HomeMy WebLinkAboutSilcox, Nathan - 2021 30-Day Post Election 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.eovicampaignfinance • ra-stcampaignfinanceC&oa.gov
Unsworn Declaration in Lieu of Sworn Statement for
Campaign Finance Statements
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 Statements. This form must be
signed by hand where a signature is required.
Name of Filing Committee, Candidate, or Lobbyist
Nathan Silcox
Reporting Cycle Name
0 Cyde 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5
6I'Tuesday 2nd 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 Cl Cycle 9
30 Day Post-Election Annual Report 2"a Friday Pre-Special Election 30 Day Post-Special Election
Part I — If this form is submitted with a statement in lieu of full report by a political
committee, the treasurer must sign here. If this form is submitted with a statement in lieu
of a full report by a candidate, the candidate must sign here. If this form is submitted with
a statement in lieu of full 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 Statement is true and correct.
t-- >J,PS $( 2£r I 0 2
Signature of Treasurer,Candidate, or Lobbyist Date (DD/MM/YYYY)
ti..7 Y��-+sa►.a P- S i t c_f rsi M i- s csr3a2G PY( f c A
Printed Name Location (City/State/Country)
DSEB-503S
Updated 1/22/2020
V
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$250.00 during the reporting period.
FILER II/UmnCATlON - REPORr iRED I•`y� ' 3.
NUMBER ON BEHALF OF ' CANDIDATE /� COBurriEE ' LO[tBYLST,
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
Al-FArm tom. S'ILcO^�
STREET ADDRESS
%•3 3 14 A HZ?I-fo A- L7L T t�>✓
CITY STATE ZIP CODE
•
M tN LA A.91Gg3026 P '70.5"A —
Type oF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF EL EC T:ON
• (CHECK ONE) i,‘AM PO Li,rJ 'r-'CJL« --^5 44•P MO.. DAY.• ..:YEAR
Ern.firesoAY..
_• C-dm tr%, S'sr oa'E�- s t 2 2-1
PRE-PRIMARY FOR OFFICE USE ONLY
.• DAY YEAR NO. . DAY YFAR
ZNO.fRIDAY
2• oATES OFREPORTING TO
:J. t- r
"PRE-PRDF/iRII' PERIOD b I$ 2I 1 t 22 Z I
3.
r'30 DAT'. r1•
i!ObT-PRIMARY......
CASH BALANCE AT END k-"
<. OF REPORTING PERIOD: $ --•.,�F i
eTH:it;ESDAY
:0144400N
TOTAL AMOUNT OF FILER'S
.5 OUTSTANDING DEBTS OR LIABILITIES
PREF;ELECTION' • AT THE END OF REPORTING PERIOD: $ C 7.,
•
..30 DAY: ..
POST-EI:EC7TON .. 74 YES NO "•.,"� --••
.,
ANNUAL
'REPORT TIONnisionft YES ND
•
AFFIDAVIT SECTION
PART I- •
If statement is filed on behalf of a Political Committee or Candidates'$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.
swEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIA.87UTlES INCURREO DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS(S250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS 1 -9 e
DAY OF 20 SIGNATURE OF PERSON SUBMITTING REPORT
,.,p-rt. a p. s-
ILL OX
SIGNATURE PRINTED NAME
EM COMMISSION EXPIRES t t 9`{ Z c S,Sr
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 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
OAY OF 200
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
Department of State • Bureau of Commissions,Elections and Legislation
DSED.$03(I2-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280