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Home My WebLink AboutFriends of Michele Forbes - 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 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 Ca Filing Commit •ee, C-andida e, cif Lob•yist fol d s 0 P fl4 rbeS Reporting Agbilccg ❑ Cycle 1 ❑ Cycle 2 ❑ Cycle 3 0 Cycle 4 0 Cycle 5 6"'Tuesday 2"d Friday 30 Day 6th Tuesday 2"d Friday Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election ❑ Cycle 6 ® Cycle 7 ❑ Cycle 8 ❑ Cycle 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. 01/28/2022 gna ure of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY) Michele Forbes Camp Hill, PA, USA Printed Name Location (City/State/Country) DSEB-502R Updated 1/5/2022 gi7Pennsylvania Department of State Bureau of Campaign Finance&Civic Engagement 500 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@pa.gov 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. A/rWelizi01/28/2022Signature ofandidate, or Lobbyist Date (MM/DD/YYYY) Ann K Fields Camp Hill, PA, USA Printed Name Location (City/State/Country) DSEB-502R Updated 1/5/2022 II III `•"f\CJCl f Vt 1A 1'^- • t-r......�n t ' • Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be dear and legible.It should be typed) Filer identification Report Filed•By Candidate ` Committee Lobbyist Number. t (Mark X) Name of Filing Committee,Candidate or Lobbyist • • Friends of Michele Forbes Street Address • • 2107 Chestnut Street Camp Hill State PA Zip Code 17011 Type of Report(Place x under report type) ( 1-6v' Tuesday, 2- 2"d Friday 3-30 bay Post 4-60'Tuesday j 5-Znd Friday 6-30 Day-Post'- 7-Annual. Special? Friday Special 30 pay Pre-Primary Pre-Primary • Primary Pre-Election Pre-Election Election Pre-Election Post-Election Date Of Election Year Amendment 4 Termination (MM/DD/YYYY) 11/02/2021 2021 Report . Report Summary of Receipts and • From Date To Date ^ For Office Use Only Expenditures - . 12/02/2021 12/31/2021 A.Amount Brought Forward From Last Report $ 0 C? o B.To ry tal Moneta Contributions and Receipts $ C - r.i (From Schedule I) 0 F" •C.Total Funds Available $ ccrt (Sum of Lines A and B) 0 D.Total Expenditures $ — (From Schedule III) 0 = , '-- E:Ending Cash Balance. $ (Subtract tine b from Line C)' 0 C7 = F.Value-of In-Kind Contributions Received $ C (From-Schedule 0) 0 Z to � G.Unpaid Debts and Obligations $ "� •w (From Schedule IV) 0 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 best of my knowledge and belief true,correct and complete. Sworn to and subscribed before me this ////1 day of 20anlit) ` /r-�� 24?*) Signature Pe n Submitting report Ann K Fields Signature Printed Name . r My Commission expires 717 579-7134 MCP. DAY YR. Area Code Daytime Telephone Number Part II-If this is a report of a Candidate's Authorized Committee,candidate shall 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 day of 20 , Signature of Ca idate Michele Forbes Signature Printed Name 717 482-3359 My Commission expires MO. DAY YR. Area Code Daytime Telephone Number 2107 Chestnut Street Camp Hill, PA 17011 December 1, 2021 Friends of Michele Forbes This letter is to inform you that the debt of$617.70 is forgiven. Please accept it as a donation to your committee. Sincerely, Robert Forbes