HomeMy WebLinkAboutGaspich, John - 2021 30-Day Post Election 1r Pennsylvania 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 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 unworn
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.
Name of Filing Committee, Candidate, or Lobbyist
Jokn
Reporting Cycle Name
0 Cycle 1 0 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 0 Cycle 7 0 Cycle 8 0 Cycle 9
30 Da 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.
IlikiatiP Ilk /� 22
og ur o reasuM andidate, or Lobbyist Date DD/MM/YYYY)
Jdk /' JR— &—da N f7c /
Print d 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 I COMMITTEES Z LOBBYIST
NUMBER ' ON BEHALF OF iiii
NAME OF FI NG COMMITTEE,CANDID OR LOBBYIST
POD 1 645p is ii ( ,—
STREET ADDRESS I��"— _"
?4 38 14-mu 641
CITY STATE ZIP CODE
0GA 1767�5,-"/ /?'.--7
TYPE OF REPORT NAME OF OFFICE
- 'SOUGHT
TBBY CANDIDATE
// DISTRICT NO. PAARRR Y (�J�/� DATE OF ELECTION
YEAR
(CHECK ONE) 1. /J /4/ eel**
CC/O/✓T+1c.,- /�-- % /t 'iY 240.24
6TH TUESDAY
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY YEAR
2ND FRIDAY 2. DATES OF ,p
PRE-PRIMARY PERIOD REPORTING /O A TO / "4„,., 2/
30 DAY 3' , {"7.
POST-PRIMARY r-,a
CASH BALANCE AT END r -
67H TUESDAY 4. OF REPORTING PERIOD: $ >� I.I cn
PRE-ELECTION - ' C-,
TOTAL AMOUNT OF FILER'S i Ci
5. OUTSTANDING DEBTS OR LIABILITIES •:
P D FRIDAY
PRE-ELECTIONAT THE END OF REPORTING PERIOD: $
L-1 `
Y
30 DAY
CO
POST-ELECTION AMENDMENT YES NO / =
REPORT? --*
7. /NO
ANNUAL TERMINATION YES
REPORT REPORT?
AFFIDAVIT SECTION
PART 1-
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 KNOT DGE AND 1EF,TRUE,CORR CT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS J /
DAY OF 20 SIGN • "ANC SyDA1ITTI EPORT
SIGNATURE d PRINTED NAME 3 Z /`+
MY COMMISSION EXPIRES ip 5
MO. DAY YR. AREA C E DAYTIME TELEPHONE NUMBER
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 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
MO. 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
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