HomeMy WebLinkAboutLeading Hampden's Success Committee - 2021 Annual Report 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 DtHTITTT,AT,ON REPORT E;T Il 7
ON
NUMBER 'BUWf OF .CANDIDATE COM FIEE LOBBYIST
I
NAmt Of FILING CO6ALIRTEL,CANDIDATE OR LOBBYIST'
dY7Tai A ms,
Pb X 93
CITY STATE ter CODE
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY , DAlE,OF ELECTION
(CHEGI:ONE) MO, DAY YEAR
6TH TUESDAY
PRE-4RIMARY FOR OFFICE USE ONLY
y RO. DAY YEAR 1.40..... DAY YEAR
2ND FRIDAY 2. DATES OF
PRE-PRIMARY PERIOD REPORTING
I
" 3 -a 1 TO J' 3 i 1 �'
iv
..
_
30 DAY 3..
POST-PRIMARY CO -rt
IT 1 rn
i
CASH BALANCE AT END 3 ��• ‘. CO
6TH TUESDAY 4. OF REPORTING PERIOD: I
PRE-ELECTION 2
TOTAL AMOUNT OF FILER'S C7
330
2ND FRIDAY 5' OUTSTANDING DEBTS OR LIABILITIES 3 O, ' . 6 d c7
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ 0
C a
B. =
AMENDMENT I
POST-ELECTION REPORT? YES NO
7.
ANNUAL / TERMINATION YES NO
REPORT Y( 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 DOL.LARs(S250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS r) L VI .
DAY OF 20 SIGNATURE OF PERSON ..e REPORT
PRINTED NAME
SIGNATURE e"----
MY COMMISSION!EXPIRES J
MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
PARTII-
If statement is filed on behalf of a Candidate's Authorized Committee,Candidate must sign here.
I s.EAR(OR AFFIRM)THAT TO THE BEST OF MY KNOWLEDGE AND BEUEF THIS POLITICAL COMMITTEE.HAS NOT VIOLATED ANY PROVISIONS OF THE ACT OF
JuHT 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
DSEB-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 it (717)787-5280
oPennsylvania Department of State
ff Bureau of Campaign Finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
www.dos.pa.gov/campaignfinance • ra-stcampaignfinancePpa.Rov
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
Lac StA-0. e e s 5 C,ovww6*e-e--
Reporting Cycle Name
❑ Cycle 1 0 Cycle 2 0 Cycle 3 ❑ Cycle 4 ❑ Cycle 5
6th Tuesday 2nd Friday 30 Day 6th Tuesday 2nd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election
❑ Cycle 6 ® Cycle 7 ❑ Cycle 8 0 Cycle 9
30 Day Post-Election
Annual Report 2nd Friday Pre-Special Election 30 Day Post-Special Election
Part 1- 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.
>Z14.0"..0z*\ r , 022
Kenneth N . Hugendubler Mechanicsburg, PA, USA
Printed Name Location (City/State/Country)
DSEB-502R
Updated 1/22/2021
....... ..._ • vvenrrvrprl,.,lLn,vrr r.rnv,,..r+,..n
j
: : CAMPAIGN FINANCE STATEMENT
• File this in lieu of a full report only if aggregate receipts, expenditures, or'
liabilities incurred each did no exceed $250.00 during the reporting period.
':
•
I.':?::. FlLER.IOi71AFICATION , REPORf FILED 1. 2 ,
' • ON BEHALF OP CANDIDATE I I COMMITTEE�'y(� LODDYIAT -
{:,,.`•.: • :NAME OF'FUND COMMITTEE,.CANDIDATE OR LOBBYIST ' . .
;: . L.e w :,.5 14,Y;,c' .r; S -s c> cl.7) Co KYN 0 ---1-e.e
ST1tDlT ADORBB$
•
CRY STATE n ZIP CODE I .
`
`- . TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY • DATE OF.ELECTION '
• (CHECK ONE) MO. DAY YEAR
. . . C90
,. 1.1 tr I
' • ':OTH TUE8bl1Y
FOR OFFICE USE ONLY''
(::.."..`.. DATES'OP MO DAY YEAR.' M0 'DAY: YEAR' Y`
•2440"FRIDAY, .. 1 ^ ^� • =•. •
".. .- RE +RJMARY • REPORTING 1ERione, 3 TO ] el �. d •
CCI
'`3O:DAx.:.:°: •: •• s. rT1.
