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Home My WebLink AboutCommittee to Elect Safronia Perry - 2021 Annual Report 11 moot i•utrtr i r tot e t tit tit Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible.It should be typed) Filer Identification Report Filed By Candidate Committee Lobbyist Number (Mark X) Name of Filing Committee,Candidate or Committee to Elect Safronia Perry Lobbyist Street Address 10 West Pomfret Street City Carlisle State PA Zip Code 17013 Type of Report(Place x under report type) • 1-6th Tuesday 2- 2"Friday 3-30 Day Post 4 6thTuesday 5- Friday 6-30 Day Post 7-Annual Special 2°°Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election IllI 7,,,I ir / Date Of Election 11/0221 Year 2021 Amendment Termination (MM/DD/YYYY) Report Report Summary of Receipts and From Date 1 To Date For Office Use Only Expenditures 11 r2Sal0 -S1',21 A.Amount Brought Forward From Last Report S /3 ✓l 57/ . B.Total Monetary Contributions and Receipts S c) *-- (From Schedule I) O Y 2 C.Total Funds Available S co (Sum of Lines A and B) ( ) rn D.Total Expenditures S r-- to (From Schedule III) �j Cf 1/ = --- E.Ending Cash Balance S (Subtract Line D from Line C) --�� () s F.Value of In-Kind Contributions Received S c IV (From Schedule II) 0 2: G.Unpaid Debts and Obligations S _ V2 (From Schedule IV) Affidavit Section Part 1-If this is a Committee report,treasurer sign here.If this is a Candidate report,candidate sign here. I swear(or affirm)that this report,Including the attached schedules on paper,is to the be t of my knowledge and belief true,correct and complete. Sworn to and subscribed before me this I day of 20 lla A44 Sig ature of Person Submitting report ifti2kLa Wig✓Ell 4- Signature Printed Name __ / �j)My Commission expires GO '' le 7/ D/ MO. DAY YR. Ar Code Daytime Telephone Number Part II-If this is a report of a Candidate's Authorized Committee,candidate shall sign here. . !swear Wanl m)fhaf to theeeesst Of my knowledgeaad1 heiief t,his7nclitical rOrnmittoe tfn not violated anyprnvisions of tile AC t otJune,3,f 937_(P.L.1333,-N0.320)as amended. SwornSw to and subscribed before me this r' `�Oar- • day f. U.Q. 20 a� • (l 1 ll Qu\c\Li j, 1y Q- )f C r Signature of ndidate V OD), r of\jG fall Signature Printed Name• ��"" My Commission expires • 14 � —7 l-1 3 (.0.-Lp l S MO. DAY YR. Area Code Daytime Telephone Number Commonwealth of Pennsylvania-Notary mai LORIE GEIS7W141 E-Notary F❑bllc Cumberland County My Commission.Expires February 14,2025 Commission Number 1305563 SCHEDULE III Statement of Expenditures Filer Identification Number: To Whom Paid Date[MM/DD/YYYY] 8 YO p e S 30 'i c Zozr 135'2. Z9 House# / q Street Address ,con .cel • Description of Expenditure CityState n Zip (14.41-,4e P� Cade 170/ J��7 0'`' To Whom Paid - Date[MM/DD/YYYY] 8 House# ■r t_-arik_;. - dit rr< City , f State 7ip____ _ Code—To Whom Paid - Date[MM/DD/YYYYj 8 r 65(et4 /74 ao - Zozi 7 25 House# ,(8 Stre Address o11/ itili c L 't,e L Description of Expenditure City Ca n k State Zip odeTo Whom Paid 9/4 Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] 8 House# Street Address Description of Expenditure City State Zip Code lirPennsylvania Department of State Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.eov/campaignfinance • ra-stcampaignfinance@pa.eov 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 Reporting Cycle Name ❑ Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5 6th Tuesday 2nd Friday 30 Day 6th Tuesday 2nd Friday Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election 0 Cycle 6 0 Cycle 7 ❑ Cycle 8 fii Cycle 9 30 Day Post-Election Annualt 2nd Friday30 Post-Special i d Elect' Report I ��luay Pre-Special Election .�a-v Day rw�-uNfcciai Election )44 L � r-Po" Part I - If this form is submitted with a Committee report, t e 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. gt 06-4 &L.__ 3/ k 26ZZ— Signature of Treasurer, Candidate, or Lobbyist Date ( D/MM/YYYY) Pat LaMarche Carlisle, Pa, USA ' Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021