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Home My WebLink AboutEvans, Mercedes - 2021 Annual Report IrjiPennsylvania Department of State Bureau of Campaign Finance&Lobbying Disclosure 500 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 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 required. Name of Filing Committee, Candidate, or Lobbyist Mercedes Evans Reporting Cycle Name ❑ Cycle 1 ❑ Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5 6thTuesday 2nd Friday 30 Day 6thTuesday 2nd Friday Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election ❑ Cycle 6 0 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 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. t /7hygdJ/r PI)V21/ Signature of Treasurer,Candidate, or Lobbyist Date(MM/DD/YYYY) ege de.5 /1,) Dor Hi» , 05- 114 Printed Name Location (City/State/Country) DSEB-503S Updated 1/5/2022 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 REPORT FILED CANDIDATE COMMITTEE 2 LOBBYIST 3. NUMBER ` ON BEHALF OF ' NAME OF era LOBBYIST -n S STREET ADDRESS 14�.0/; �I{(,rt,�n tbDD ' r 1 1 Itigka CITY sTAT ZIP y CODE r a ill r I li fl- TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE, R DISTRICT NO. PARTY DATE OF ELECTION (CHECK ONE) C1IV)Pi t l b/0-144 (An -r) _t MO, DAY`''� A YEAR 1. GTH TUESDAY PRE-PRIMARY .FOR_I EE CE USE ONLY _ MO. DAY YEAR MO. I DAY YEAR . 2ND FRIDAY 2. DATES OF n PRE-PRIMARY REPORTING iE {t I TO i n(Cgs f1 „so PERIOD p F i�� p Ali CO .t 30 DAY 3' POST-PRIMARY L IV CASH BALANCE AT END FiTH TUESDAY 4. OF REPORTING PERIOD: $PRE-ELECTION TOTAL AMOUNT OF FILER'S n = s• OUTSTANDING DEBTS OR LIABILITIES 0 2ND FIDAYPRE-ERE s ON AT THE END OF REPORTING PERIOD: $ e, +.< IA) 30 DAY AMENDMENT POST-ELECTION REPORT? YES NO 7. ANNUAL TERMINATION YES NO REPORTy REPORT? , 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 UABIUTIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT EXCEED TWO HUNDRED AND FIFTY DOLLARS(S250.00)AND THIS REPORT IS,TO THE BEST OF L1Y KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE. /SWORN TO AND SUBSCRIBED BEFORE ME THIS j DAY OF zO^_ SIGNATURE OF PE��/ISU�tNG REPORT SIGNATURE ((v(y6^ifff,,.. y^Fl es PRINTED NAME MY COMMISSION EXPIRES -7 7 .1)7 34 3 MO. DAY YR. AREA CODE DAYTIME TELEPHONEE 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 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 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 psr_13-503(12-99) 240 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280 . ... ....._ ..._.,.- -- ._-._._. ._ _. .