeGha.vt i GS /� PIS 1 70 So --
TYPE OF REPORT NAME OF OFFICE SOUGHT B CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) Sew r{00 I Yi ve_ - MO. D/A'�Y YEAR
6TH TUESDAY - _ 1) d
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY- YEAR MO. DAY YEAR - - ---- - -- -
2ND'FRIDAY 2, DATES OF -
PRE-PRIMARY PERIOD ((J a REPORTING _ I TO 10
,1 I g(
*a
30 DAY 3' ° x
POST-PRIMARY _ ..--1,..
CASH BALANCE AT END L
< OF REPORTING PERIOD: $ o E
6TH TUESDAY , --
PRE-ELECTION
TOTAL AMOUNT OF FILER'S •
M
O ,
2ND FRIDAY s. OUTSTANDING DEBTS OR LIABILITIES
PRE-ELECTION "I, AT THE END OF REPORTING PERIOD: $
30 DAY -77
AMENDMENT
POST-ELECTION YES NO ! -,,
REPORT? CD
7. r "'"I ..0
ANNUAL TERMINATION YES NO X
REPORT REPORT?
AFFIDAVIT SECTION
PARTI -
If statement is filed on behalf of a Pblitical.Comntittee orCandidates'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-Contributi g Lobbyist,the Lobbyist must sign here.
,
I SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 URE"OF PER N SUB TTING REPORT
•
•
SIGNATURE -
MY COMMISSION EXPIRES , 7
MO. DAY YR. A -4A4V1E TELEPHONE N
PART II -
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 VIOLA SY ' )VISIONS OF THE ACT OF
JUNE 3, 1937(F.L. 1333,No. 320)AS AMENDED. ' 1.) !f
SWORN TO AND SUBSCRIBED BEFORE ME THIS le
6
SIGNATUF3 OF C ATE
DAY OF 20 i
.4.).. C
PRINTED NAME
SIGNATURE _' 7 j `0(�f�
.).96.
MY COMMISSION EXPIRES MO. DAY YR. AEA CODE OAYTIME TELEPHONE NUMBER'
Department of State f Bureau of Commissions,Elections and Legislation
DSEt3-503(12-99) 210 North Office Building ♦ Harrisburg,PA 17120-0029 • (717)787-5280