POS!T-PRIMARII.. 7 CrJ .
.:'. : ': :. . ._, CASH BALANCE AT END . • I
a ' OF REPORTING PERIOD: $. .�.' �°. •
.6tt NE$DAY.,. •
:'PRE-FLEC'RLIN
TOTAL AMOUNT OF FILER'S t`)
' 6: • . .OUTSTANDING.DEBTS OR LIABILITIES d a ' • ' CD -.;.-
-. 2kiLi tIOAY,' a 3 : • ;
'r:;`, . AT THE END OF REPORTING. PERIOD: . $ • '.- •. C a
Fkktt'LECTWN �,. i.
83 ..30`o:}i1�;:+ aME1iDMENr
•
. . ?,FOSTEEIECTt0N YES• N0. - . . •REPORT�I
...7 .. •
in,:'•'..:';":ANNUAL:'''.' -
REPORT�I
AFFIDAVIT SECTION
PART 1:- • • . • .
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• flied on'behalf of a Contributing Lobbyist,the.Lobbyist must sign here. . .
• • • i°SWEAR(OR"AFFiRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS'OR LIADIL RIES INCURRED DURING THE REPORTING PERIOD'INDICATED.ABOVE DID NOT
• EXCEED TWO HUNDRED AND FIFTY DOLLARS'(S25O.O0)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND,BEUEF,TRUE,.CORRECT AND COMPLETE..: . .
SWORN,TO AND SUBSCRIBED•BEFORE ME;THIS. .• • IA. in •q.
..DAY OF 2t1• _. SIGNATURE OF PERSON INg REPORT
,• • •.. : • • .•. • . . . . PRINTED NAME '' '
SIGNATURE +, /."•
•MY COMMISSION EXPIRE&. / I �.. '7.3. "` L •
KO. co. YR. ' AREA CODE DAYTIME TELEPHONE NUMBER
•
:.;::PART li ••..,.. .
1f,statement•is.filed'on:behalf of a".Candidate's Authorized:Committee,Candidate must sign here.
•
`.':�., '•:,__:..: •,' •I'svvsAR,(QR AFFIRM)THAT TO:THE':BEST'OF MV•KNOWLEDGE AND BELIEF THIS POLITICAL COMMITTEE HAS NOT VIOLATED ANY PROVISIONS.OF THE ACT OF
: ;.;!'::^;' ::. `-';JuNE 3;'1.937(P:L.1333;.No.320)AS.AMENDED: '
e:; :: ' S WON TOANSUSCRIBEDEFORE fits THIS A • :.!c ..R.,' `,....: ... ,. .:
SIGNATURE OF
OF NDIDATE
DAY:oF. 20 • j/1,(\ ��c3'\ l -�c S �
' ' • • v , -G - PRINTED NAME
1.4-:`. SIGNATURE • —1 v 7 3 G 7 .19 S
�: "'' ` MY:COMMIBSK)N EXPIRES '.•S�`;':::i:'�:: '':- : �, AREA CODE DAYTIME TELEPH�E'NUMBER
II,•'" • MO. DAY 'YR:
5"5 '" - Department of State'4•Bureau•of Commissions,Elections and Legislation
:‘:•`:::'DSLB-503,(i .2,99)• ; • 21,0 North Office Building a Harrisburg,•.PA 17124-0029 .• (7,17)787.5280
ir• Pennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
yvww.dos.pa,eov/campa1gnfinancq • ra-stcamaaianfinancera pa.Rov
Part!!-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.
./t5//2.
Signature of Treasurer, Can idate, or Lobbyist Date (DD/MM/YYYY)
tAAk C e-4. i"1 >��n" �-fir {� (4 A-
Printed Name - Location (City/State/Country)
DSEB-502R
Updated 1/22/2021
COu►.'ONATALtH CF PE?NSYLVAN'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.
