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HomeMy WebLinkAboutSmith, Emily - 2021 30-Day Post Election Pennsylvania Department of State Bureau of Campaign Finance&Civic Engagement t'-z 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 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), 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 Reports. This form must be signed by hand where a signature is required. G9MDCOROW Committee,Candidate,Ca Lobbyist Emily Smith Reporting ] ❑ Cycle 1 ❑ Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5 6th Tuesday 2"d Friday 30 Day 6th Tuesday 2"d 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 2"d 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 accompanying Campaign Finance Report is true and correct. 12/3/21 Signature of T r, Candidate, or Lobbyist Date (DD/MM/YYYY) Emily Smith Camp Hill Borough Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 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 y COMMITTEE z LOBBYIST 3•NUMBER ON BEHALF OF NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST Emily Smith STREET ADDRESS 2002 Columbia Ave CITY STATE 'ZIP CODE Camp Hill PA 17011 TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION (CHECK ONE) Borough Council D MO. DAY YEAR 6TH TUESDAY I - - - - - - PRE-PRIMARY FOR OFFICE USE ONLY MO. DAY YEAR MO. DAY YEAR2ND FRIDAY - - - -_--- 2• 1 DATES OF REPORPRE-PRIMARY PERIOD TING 11 3 21 TO 11 22 21 30 DAY 3' POST-PRIMARY CASH BALANCE AT END 6TH TUESDAY 4. OF REPORTING PERIOD: $ 0 C PRE-ELECTION -,' • TOTAL AMOUNT OF(FILER'S rl 2ND FRIDAY 5' OUTSTANDING '.DEBTS OR LIABILITIES �.7 rri PRE-ELECTION AT THE END OF REPORTING'I PERIOD: $ t- i B. ._... 30 DAY L. POST-ELECTION X AMENDMENT REPORT? YES NO 3> 7. ram" ANNUAL TERMINATION YES NO C REPORT REPORT? —4 IT- 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 UABIUTIES 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 B LIEF.T= _ COR-ECT AND COMPLETE. SWORN TO AND SUBSCRIBED BEFORE ME THIS 1 // DAY OF 20 SIG URE OF P • o BMITTING REPORT Emily Smith SIGNATURE PRINTED NAME MY COMMISSION EXPIRES MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER 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 IMO. 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