HomeMy WebLinkAboutThe Daniel Freedman Election Committee - 2021 30-Day Post Election Pennsylvania Department of State
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210 North Office Building,Harrisburgce ,PA ic 17120 • 717.787.5280(Option 4)
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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 unsworn
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 gjEm 07 fynxt2 Committee, Candidate, Cri Cobb ist
12 Uou'U'Pj 6riadineLvi El e_C4Ion5/-0/7trvu 2_ie---
Reporting 6Nitg Name
0 Cycle 1 ❑ Cycle 2 ❑ Cycle 3 ❑ Cycle 4 0 Cycle 5
6th Tuesday 2nd Friday 30 Day 6th Tuesday 2nd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election
Ei Cycle 6 0 Cycle 7 ❑ Cycle 8 El 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 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.
7 ',IA/ O 3/
Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YY Y)
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ret i-lis i-e P 0,5 -
Printed Name Location (City/State/Country)
DSEB-503S
Updated 1/22/2020
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-stcampaignfinancePpa.gov
Part II - If this is submitted with a statement in lieu of full report by a Candidate's
Authorized Committee, candidate sign here.
I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania
that the accom anyin Campai nce Statement is true and correct.
Signature of Candidate Date (DD/MM/YYYY)
DA,J ra_ i-2 Dru�4r� OAR-uric, PA aril.
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Printed Name Location (City/State/Country)
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DSEB-5035
Updated 1/22/2020
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 Ow REPORT FILED CANDIDATE 1. COMMITTEE ? LOBBYIST J,
NUMBER ON BEHALF OF ,
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
The Daniel Freedman Election Committee
STREET ADDRESS
P.O. Box 114
CITY STATE ZIP CODE
Boiling Springs PA 17007
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) Magisterial District Judge Rep.
MO. DAY YEAR
6TH TUESDAY 1 11 02 2021
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY I YEAR
2ND FRIDAY 2. DATES OF
PRE-PRIMARY REP ORD G 10 19 2021 TO 11 22 2021
PERC.)
30 DAY 3"
POST-PRIMARY 0 '.n rya
CASH BALANCE AT END ,. .
6TH TUESDAY J.
4. OF REPORTING PERIOD: . irli
-
PRE-ELECTION
TOTAL AMOUNT OF FILER'S -.,; 1
2ND FRIDAY 5. OUTSTANDING DEBTS OR LIABILITIES 0 '- LA)
PRE-ELECTION AT THE END OF REPORTING PERIOD: $
c
s.
30 DAY )
..,..
AMENDMENT ve �;'
POST-ELECTION REPORT? YES NO a .
7. ...-' a
ANNUAL
TERMINATION YES NO
REPORT REPORT?
• 2
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 LI . URRE DURING TH PORTING RIOD INDICATED AB VE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS(S250.00)AND THIS REPORT IS,T HE BEST OF M , DGE A EUEF,TR CORRECT AND C PLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS , ...---
DAY OF 20 SI TURE OF R BMITTING REPORT
'D2eN1 t'L J.. AI-)
M.rINTED NAME
SIGNATURE `� /-/v lJ�
MY COMMISSION EXPIRES / 1 6( .ce
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 COMM TTEE HAS OT VIOLATED ANY OVI OF THE ACT OF
JUNE 3, 1937(P.L. 1333,No.320)As AMENDED. i
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 / SIGNATURE OF ANDI A E
Aecclop
PRINTED NAME
SIGNATURE ' 7 fl y, - - y,
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
Department of State • Bureau of Commissions,Elections and Legislation
DSEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280