HomeMy WebLinkAboutPerry, Safronia - 2021 2nd Friday Pre-Election 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 REPORT FILED CANDIDATE COMMITTEE" 2 LOBBYIST
NUMBER ' ON BEHALF OF ' I. 3.
NAME OF FILING COMMITTEE,C IDATE OR LOBB T
STREET ADDRESS
(
11) W .. om + S .
CITY ZIP CODE
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) MO. DAY YEAR
1.
6TH TUESDAY. -
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY YEAR - - ---"
2ND'FRIDAY 2. DATES OF
PRE-PRIMARY REPORTING TO ��
PERIOD
30 DAY 3' r"a
POST-PRIMARY r-.s
CASH BALANCE AT END zi ""
C
6TH TUESDAY 4' OF REPORTING PERIOD: $ 0 rn
PRE-ELECTION
TOTAL AMOUNT OF FILER'S NJ2ND FRIDAY 5. OUTSTANDING DEBTS OR LIABILITIES :A t.l
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ C7
B.
30 DAY CD AMENDMENT C tV
POST-ELECTION REPORT? YES NO 2
--
7. —...I . .
ANNUAL TERMINATION YES NO
REPORT REPORT?
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 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.
S N TO AND SUBSCRIBED BEFORE ME THIS
D F Y 20a I SIGNATURE OF PERSON SUBMITTING REPORT
PRINTED NAME
E Aar MY COMMI SION�G IRES
MO. DA YR. AREA CODE DAYTIME TELEPHONE NUMBER
PART II- .
If statement is filed on behalf of a Candidate's Authorized Committee, Candidate must sign here.
c
I SWEAR(OR AFFIRM)THAT TO THE BEST OF MY •OWL ,0 BELIEF THIS POLITICAL COMMITTEE HAS NOT VIOLATED ANY PROVISIONS OF THE ACT OF
JUNE 3, 1937(P.L. 1333,No.320)AS AM-,DED. icy 7 Q_1
SWORN TO AND SUBSC/RIB�E.D��BE�FFORE ME THI' �� o )1n
DAY OF 6L%i c/(J D X ,� SIGNA U CANDI TE
to
1 As44, ( mn;a 49m1
t-.�!��etA-A-- t Ipj PRINTED NAME
GNATURE �// 6 3 3pG)CS,/,
oIQ
MY COMMISSION EXPIRES Njai(.Y1 1 / o-�J AREA CODE DAYTIME TELEPHONENUMBER
MO. DAY YR.
Department of State • Bureau of Commissions,Elections and Legislation
i)SEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787.5280