I
rue CtMTM tA17JM ii
'' � OR aGIAALF tANmnAt[ I' I COr�;rT1s �Ol4fYRT }
'NAYt CP'LM3 COIIW RTt.CANDIDAT%OF LW'*YRT / .pJ I!/��
i Le4 ' rS 4%Ml- n 6 `.lCL(D L_. ienfr --- �i
....Y ATA*f$4
I art
-` STATE /� Dr COOL
-�
C m``' Ti f 1 'k
t A + /t a o1 _-
TYPE of REPORT NAME OF OFFICE SOUGHT ET CANDIDATE DISTMCT NO. PARTY DATE OF ELECTION
(RktCH ONE) rr'� ^�_
6T„TVEDDAY T l�V 1 I a. ql
me-Nnauty
FOR OFFICE USE ONLY
2 N 'MARO. DAY AR WO. DAY KAR
2N0 WRAY DATES OP
PRE-TIOAMRY PE ' a 3 a ` TO 4 3
1000
I 30 DAY '3 N
PORT-PRPIY -M N
CASH BALANCE AT END J �1 t� -r1
6TH Ts/emu). 4 OF REPORTING PERIOD: 3 �• v-n rn
MS-4LECTION70 Ca
TOTAL AMOUNT OF FILER'S yr, L
2t,0 CRroaY s- OUTSTANDING DEBTS OR LIABILITIES 3bJ 6 0 Z C
PRE-ELECTION AT THE END OF REPORTING PERIOD: $ Q Tam
30 oar - 0
FO$T4LECTTON AMENDMENT YES NO C
REPORT?
T . . —
ANNUAL
T2RM+TIATON YES NO
. 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 fled on behalf of a coitributing t,obbvist.the Lobbyist must sign here.
a stwEAR(OR AFT.RM)TWIT RV .-JFGATE RECEIPTS OR SSURDEM NTS OR WRO.mE5 NCURRED DURING TI♦E REPORTING PFRI00 INOIGTEC ABOVE ErO NOT
FYCr4D TWO SI.NDREo AND FIFTY DOLLARS($250.00)AND THIS REPORT O.TO THE BEST OF RAY 1040%M.EOGE AND eaicr.TRUE.cortnEC7 AND C UPL$TE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS () LI\ ✓n 1
DAY OF 20 SIGNATURE OF PERSON IlifTIPT REPORT
)1� �� �a_1 hr
siGNAT PURFRINTED NAME
'NIY COMMISSION EXPIRES i "► ~1 3 _1 — D G ,
MO. DAY YR. AREA CODE DAYTIME TELCPHOI,E NOMDER
/
PART ti-
If statement is filed on behalf of a Candidate's Authorized Committee,Candidate must sign here.
I SWEAR(OR AFFIRM)T AT TO THE BEV OF MY INOW.EDGE AND BFUEF Tte POUTICAI COIRETTEC HA.9 NOr Yio,ATED Mn C-.ty n:.•0'lo OF t.tE ACT OF
Junk 3,1937(P.L.1333,No.320)m ALIEJIDFo
SWORN TO AND SUBSCRIBED BEFORE ME THIS __ Q\ -SSZNAIW OF
.
DAY OF TO �`v_
PRINTED NAMEa 1 /
1i MY COMMISSION EXPIRES AREA ODE DAYTIME TELEPHONE NNUMOER
IAO. DAY YR,
Department of State • Bureau of Commis ons,Elections and Legislation
A5LT3-Sol{u-CM 210 North Office Building • Harrisburg,P 1T120-0029 • (71T)787-5280
Pennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
500 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
h www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@pa.gov
Part II-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.
01/31/2022
Signature of Treasurer,Candidate,or Lobbyist Date(MM/DD/YYYY)
Sherri B. Chippo Hampden Township, PA
Printed Name Location (City/State/Country)
DSEB-502R
Updated 1/5/2022
"- ` .
Cossti0N4Y U1I or PO* .VAN!A .
CAMPAIGN FINANCE STATEMENT
Pilo this in lieu of a fuil repent only If aggregate receipts,expenditures,or
liabilities incurred each did net exceed S250.00 during the reporting period.
