HomeMy WebLinkAboutForbes, Michele - 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.clos pa.gov cafi)UaI.ntmar,i e • rd- tianito16;11!ldn E'to'pa.gcv
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
Miu,11QJ Frto.es
Reporting Cycle Name
❑ Cycle 1 ❑ Cycle 2 ❑ Cycle 3 0 Cycle 4 0 Cycle 5
6th Tuesday 2'd Friday 30 Day 6th Tuesday 2nd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election
B Cycle 6 0 Cyde 7 ❑ Cycle 8 ❑ Cycle 9
30 Day Post-Election
II Annual iteport k 2rd Friday Pre-Special Election I 30'Day Post-Speciai Election 1
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.
12/03/2021
Signature of Treasurer,Candidate, or Lobbyist Date (DD/MM/YYYY)
Michele Forbes Camp Hill. PA USA
Printed Name Location(City/State/Country)
DSEB-502R
Updated 1/22/2021
a
IIIReset Form _A Print Forrn
Commonwealth of Pennsylvania-Campaign Finance Report
(Note:This report must be dear and legible.It should be typed)
Flier Identification Report Bled By Candidate Z Committee ittee 1'""( Lobbyist n
Number (Maria) j
Name of Ring Committee,Candidate orLobbyist Michele Forbes
Street Address 2107 Chestnut Street
City I Camp Hill J State PA rilp Code 117011
Type of Report(Place x under report type)
1-Bs'Tuesday 2- 24 Friday 3-30 Day Poet 4 gib Tuesday 6-20'Friday II.30 Day Post 7-Ammal Spedal r Friday Special 30 Day
Pre-Primary Pre-Primary Primary Pre-Becton Pre-Balton Election Pre-Becton Post-Beeson
Dete[I on E El YearAtnendmerrt � ' ec Termination ❑,
(Mid/DD/YYYY) 11/2/2021 2021 Report Ei
Report Li
Summary of Receipts and From Date To Date For 61ftee Use Only
Expenditures ,
10/19/2021 11/222/2021
A.Amount Brought Forward From Last Report 1' r b'
B.Totall►Aonetary Contributions and Receipts $ `
(From Schedule I) °
C.Total Fiends Available I :c c--)
(Sum of Lines A and B) ° I
D.Total Expenditures $ x o c
(From Schedule BR4w.
E.&tang Cash Balance $
(Subtract tine D from line C) ° .„,,
I.Valle of in-lltnd Contributions Received I C
(From Schedule B) ° 2....-. c)
O.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,Ts to the best or my knowledge and bell true,correct and complete.
Sworn to and subscribed before me this ii r , ' 1, ,� //Ai
day of 2D
r.- r re of Person Submitting report
Michele • •-
Signature Printed Name
My Commission expires 717 462-3359
MO. DAY YR, Area Code Daytime Telephone Number
Partll-if this lea 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 pats icai committee has not violated any provisions of the Act of June 3,1937(P.L 1333,N0.320)as
amended.
Sworn to and subscribed before me this
day of 20
Signature of Candidate
Signature Printed Name
My Commission expires
MO. DAY YR. Area Code Daytime Telephone Number