HomeMy WebLinkAboutSilcox, Nathan - 2021 Annual Report lify Pennsylvania Department of State
Bureau of Campaign Finance&Lobbying Disdosure
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 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
Nathan P. Silcox
Reporting Cycle Name
❑ Cycle 1 0 Cyde 2 0 Cycle 3 0 Cycle 4 ❑ Cyde 5
6th Tuesday 2"d Friday 30 Day 6th Tuesday 2nd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election
0 Cycle 6 Cyde 7 0 Cycle 8 0 Cyde 9
30 Day Post-Election
Annual Report 2"d 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.
I Z
Signature of Treasurer, Ccdida9 or Lobbyist Date (MM/DD/YYYY)
a�i�Tt�-iJo-a P S Ic._ 1- rn P u ,t j
Printed Name Location (City/State/Country)
DSEB-502R
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 10E7mFlCATION REPORT FR.ED I./� 1 7. ' T.
NUMBER oN BEHALF of 0- .CANDIDATE . f 1-GCM MRTE L0m6Yt9T,
NAME OF RUNG COMMITTEE.CANDIDATE OR LOBBYIST
1:73 f-;tiit-Y�.7 511r- O.L
11NEtr ADDRESS
\'' ,.- 1 Y.�� IJ Q.'C"l4'19 tL- Cl..1 c....a--.
CITY STATE ZIP CODE
p
MFt�kek c I CS 0D(L.(�, T 6. 1`2 05D
7,,FE of REpon.T. NAME OF OFFICE SOUGHT BY CANDIDATE IDLSTRICT NO. PARTY DAT A OF ELECTION .._
(Ci1ECK ONE) -.T'�bi->f,y.'I-4 ,P (�
. G�jrY1M1 SS1�� � Y" it 2 2O2t
�.,tires TUESDAY:. -
PRE4RIMARY • .. _ FOR OFFICE USE ON 1iy.. • •
.Imo.. PAY _•YEAR NO. DAY YEAR
Z. ,
•.2KD.FRIDAR DATES OF -
REPORTING TO
PS-PRIMARY PERIOD 1 1 22 2 ( , l 2 31 2 k_ C)'
•SO DAY• PV
.POST-PRIMARY •V
CASH BALANCE AT END
Em ti DAY ' a. OF REPORTING PERIOD: $ H, Pa
PEE-EIECftoN r". • A3
TOTAL AMOUNT OF FILER'S )" ...j
_2ND.FRIDAY: ' •
OUTSTANDING DEBTS OR LIABILITIES
elm. LECT1oN . : AT THE END OF REPORTING PERIOD: $ • 2
_ 8 -
30 niwr. : _ ' ' 0 - .
= •
POST-ELECTION '.. :. YES NO g ,
7
• T. - •,.
ANNUAL • mime :nos
REPOR! •REPORT?. YES NO X
+ a
AFFIDAVIT SECTION
PART 1-
If statement is filed on behalf of a Political Committee or Candidates'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.
t SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DLSEURSEMENrS OR WtSIUTIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE Do NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BEUE7'% 1 5CT AND COMPLETE.
SWORN TO ANO SUBSCRIBED BEFORE ME tins " cS •, .
OAY OF 20_ SIGNATURE OF PERSON SUBMITTING REPORT
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES `2 L rJ 'liC$�
MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
I
PART 11-
If statement is filed on behalf of a Candidate's Authorized Committee,Candidate must sign here.
I SWEAR(OR AFFIRM)THAT TO THE E£ST OF MY KNONSEDGE AND CG.G Tots POLrCAL COMtS'TEE HAS NO,YiOLATED ANY PROVISIONS OF THE ACT OF
JUNE 3,1937(P.L.1333,No.320)AS AMENDED.
SWORN TO ANO SUBSCRIBED BEFORE ME THIS
SIGNATURE OF CANDIDATE
DAY OF 20___
PRINTED NAME
stGNATURE
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.
Department of State • Bureau of Commissions,Elections and Legislation
D5EB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280