' ti Art-♦ ::*.sc Auor ti ���12=1
y +tt^t',0+H1p o5.'.^CT, .,tur�A,at el tom TKf
f 1'7d 4f —
Tl'ME OF rEP0.4T RAMP Or Orms SCOOT Pr CANDIDATE oei-R7 Ito. rainy
(O¢at OM p4_ ,
Ent 1 {
FRI Ofntr Mr D T
2,o r1GbUT" =" DATES Cl try OAY tuxNO. my run
►REiRr1ARr , 1 3 a 1 7O 1 a 3 1 )
30
acuy.eyraut,r tV
CASH BALANCE AT END 1 3 f? Q rC l r�rl
fine rursam A' OF REPORTING PERIOD: $
►aE4ELEenm.. _ CO
T TOTAL AMOUNT OF FILER'S 1I.-.
1
7ND RAY OUTSTANDING DEBTS OR UABIUTIES B a 5 d ( ''
rRE{LECnOH AT THE END OF REPORTING PERIOD: S
30 DAY , ,Zy
tWSSKI.fCTtDit AMCNOtfENY tweet
YET HD y,,
C� _
ANMIAL 7Y TEMt"AR110N
" /' ROM? Yrs No
4 ,:ti'. dA F.FIV T: c'T,ON't'' rir'-�.d.4*J5 R d; Tr. N
v
PART!.
If statement is feed on behalf of a P_glitica)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 Cslntrfbut(rtg obbvis(.the Lobbyist must sign here.
1 SA•W(OR ATE-VA)THAT RAE AGGREGATE RCtICPTT OD RSSUTOJC-Ms CO lOLTIOEs r.a.-1 o o rt`.L t' 2•,.""00,:'OGALED A^DYE O'D HOY
Exam r- HASIa^rro AHD fr"re ocuAAS(5250.00)AAO TKO AT:DOT T t9.To Ttc 7,`1 Cr to Tra:At1FAC'/TAD['nits'.1A1..Z.CD'''"CT Ant ar'.'ItTE
SWOON TO AND WeSCRC3EO OEFORE AM THe r VI ,t
OAY OF 20 totoe ne OF PERSOtt Ilrip REMIT
Pnmm TAM U
t,•r GO•in�s.S OH exPelto i 'i 3 -7 - L J S
P.O. DAY rt. AREA C003 DAYTr..4 TELEPHONE fW ER' i
PART It
if statement is filed on behalf of a Candidate's lout,t i .rid i1 Candidate must sign here. t
-1-:::',,,((J.-PT-17ml io tr<'Cf`TO:+^5.1tUt.SEIY7 A":Dr'il'i let;IC,nliCld 00K"'?Ti.t, tcV/, rt.:'01v
:. : ::' ::::
I``II 0 ti4 _ _ �. r 521
OAY of 20 r5'-f1 � tl vaento_Nu. I -
62
1'2-
,,,c'4vs..a,4Eir,Rr, __ W.ARZACO -- DAYT+k�TELEIEtCU^.i o-
i .....MO DAI IT.
J Oeputmsrtt of State • Burcau of Commtastona,ElCdtona and t.cgtslation
+ i 210 north Offlce Buliding o Hanitburg,PA 17,120.0024 0 (717)707-S2C0
i
.IPennsylvania Department of State
Bureau of Campaign finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 •717.787.5280(Option 4)
www,dos.pa,aov/campaianflnance • ra-stcamoalanfinanceC)pa.eov
Part N-if this form is submitted with a report by a Candidate's Authorized Committee,the
candidate must sign here.
I dedare under penalty of perjury under the law of the Commonwealth of Pennsylvania
that the accompanying Campaign finance Report is true and correct.
