HomeMy WebLinkAboutPerry, Safronia - 2021 30-Day Post 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.
NUMB IDENTIFICATION REPORT FILED ' CANDIDATE I. COMMITTEE:. 2 .LOBBYIST 3.
NUMBER ON BEHALF OF
NAME OF Fl COMMITTEE, LOBBYIST
STREET ADDRESS
1 n 0 )rn-CrA- q--
Cm STA ZIP CODE
Oa( l'
(n 1-7e
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) `
1 .,�^ C� I MO. DAY YEAR
y-o, ,
6TH TUESDAY''
PRE•PRIMARY:% FOR OFFICE:USE,ONLY
MO. DAY
.. YEAR'�. :.MO. ...DAY ' :':vEAR..
2N1)FRIDAY 2. DATES OF /%y 2 PRE•PRIMARY' ` PERIOD NG l V//�/ // I TO // e2,(2....
�(/2'v r
30 DAY 3. ry
POST+PRIMARY . iv
CASH BALANCE AT END /'�
GTH TUESDAY.: ""
4• OF REPORTING PERIOD: $ V
':;`: �•.
PREELECTION
TOTAL AMOUNT OF FILER'S - I
OUTSTANDING DEBTS OR LIABILITIES 0 N
21raFitmAr
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ , ,
.::;<
s. LI
3O DAY,
POST-ELECTION. AMENDMENT YES NO
7. J\ *1 Cd1
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 Contributina 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.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 SIGNATURE OF PERSON SUBMITTING REPORT
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES
MO. DAY YR. AREA CODE 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 KNOWLEDG • BELIEF THIS POLITICAL COMMITTEE HAS NOT VIOLATED ANY PROVISIONS OF THE ACT OF
JUNE 3,1937(P.L.1333,No.320)AS AMENDED.
SWO TO AND SUBSCRIBED BEFORE ME THIS y IF4.. ( I CIC vIn V\
t '1( jr of C/� n SIIG�NATU CANDIDATE
DAY OF f1'II..PPLItAam`. . � 9i�' Jl®1-f 1 li I l LJI -•p 1 l L
��5''6p?'A y •
s�Sic i
1 -- ,(-4,ayAti, ^7 PRINTED�Tn NAME
))
NATURE ��''"L�-\ l , )11(...?) -•Lc )S
(.� /�/ '
MY COMMISSION EXPIRES MO. DAY (��•��i°6?��,� •• -• CODE DAYTIME TELEPHONE NUMBER
DSEB-503(12-99)