The URL can be used to link to this page

Home My WebLink AboutCamp Hill Democrats - 2021 30-Day Post Election 1, Pennsylvania Department of State ' Bureau of Campaign Finance&Civic Engagement �is 210 North Office Building,Harrisburg,PA 17120 • 717_787.5280(Option 4) www.dos pa,govfcampaiHnfinance • ra-stcampaignfinance@pa.gov Unsworn Statement 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 unsworn declarations, Campaign Finance Reports(form DSEB-502), Campaign Finance Statements In lieu of full reports(form DSEB-5O3); 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. GlifIRLD ca ROW Gomm ittee Candidate,Cp Lob ist _ Reporting ip- 0 Cycle 1 ❑ 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 0 Cycle 9 30 Day Post-Election Annual Report 2nd 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 foregoing is true and correct. o=- / 1poi2.'Z1 Signature o reasurer,Candidate,or Lobbyist Date(DMM/YYYY) te. -1-1.,� �r�.,�1 cet�. 0 r��i t J PA- Printed Name Location �ount (City/State/ rY) DSEB-502R Updated 6/24/2020 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. FRER IDENTIFICATION REPORT FILEDillo. CANDDATE I COMMITTEE S X LODBYFSS t < NUMBER ' ON BEHALF OF I '` ... NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST STREET ADDRESS 1).0I ll'e)1' 14i5 CITY STATE ZIP CODE �T Cotirv•Q N I`11 e I 'loot TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION (CHECK ONE) MO. ..•, DAY YEAR t, 6TH TUESDAY PRE-PRIMARY FOR OFFICE USE ONLY MO. I.DAY YEAR MO. DAT I YEAR ' 2ND FRIDAY 2. DATES flF PRE-PRIMARY PER OD NG I o I dZ l l TO 1 ( Z.2 f �1"l 1 1 `I O 30 DAY 3 4 POST-PRIMARY CASH BALANCE AT END 6TH TUESDAY 4. OF REPORTING PERIOD: $ I5.$I. 3 I PRE-ELECTION ::", TOTAL AMOUNT OF FILER'S OUTSTANDING DEBTS OR LIABILITIES PRE ELECTIFRIDAY AT THE END OF REPORTING PERIOD: S o $ PRE-ELECTION i 30DAv a, ' POSTELECTION REPAMEORT? YES NO S. , Q _ REPORT? . 7. C.: ANNUAL TERMINATION YES N4 '�( (- REPORT REPORT? C) 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 Contributing 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 SIGN IRE OF PERSON SUBMITTING REPORT PRINTED NAME SIGNATURE MY COMMISSION EXPIRES —1 I-7 -7-13 ^57 d0 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 COM!61n EE 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 DAY OF 20__ PRINTED NAME SIGNATURE MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER. MO. DAY YR. Department of State • Bureau of Commissions,Elections and Legislation Da::13-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280