j
4.011111. ,"_,,, ile, i 24 (2O21-
Trea tire_ Candid. e,or lobbyist pDate(DD/MM/YYYY)
Li
Printed� c/tC j?-, Eit.t.a )o, vIA
Prin ed Name Location(City/State/Country)
OSEB-502R
Updated 1/22/2021
„-_-:'
,
-: • FINANCE' STATEMENT Cau. e4?�vf:�tt�!pF'PE��eiSYi.VANiA
CAMPAIGN $TAT ME
Fite this:In lieu of.a twit report only if aggregate receipts1 expenditures, or ` . ,`
: aiabiiittes'incurred'each did not exceed$250,00 during:.the reportiing peri�ac. .tOh?F1LW 1 l.L 7
BEMdLi�
tlabYl67
r; 'NAVE O '311 FYE!',• :CAN fltg i#t L06rrAT' -
r
.��,..••� s�.� ,tom a _
.i-:a•;•. ••
1Yf'f OCR REPORT. :".NALE OF'OFFlCE SOUGHT 6Y CA11DlDA?E :.. `DISr —
:„.'..:. '.:may,:.. :::YE71E :'•
a�cr t+o PAtrrr nti�
•
s:a . 9d
•
s►,,- �..
'pOR. 1� :Y':
ORiF�tli
2 to'
. : .. : .. ...
i
':
DAY� • -. •:r.'�::=�;
:1 67%PL. .` ,,,
BALANCE ATErn.:
•is� •
Q. '�. •...r.
b"tti• N Y:' :�,
OF REPORTING PERIOD. ; '
` tip:
r
is' - -
,.•e,
TC3 • {`- AL AiliciuNT<}F FILER .S
ZNYL. ,Y
OUTSTANDING �T t1R LtABIUTIES_”
�J;'fir:'"
.. . ..: .. : . AT'THE . ..
5
•
END OF REP4RTING
,�i4. IlY -
P031.. • •• -?c: r w
Et:Efi110H c
YES: :MD: - �.y:a -
- .. . .::7 • - _ -
i�1tTN
$0..i
AFFIDAVIT SECTION
••
•
..
PART t . :._.:. _
tf.statement is fled•'on behalf of a Political Co mmtttee:orCand -`s :mitt ":tt T `•:must fii a
rl�t�. i'easut '_:: slgrfis�e :_'
If tatement'i Teti behalf of a .-nd' t -.ida .',*'- ,::_-, ' the Catzd ta�trittst`sr�
: .� s s oil C,a �e.. . :tere� ; - -- •
f. n CI 'b I s to nt.is ehatf of rrie d. b Ca to Lai :.Y�:`:is �i e o a =t `_
t: -
?}ritis sty 't -v
- ,,.,..
.... 1.SVdEif2 (}�..�AFt1RM TH4T.7t•!E R(a'GREpATE Rf3.Mt' ..bR�_!S!C�1rylES� ..`�.11�i,...FA�LIIRiMG
{... . . ) _ - ..,.. •.. ;7liERt�A'Qf[I�.FBCpD`±F.�CATEQ'l�Bdr1E'CID`1!KDT.'•. : .;
r'.t-r,Ixxtr.E(�Aal ii%s� `pia _ , 7b .: '�
SWORN O.AND RlBEO REf.QRE.i�T!# .: .�,•..,....: .... .....' ._.:�<:-..'` :"•1`''`
v -
O Y.tlF :
J
�R. ti4,
- ,y�
�DAY:- ::�► laAYi'Rl1E•,TR:EP NUMBER
1 `
Ifstatement:i=M ;bn l a cte"s i i ed Comrjlt#se, drate must:sign here:'''
- a .
LS%YBAR fCR'.. T,AT•TO 31 :BE CFitlK,IQ O�htBX E ANbJEP tS POPJ�ICXL COM)ETVEE I4ASWOT•VIOLATED'ANY'PRG,fS�OPiS OF''ThE'ACT or.
':Ji 3i 1937(RL..,,1333,No�j 4.iLr �
:: :.+fir;, :•. i`ORN TO ANif :BEFORE 16 PBS P r k • • .
:-r' G•- °•`_ :n. 'SfGJ�fATURE.Of GWOIOATE'•. • ,
•
- �tra; a , ►^ P.-S;i L. cam'
- P NAME`
..d.;y.:•.::;,::, BSc;>.
