HomeMy WebLinkAboutMangan, Jennifer - 2021 30-Day Post Election Pennsylvania Department of State
\-77
44.1,1 Bureau of Campaign Finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
.,�.,, ,JrvA, www.do ov/carpognfinance • ra-stcampaignfinancg@pagov_
(Jnsworn 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.
5M2cO# `-43 ommi tee ,ay o• •yis3
•epo tingCJD!Thlame
0 Cycle 1 0 Cycle 2 O Cycle 3 0 Cycle 4 0 Cycle 5
6tn Tuesday 2,d Friday 30 Day 6th Tuesday 2nd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election
Cycle 6 ❑ Cycle 7 0 Cycle 8 0 Cycle 9
30 Day Post-Election
Annual Report rd 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 acco panying Campaign Finance Report is true and correct.
ie-Z___„____ 0////a0,Z.i
Sig ure o asurer, Candidate,or Lobbyist Date (DD/MM/YYYY)
USAI
Printed Nam( Location (City/Site/C ntry)
DSEB-502R
Updated 1/22/2021
9
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 I> REPORT FILED > CANDIDATE I� COMMITTEE _ LOBBYIST l
NUMBER �+ ON BEHALF Ob 1!1
HAME OF NUNS COMMITTEE,CAN DATE OR LOB. ST
�€✓i/ir ') �• 147�lLe'tP;t�m
ST WTI ADDRL SS f
`/fs f'yl e r1 of y (ie.
CITY STATE Z.I?COOT
/ //
TYPE or REPORT NAME OF OFFICE SOUGHT'CANDIDATE DISTRICT NO. PARTY t,�:J W.EL CTION;
I (CHECK ONE) �'7��� 7 y,. ,,q Pe ^"MO. DAY YEAR
6TH TUESDAY 1. (J f✓E/ L I >r�!•�� J ry'!�+/r;L/i ./ e-Al ii o y., , 0d""( ,
PRE-PRIMARY i FOR OFFICE USE ONLY
MD. i DAY YEAR MO. 1 DAY I YEAR -
2ND FRIDAY z' DATES OF 0 / i PRE-PRIMARY REPIOD
OR NG / I, :! TO // IA
2if30 DAY r ���
. .POST-PRIMARY ...
CASH BALANCE AT END 0 t
BTH TUESDAY
III OF REPORTING PERIOD: =<
PRE-ELECTION n
TOTAL AMOUNT OF FILER'S r
1,711
OUTSTANDING DEBTS OR LIABILITIES ~^ rt T
IDAy
F stE-cli AT THE END OF REPORTING PERIOD: $ t--- c1
30 DAY j IAr�E3r:nrsEFaT
POST- X.
j C-,:i .>
F.LECTEOSS YES He ,„:
__ REPORT?
� C)
�ANNUAL TERMINATION C";�
REPORT REPORT? II
,,
cr
AF IDA .IT.SEC ION ''''': .".,
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 AGGNF.GATE-RECEIPTS OR ntSBTRETAZNIS OR IJAtiSL7tiF.S INLUT=RND DUP.::: THE REPORTING PERIOD INDICATCE ABOVE oto NOT
CY:GEED TWO HUNDRED AND FIFTY DOLLARS($250,00)AND THIS REPORT IS,TO THE DES}OF FAY KNOV." AND BELIEF,TRUE,CORRECT AND CC."PLETE.
SWORN TO AND SUBSCRIESpo BEFORF ME.THIS V 1
DAY OF 20 .,IGNATURC OF.MOti S ITTINGREPORT
-ems4 { r A, Plat ete q,il
PRINTED NAME
SIGNATURE /y
MY COMMISSION!EXPIRES 50) D 4,��•-'7
, j
ISO. DAY YR. AREA CODE G DAYTIME TELEPHONE NUMBER
PART II-
ii statement is filed on behalf of a Candidate's Authorized Committee, Candidate must sign here.
i VFW-AR OR Ar F,;E' THAT TO T H I FIE ST Or I.`.'KNOWLEDGE AND LINT F THIS POLITICAL COL,.F.ITTLE.HAS NOT VIOL TED A?1Y PROVISIONS OF THE AI:T CF
NUNE 3,1937(P.L,13:33,Na.320)AD AMENDED.
SWORN TO AND SUBSCRIBED BEFORE ME THIS _
—~SIGNATURE OF CANDIDATE
DAY OF 20
t_._-. PRINTED NAME
SIGNATURE -�
MY COMMISSION EXPIRES _ AREA CODE '- *'"""—'DAYTIME TELEPHONE NUMBER
MO. DAY YR.
Department of State 0 Bureau of Commissions,Elections and Legislation
i>SIiM-513(i -49) 210 North Office Building 0 Harrisburg,PA 17120-0029 0 (717)787 5280