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HomeMy WebLinkAboutCommittee to Elect Safronia Perry - 2021 30-Day Post Election Yfiri . 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(alpa.gov a 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 > 1-I-.Q--Q.----I El e_d- s P 1a f� Reporting Cycle Name ❑ Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5 6th 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 ® Cycle 9 30 Day 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 a ompanying Campaign Finance Report is true and correct. i . l� c ii,„,_,„ , z, ,( Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) Pat LaMarche Carlisle, Pa, USA Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 g) IIa FIG VL1 Uttit I a gnu I ui III Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be dear and legible.It should be typed) Filer Identification Report Filed By Candidate Committee —' Lobbyist Number (Mark X) Name of Filing Committee,Candidate or committee to Elect Safronia Perry Lobbyist Street Address 10 West Pomfret Street City Carlisle State PA lip Code 17013 Type of Report(Place x under report type) 1-6th Tuesday 2- 2nd Friday 3-30 Day Post 4 6th Tuesday 5-2"d Friday 6-30 Day Post 7-Annual Special 2"°Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election X Date Of Election it/o2l21 Year 2021 Amendment Termination (MM/DD/YYYY) J Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures fOhf/774 11Ii� A.Amount Brought Forward From Last rt $ 1/ 7 wo �� B.Total Monetary Contributions and Receipts t (From Schedule I) `--' cc . __ C.Total Funds Available S ✓ = (Sum of lines A and B) 5 3 , fj 7i rii D.Total Expenditures : Q c-ti (From Schedule III) 3 13 q g r I E.Ending Cash Balance J^ /� (Subtract Line D from Line C) �I 4` 5 t F.Value of In-Kind Contributions Received I r `D (From Schedule II) G.Unpaid Debts and Obligations S �+ CD (From Schedule IV) Affidavit Section M` 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,Is to the best of my knowledge and belief true,correct and complete. Sworn to and subscribed before me this day of 20 V�.i 6 Y ;� i slur of arson Sub fitting report Signature Printed Name My Commission expires lj 7l i 1r4O MO. DAY YR. rea� Daytime Telephone Number Part II-If this is a 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 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 g A s • i n�` day ofA /� 20 Al ' g�i ( A Q_ATI A 1-41411 Pith--( i- N C��S( 1rGf� •edt"CL .,fie Signature a a Printed Name My Commission expires ja.. . /Lf ,va3 g 7- ''l f1 • sC 14- is, l S A. MO. DAY YR. t Area Code Daytime Telephone Number SCHEDULE III Statement of Expenditures Filer Identification Number: To Whom Paid ' / Date[MM/DD/YYYY] 8 )/ i.', ilk 11 �51 !of 31I Zj 60 House# Street Address faiDescription of Expenditu i.kei ttic A City State , p / (r V;Ct GA �l p Re �� / Code 17©l �e�✓G f----c_e To Whom Paid Date[MM/DD/YYYY] $ Y , keI— Ctoz pub ' l of 1 z1 ` 7e: 9 " House# Street Address Description of Expenditure City CA4415 State a Zip Code )7,0/ 3 In? p ryo f'To Whom Paid Date[MM/D = Oth✓n ;&ifs /3( n 11 II 31 • 610 House# Street Address Description biture dc?,5 Co(A-14v e- IA/a-4/ State Zip V'M y}f ACode ) 7�,5'7 PAØ*,1- kip 4e To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code