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HomeMy WebLinkAboutFriends of Jeffrey Filler - 2021 2nd Friday Pre-Election yfiiPennsylvania 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 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. • Name of Filing Committee, Candidate, or Lobbyist f l ri'ei,61c or 7E -rrc F)lel' Reporting Cycle Name "• 0 Cycle 1 0 Cycle 2 0 Cycle 3 0 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 0 Cycle 8 ❑ Cycle 9 30 Day Post-Election Annual Report 2nd Friday Pre-Special Election 30 Day Post-Special Election Part l-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 foregoing is true and correct. 6` 18 / )o / 20/2 ignature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) pD A 19. go,A , C�,� )1,1k / RA / USA Printed Name Location (City/State/Country) DSEB-502R Updated 6/24/2020 IIIt Reset Form Lyrint Form 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) 4X` Name of Filing Committee,Candidate or -� Lobbyist I/.tAd( o i JZ F�it..i Ft'Ihr- Street Address r' U 13,x '4 3 City � � ! State PA Zip Code I 1 a o ) Carty Type of Report(Place x under report type) 1-6th Tuesday 2- 2'"'Friday 3-30 Day Post 4 6u'Tuesday 5-2nd Friday 6-30 Day Post 7-Annual Special 2"1 Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election 1 Date Of Election Year Amendment � Termination (MM/DD/YYYY) (t/0 //62.( 2 n oZ I J Report lfvr��IJO Report Summary of Receipts and From Date To Date For Office Use Only Expenditures GYM /e2) i0 / l8 /01 A.Amount Brought Forward From Last Report $ n k— B.Total Monetary Contributions and Receipts $ f O ll. v``�t v r.-I c.'-' (From Schedule I) I ;-'3 --r C.Total Funds Available 1 f"' yNa (Sum of Lines A and B) $ I1 Dd.. 00 › N D.Total Expenditures $ / C.:) q (From Schedule III) 616 c 6 (-) E.Ending Cash Balance $ -7 C� (Subtract Line D from Line C) 1 ( 3_ ©y � W F.Value of In-Kind Contributions Received $(From Schedule II) — —` G.Unpaid Debts and Obligations $ (From Schedule 1V) '---- U --- 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 I !� I!_� Signature f Pe on Submitting report oh 1),. � >, Signature I r Printed Na tme /�-7 My Commission expires r70 ( G� 6 / MO. DAY YR. Area Code Daytime Telephone Number Part II-If this is a report of a Candidate's Authorized Co ' ee,candidate shall sign here. I swear(or affirm)that to the best of my knowledge a•.bye his political committee has not violated any provisions of the Act of June 3,1937(P.L 1333,NO.320)as amended. 'fir, Sworn��22 to anc)subscribed �before me this �, ��Wp�� �J� �1� -/F allay OC b-e �1 ‘ ' ,a . i •.��I i V Gl t at �G � 0oai� sy „Si ature pf a�, (date / , e d l6 p d (O(� uf` Signature 2 �ts�,oj3 P nted Name My Commission expires Jf� . /V r v_D?3 • 1-( � " 6(— D`(1 3 MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number I 1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total for the reporting period (1) $ I v. 0d I2.Contributions of$50.01 to $250.00(From Part A and Part B) Contributions Received from Political Committees(Part A) $ V- 0U /1 All Other Contributions(Part B) $ o ! v 0_ v Total for the reporting period (2) $ 1 0 0. U D I3.Contributions Over$250.00(From Part C and Part D) I Contributions Received from Political Committees(Part C) $ 1 v o All Other Contributions(Part D) $ o 0 . Total for the reporting period (3) $ f0vD_ Dv I4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) I Total for the reporting period (4) $ `—i-- LI c�, V. 00 Total Monetary Contributions and Receipts during this reporting period(Add and $ enter amount totals from Boxes 1,2,3 and 4;also enter this amount on Page 1,Report / !,l Cover Page,Item B) F/ D . D PART B All Other Contributions $50.01 TO$250 Use this Part to itemize all other contributions with an aggregate value from $50.01 TO$250 in the reporting period. (Exclude contributions from political committees reported in Part A.) I Filer Identification Number. I Full Name of Contributor , .- Date[MM/DD/YYYY] $ 30A, P 8.5A,L 66 /.23/a0a) !OD- Od House# Street Address Date[MM/DD/YYYY] $ 5 Cale_ CirL'e City State Zip Code Date[MM/DD/YYYY] $ Cu,44�� 01 I 117o t 1 Full Name of Contributor 1 Date jMM/DD/YYYYJ $ House# Street Address Date[MM/DD/YYYY] $ City , State .Tap Code Date{MM/DD/YYYYJ $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYV] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date jMM/DD/YYYY] $ House# Street Address Date]MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date jMM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date{MM/DD/YYYYJ $ V PART C Contributions Received From Political Committees Over$250.00 Use this Part to itemize only contributions received from Political Committees with an aggregate value over$250.00 in the reporting period. Flier Identification Number: 1 Full Name of Date[MM/DD/YYYYJ $ Contributing Committee C 6 ) J pc c , C p e D /l a/a o 1 I i d a d.. o O House# I Street Address Date[MM/DD/YYYYj $ City State Z.ip Code Date[MM/DD/YYYYJ $ Full Name of Date[MM/DD/YYYYj $ Contributing Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date[MM/DD/YYYYj $ City State Zip Code Date[MM/DD/YYYYJ $ Full Name of Date[MM/DD/YYYYj $ Contributing Committee House# Street Address Date[MM/DD/YYYYJ $ City State Zip Code Date jMM/DD/YYYYI $ Full Name of Date[MM/DD/YYYYJ $ Contributing Committee House#— Street Address Date[MM/DD/YYYYJ $ City State Zip Code Date[MM/DD/YYYYJ $ Full Name of Date[MM/DO/YYYYJ $ Contributing Committee House# Street Address Date[MM/OD/YYYYI $ City State Zip Code Date[MM/DD/YYYYI $ SCHEDULE III Statement of Expenditures I Filer Identification Number. I To Whom Paid Date[MM/DD/YYYY] $ f r5 J 'ant, ( 8u•.L 06 /237262,1 2 b. 16 House# 3a o) Street Address i 9" pap Description of Expenditure L(n7 i- /,. U lJ� city CA v"n I)1')f State /. ZipII 1 PA Code /70i/ GheG1 S To Whom Paid Date[MM/DD/YYYY] $ frieAas or 176uocs) F,5-i. to /07 20z( 9 Oa. Ob House# �S Street Address 1 1 Description of Expenditure LI Lam ki Cp �ms% l- city 1 *-p N,`11 State PA ZiCopde. f 7 t 1 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 pti Expenditure .- City State Zip - Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City ' State Zip Code