J�y�y��, :.r
..... .. .:_. a .: ... ._,:,tt.... ....ti_ ..,-,.-._. ...,.
z,�
DAYit#kE HONE. b iELEP NUtd t7:
•f%•••'i S:: ..,.-.. ._ ..,.. :ii•'.4.ram _-
...w...-.. ... -., :.. .: _,,ems`•r'
_._.,:..:•t• ;:.-4.!:ice_:{.,.�,. _ _ ..,'.5
....... .... . . ....:,, .-... .. ., ....,.:.. .. :ofst�Ne.._.:.:Sur!eaut[�;Gati�iitsa�eu���E.�', -_,`and£''`fsisti�oC.rt�p:4'�-
.a:'1.. _T Y .b_-.._.t_ �..•5,.. F_ ..•e.Ck c+af• :'��'• �i� -
- (Fqt,..,,_.•..:�_-__.'.___4o._.r_e--.._-._._.v.vii.,,._._... ..-_•a....,-..:.,....:�_ - , .• t - t »..— .J.
. ... ......-t..w.Y.lS._ .O rrr. ..-3+�n-o-:..n,-.,._n,::.[,__.�'?.J ..... ':•:••rR r:•-r.y.- ,e.
iIrPennsylvania Department of State
Bureau of Campaign Fnance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
w .dos.aa.gov/campaignfinanct, • ra-stcampaignfinance( pa.Rov
Part Ii-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.
Signature of Treasurer, Candidate,or Lobbyist Date (DD/MM/YYYY)
Printed Name Location (City/State/Country)
DSEB-502R
Updated 1/22/2021
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 '. DIOATE t. COMMITTEE. 1.) .
LOBBYIST. 3.
NUMBER ON BEHALF OF
NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST
LJe,,(C '1/I1 *1- ;JAW CLU .` 5 5 c,_C,C.e.S 5 6yvvutt.Li /-1-
STREET ADDRESS
Po &)V aS3
CITY `/I STATE pA ZIP CODE -
TYPE OF REPORT NAME OF OFRCE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) MO. DAY YEAR
0TH TUESDAY'
PRE-PRIMARY, FOR OFFICE USE ONLY
. . ... MO. _. •.DAY YEAR MO. -"OAY ' :':YEAR:.
2N0 FRIDAY DATES OF
PRE-PRIMARY PE ODTING // � pC^ I/ TO /�
I (
czo
30 DAY 3. atm: t'V
POST-PRIMARY : ?Q� p / • Ica ' C-..
4 OF REPORTINGCASH ERIOD:AT END $ I✓U. 0 I
6TH.TUESDAY:'".?, . I"' Ca)
PRE-ELECTION
TOTAL AMOUNT OF FILER'S ,,y9y�..,,
2NDFRIDAY 5. OUTSTANDING DEBTS OR LIABIUTIES � vv n ' -
PRE-ELECTION; AT THE END OF REPORTING PERIOD: $ ....
s.
C r,h)
30 DAY.:
POST-ELECTION AMENDMENTREPORT? YES NO X C
ANNUAL TERMINATION. ' ` /
REPORT REPORT? YES NO y
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 LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BEUEF,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 SIGNATURE OF PERSON SUBMITTING REPORT
SIGNATURE PRINTED NAME
MY COMMISSION EXPIRES
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 VI LA PROVISIONS OF THE ACT OF
JUNE 3, 1937(P.L.1333,No.320)AS AMENDED.
(604iX
SWORN TO AND SUBSCRIBED BEFORE ME THIS
6 SIGNA E AND
JCn
DAY OF 20_ G/C
PRINTED NAME
ny.
MY COMMISSION EXPIRES ARCODE
SIGNATURE --rlEA i�" /)() /
AYTIME TELEPHONE NUMBER
MO. DAY YR.
DSEB-503(12-99)
iPennsylvania Department of State
Bureau ofCampaign Finance&CivicEngagement210 North Office Building,Harrisburg,PA 17120 717.787.5280(Option 4)
www.dos.pa.gov/campaignfinance • ra-stcampaignfinance(u�pa.gov
Part II - If this is submitted with a statement in lieu of full report by a Candidate's
Authorized Committee, candidate sign here.
I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania
that the foregoing is true and correct. 3 / 0 C (9--0 a---
c3I T e c i-
Signat of Candidate Date (DD/MM/YYYY)
6 VLS 1/1PC IJ
Printed Name Location (City/State/Country)
DSEB-503S
Updated 6/24/2020