HomeMy WebLinkAboutFriends of Nate Silcox - 2021 30-Day Post Election yfiiPennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
www.dos.pa.Qov/camoaienfinance • ra-stcampaignfinancePna.gov
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
Friends of Nate Silcox
Reporting Cycle Name
0 Cycle 1 0 Cycie 2 0 Cyde 3 0 Cyde 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
Cycie 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 accompanying Campaign Finance Report is true and correct.
6,77.4car 11/28/21
Signature of Treasurer, Candidate,or Lobbyist Date (DD/MM/YYYY)
Craig Mellott Mechanicsburg, PA
Printed Name Location (City/State/Country)
DSEB-502R
Updated 1/22/2021
ftPennsylvania 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-stcampaienfinance(npagov
Part II-If this form is submitted with a report by a Candidate's Authorized Committee, the
candidate must sign here.
I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania
that the accompanying Campaign Finance Report is true and correct.
t.` jl.ln 1 1 2gi Z.02
Signature of Treasurer, idate, r Lobbyist Date (DD/MM/YYYY)
P. S 1 L.G.p c ✓v�r�►�- . c S rr�ca CC. /O fice. u SA
Printed Name Location (City/State/Country)
DSEB-502R
Updated 1/22/2021
II
Commonwealth of Pennsylvania-Campaign Finance Report
(Note:This report must be clear and legible.ft should be typed)
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Affidavit Section
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 kno and bet true,correct and complete.
Sworn to and subscribed before me this
. 1 ...smen•••1
d_ay of 20 —
1...... .......____......,.......1
1 Signet Ul C Of Person&Omitting report
Craig Mellott
Signature Priritz,-11 ,1-,,E•
717 234-1430
My Commission expires
-
MO. PAY YR. Area Code 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
__-...[.......r......7„......,......................, ...............................,.-....----'""""---1.1'1
day of 20 • 1
[..... ..................„............
Signature of Candidate
f..,l' I-1=f-rat,-, t.. .. Si or,_c_clue-
Signature • I . Printed Name
*-1, Cp 141
My Commission expires 1,2 —
MO. DAY YR. Area Code Daytime Telephone Number
SCHEDULE I
Contributions and Receipts
Detailed Summary Page
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Total for the reporting period (1) $ 0
Fil*A*441*0.1 :'':'' •:. ;': '.'Z:... 5 '..,.... '.•*.'''':•:. :.:'':.;':::•.':::...: •1:-':.'?'?.:,:::'''.:".::: ''.1:::.'-';'::„1:'-.. :?5::::5:.:.":.'',1 j4"..i:::,::: :.:7:'Ji•V::::,.:-;i:::•::::-:':;: •':: ... :":•.''''
Contributions Received from Political Committees(Part A) $
All Other Contributions(Part 8) $
o
Total for the reporting period (2) $ 0
:v 4!CAV4115:011.*;$2,50:40:Proitilaft c*/$1P*tDr:: • , :....• •' 'L./'::•:':•• :'.: ::. ,-:'...;'.i.:-...; ..'.:::
Contributions Received from Political Committees(Part C) $ 480.92
All Other Contributions(Part D) $
soo.00
Total for the reporting period (3) $ 980.92
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Total for the reporting period (4) $ 0
Total Monetary Contributions and Receipts during this reporting period(Add and $
enter amount totals from Boxes 1,2,3 and 4;also enter this amount on Page 1,Report 980.,2
Cover Page,Item B)
PART C
Contributions Received From Political Committees
Over$250.00
Use this Part to itemize only contributions received from Political Committees
with an aggregate value over$250.00 in the reporting period.
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; wM r ' ;,,,„ Friends of Kathy Silccox 10/28/2021 480.92
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e Camp Hill PA " " 17011 _� Aced
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PART 0
All Other Contributions
Over$250.00
Use this Part to itemize all other contributions with an aggregate value over$250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C)
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SCHEDULE III
Statement of Expenditures
rs?..3: y 20200372
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