HomeMy WebLinkAboutSabadish, Dale - 2021 Annual Report Pennsylvania 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
DA4s- SA4tbISN
Reporting Cycle Name
❑ Cycle 1 ❑ Cycle 2 ❑ Cycle 3 ❑ Cycle 4 ❑ Cycle 5
6th Tuesday 2"d Friday 30 Day 6th Tuesday 2nd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election
❑ Cycle 6 IN. 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 t cco anying Campaign Finance Statement is true and correct.
Signature of Treasur r, Candidate, or Lobbyist Date (MM/DD/YYYY)
"Dug CARAassm Met ItAwic4Au&G IPA f(AA
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 Z• LOBBYIST �•NUMBER ON BEHALF OF /�
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
bAL6 SAdwnts M
STREET ADDRESS
S see y vAw6
CITY STATE ZIP CODE
M CC M ALSOVRAP Ph- l?0ST "—
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) MO. DAY YEAR
sTH TUESDAY 1. Peel lid 461V1 - (1/49L*1•44p ( pr
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY YEAR - "
2NDFRIDAY, 2. DATES OF
PRE-PRIMARY REPORTING It a ,.. TO 12 3' ' t
PERIOD f�
30 DAY 3.
POST-PRIMARY V
CASH BALANCE AT END $ (i b6�,;L� CO -
6TH TUESOAY. 4. OF REPORTING PERIOD:
•
PRE-ELECTION
TOTAL AMOUNT OF FILER'S n - I\)
5. OUTSTANDING DEBTS OR LIABILITIES CO
2ND°FwoAY AT THE END OF REPORTING PERIOD: $ O C7
PRE-ELECTION —0
S. O �+'
30 DAY `
POST-ELECTION REPORT?AMENDMENT
YES NO A =
T
ANNUAL TERMINATION
REPORT REPORT? YES NO
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 INCUR- % = RING E REPORTING RIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF ••1 KNOT• AGE AN LIEF,T E,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS / %/ JJ
DAY OF 20 NATO OF PE SON BMITTING REPORT
Ul+t.e IE. SASAbis II
PRINTED NAME
SIGNATURE -1
MY COMMISSION EXPIRES 1l r� 43; -OT1
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 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
DSE13-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280
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