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HomeMy WebLinkAboutFish, David - 2021 Annual Report • Ir Pennsylvania Department of State Bureau of Campaign Finance&Lobbying Disclosure 500 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) +wlw,dos.pa.govrfcaamp nfinance • la-sttamoaignfinancrr!*apa.Suv Unsworn Declaration in Lieu of Sworn Statement for Campaign Finance Statements Note: Per Act 2020-15, which was signed into low 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-S05)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 --. David J. Fish Reporting Cycle Name o Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle S 6t Tuesday 2"d Friday , 30 Day 6h Tuesday 261 Friday Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election O Cycle 6 0 cycle 7 0 Cycle 8 0 Cycle 9 30 Day Post-Election Annual Report 2"41 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. cDe:c. 17) at 7.,_./.,,,.,i,„/i 01/28/2022 Signature of Tr- surer,Candidate,or Lobbyist Date(MM/DD/YYYY) David J. Fish Hampden Twp/PA/USA Printed Name Location(City/State/Country) DSEB-S03S Updated 1/5/7022 • CCtl XIONWEAI.T 1 05 PYNNSYR VAtt!A 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. FAIR IDENTIFICATION ""a'PVC' •'t Kuusin , ON&ChM,OF Pk CANDIDATErAYA1RTE:E L01111TT31 17— __ r V NAME Of FILING COMINTTLE,CAW:MATS OA tA t IPOI 11 S t T A......6 'joc L0 f '(0> " Lu' City / iF, .+ l i-L I( STATE n OP)o / ( i Y TYPE OF REPORT NAME OF OFFICE SOUGHT by CANDIDATE TOISTRICT NO. PARTY DATE OF ELECTION (eRREcRoDE) TOOL' e' (OMn►ts;ldr''.c,� De OU ►TpC r7. J 6H TUESDAY - - t /`Va PRE-PRO/AIRY _- - POR O!FICE USE ONLY to. i CWY YEAR teC. DAY R YPA'R , - - -- -- - - - ,2ND FROM 2. OATES OF J ►RE-►RIFONTY PRLE"motil N6 1 a'1 a t0 -i�I r I a-I . I f/ { 30 DAY —'R— rf. PoaT<PRIAuaY DASH BALANCE AT END 6TH TUESDAY 4 OF REPORTING PERIOD: S i t7RE•EUECTON ja TOTAL AMOUNT OF FILER'S 7r = 2ro FPIIDAY s" OUTSTANDING DEBTS OR LIABILITIES P" N ARE-ELF'rCTgN AT THE END OF REPORTING PERIOD: S › CO o © 30 DAY POST-ELECTOR A RETORT? YES NO 0 MC ANIMAL �;/ TERMINATION YES NO ���• tttt • NIRtPORT /�` REPORT? ' (r ' AFFIDAVIT SECTION PART I- If statement is filed on behalf of a Political Committee or Candidates's Commi tea,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 S'NECR(OR AFFIRM)TDAT The AGGREGATE RECEPS ON DIS@URSE: .NT3 OR LI.DU1 ES Ir:;'-REC DURING we REnORnt,15 FI YOD FASICATEO Ard`ror 0.6 VC, EXCEED rex:.KfrtioF:D At.O*wry OOti ARS($250.00)A'rI THIS RU'C RT,'5,TO THE US-O!'I 'Wt.EOG►_'N:D EE_ifF.TRUE. GT AI,D CCR.tPtPTI-. SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF 20 SIGNATURE PERSON SUSRtrTT;NG REPORT — PRINTED NAVE I SIGNATURE J � // MY CoAR1RISSION axelnr.s 7 +7 ^!3> -iL U 3 MO. DAY YR. AREA CODE DAYTIME TOLEPHONE NUMBER PART II- If statement is filed on behalf of a Candidate's Authorized Committeg,Candidate must sign here. I SWEAR(CFI AFFIFRM)TRRT TO T pm!•E;'T Cr try NNOwLEO:st AVD Tr,i-F TM PQL-ICM.CC, t0 tt NAS NST YTCTATEt)ATIv PROmtuXes C*tit etrt Ca Juvt,3,1937(r.L.1333,N .320)AS AmENCEO. SWORN TO AND EUILSCRIRED EE.PORE ME IRIS SIONATURS,OF CANDIDATE OAT OF 20 —PRINTED NAME ETGNATURS MY GONARDSSIFt EXPIRES AREA CODE -'-" QAYTINE TELEPHONE NUMBER NC. DAY YR. Department ofState • Bureau of Commissions,Elections and Legislation f)S1113-50.1 412-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787.S280 A-