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Home My WebLink AboutFriends of Dale Sabadish - 2021 30-Day Post Election • Pennsylvania Department of State ti 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@pa.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 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 Reports. This form must be signed by hand where a signature is required. Name of Filing Committee, Candidate, or Lobbyist FRIENDS OF DALE SABADISH Reporting Cycle Name ❑ Cycle 1 ❑ Cycle 2 ❑ Cycle 3 ❑ Cycle 4 ❑ Cycle 5 6th Tuesday 2"d Friday 30 Day 6th Tuesday 2"d Friday Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election I] Cycle 6 ❑ Cycle 7 ❑ Cycle 8 ❑ 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. tZ/7/2" Signatu4 Tr urer, Candidate, or Lobbyist Date (DD/MM/YYYY) Co" 6S AO/a i CA"( if lu.( 0� Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 Pennsylvania Department of State Bureau of Campaign Finance&Civic Engagement tio 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@pa.gov Part 11-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. 12/7/207I Signature of reasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) ice SAriAD►SH Mec1twtcc4 ,Q 1M t' Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 111 II j Reset Form Print Form Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible.It should be typed) Filer Identification Report Filed By Candidate Committee ` Lobbyist Number (Mark X) n Name of Filing Committee,Candidate or FRIENDS OF DALE SABADISH Lobbyist Street Address 5 SURREY LANE City MECHANCISBURG State PA Zip Code 17055 , Type of Report(Place x under report type) 1-6th Tuesday 2- 2"d Friday 3-30 Day Post 4-6th Tuesday 5-2nd 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 Date Of Election Year Amendment Termination (MM/DD/YYYY) 11/02/2020 2021 Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 10/19/2021 11/22/2021 A.Amount Brought Forward From Last Report $ 1,915 B.Total Monetary Contributions and Receipts $ ("-) (From Schedule I) 300 '-5 _ C,-":" , C.Total Funds Available $ -- 2,215 `(Sum of Lines A and B) r•i . D.Total Expenditures $ '> C, (From Schedule III) 0 I E.Ending Cash Balance $ —.I (Subtract Line D from Line C) 2,215 F.Value of In-Kind Contributions Received $ C") — (From Schedule II) 0 C. „ G.Unpaid Debts and Obligations $ ..... Cfl (From Schedule IV) 12,500 „,-• [V 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 knowledge and belief true,correct and complete. Sworn to and subscribed before me this day of 20 I Si r o son Submitting LIreport Signature 1 Printed Name My Commission expires 711 S76-7 re6 MO. DAY 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 e / t '� i, day of 20 • i ��r it/�L _ . i. ii/ `/a•—• "Sig atur=V'Can idate -'/ /if'If S Signature Printed Name `` My Commission expires / 7 � - MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number I1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total for the reporting period (1) $ 0 2.Contributions of$50.01 to $250.00(From I Part A and Part B) Contributions Received from Political Committees(Part A) $ 0 All Other Contributions(Part B) $ 0 Total for the reporting period (2) $ 0 I3.Contributions Over$250.00(From Part C and Part D) I Contributions Received from Political Committees(Part C) $ 300 All Other Contributions(Part D) $ 0 Total for the reporting period (3) $ 300 I4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) I 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 Cover Page,Item B) 300 SCHEDULE IV Statement of Unpaid Debts Use this Section to itemize all unpaid debts and obligations which are outstanding at the end of the reporting period. Filer Identification Number: Name of Creditor DALE SABADISH Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ 5 SURREY LANE [MM/DD/YYYY], VARIOUS City State Zip 12,500 MECHANICSBURG PA Code 17055 Description of Debt PERSONAL LOAN FOR CAMPAIGN Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ v [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City - State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt