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Home My WebLink AboutCommittee to Elect Safronia Perry - 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) N,yyy,.dos.pa.Qov/campaignfinance • ra-stcampaignfinance@Pa.ROv_ 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 unworn 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 eDYh riA,+#e-e_ I E7 e } Sari/0 kIA A a� . r Reporting Cycle Name ❑ Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 or Cycle 5 Tuesday 2nd Friday 30 Day 6th Tuesday 2nd Friday Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election 1 ❑ 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 foregoing is true and correct. 2f Orly az/ Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) (1111\31717tt/Itiat)illejA)/&0117,,, Printed eV cs�ra T'1�Y ,s.:7 Location (City/Sta Name a/Country) 4 11, • • "4 : • DSEB-502R t Updated 6/24/2020 II Reset Form 'Print Form _1 111111111 Commonwealth of Pennsylvania-Campaign finance Report (Note:This report must be dear and legible.It should be typed) I NumberFiler n cation I Report'led Sy I Candidate I r I Committee 11 11 Lobbyist l Name of Filing Committee,Candidate or n (� `� 1 I 1 �p ( f Lobbyist [ b Pi MI t i C-e To 6fPr.r1'- &(Y d f y Street Address (1 1 tlJ 1P 5� fr2,0 �iq S(�j�Q City 1 1/ State I{ Zip Code i- / - iType of Report(Place x under report type) # 1.6t"Tuesday 2- 2"Friday 3-30 Day Post 4 6t Tuesday 5-2"4-Friday 6-30 Day Post 7-Annual Special 2"a Friday Special 30 Day 1 Election Pre-Election Post-Election Pre-Primary Pre-Primary Primary Pre-Election Pre-Election it I J11 11 Date Of Election Year Amendment Termination 1 1 I I,(MM/DD/YYYY) 11)D i J1 j V Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures A.Amount Brought Forward From Last Report $ J�2/ N B.Total Monetary Contributions and Receipts $ i ,: Cl (From Schedule I) C.Total Funds Available $ (Sum of Lines A and B) ) 753. 6-2- , _ ' c n D.Total Expenditures $ '� (From Schedule III) :� E.Ending Cash Balance $ �- tv (Subtract Line D from Line C) i?S7r S 2 : •' us F.Value of In-Kind Contributions Received $ , —1 ..c* (From Schedule II) G.Unpaid Debts and Obligations $ /�' (From Schedule IV) ��/ 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 '�/)) /a, � 1nf�— •day of 20 . L (..�1, 1� 1 rature o erso Su i In report (`h'i [ t14We.�� L- Signature Printed Name ��/777 My Commission expires r�e 7 h 7/ t /PO 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 subscri ed before me this Q7� day of efi7h"' 20 } (2c \ ..fc ,c,A . V,Signature of, an date 1 1� )(-;',a-,�1 rf, -e( �c ) Signature , / Printed Name <I , y Commission expires I`7-�-�✓l. gao -J�--1 20 1 S D MO. DAY YR. Area Code Daytime Telephone Number Commonwealth or Pennsylvania-Notary Seal MEGAN ORRIS-Notary Public Cumberland County M,Corn..dse:en C.Qi,c,den 11,2023 , Commission Number 1260066 a 40