HomeMy WebLinkAboutKeystone Taxpayers Unite - 2021 Annual Report Pennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
1.0
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
www,dos.Da.gov/campaignfinance • ra-stsamnaignfinance(apa•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 of Filing Committee, Candidate, or Lobbyist
Ke sion..e 1 ax• -e,cs 1ani3-e.
Reporting Cycle Name
❑ Cycle 1 ❑ 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
❑ Cycle 6 lb Cycle 7 0 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.
I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania
that the accompanying Campaign Finance Report Is true and correct.
/,t 1AJ / ,i/4, ,f1 bi-i-ad,a
Signature of Treasurer, andidate, or Lobbyist Date (DD/MM/YYYY)
S ro. Th A)&13Grici ch, PA) USM
Printed Name Location City/Sate/Country)
DSEB-502R
Updated 1/22/2021
Commonwealth of Pennsylvania
Campaign Finance Report PAGE 1 OF ,.
(COVER PAGE N
(NOTE: This report must be clear and legible. It may be pad or printed in blue or black ink.)
Filer Identification Report 1.
2• 3.
Number: 0. ,Zp] g O R$a Filed by: CANDIDATE COMMITTEE ✓ Lg13t Y1ST
Keystone Taxpayers Unite
Street Address:3908 Primrose Road
City:Eno. State: Pa Zip Code: 17025
r
TYPE OF $TH TUESDAY 1. 2ND'PRIDAY 2. SO,DAY 3. AMENDMENT `%ES , NO ✓
REPORT Pt -P:FUMARY R!j('•PfiiMAfiY' POST PRIMARY REPORT?
GFftTUESDAY 4. 2NDFRIDAY 5. 8045AY 6. TERMINATE:IN YES 1/ NO
(place X to pFtE ELEG/ION PRE-ELECTION Tlk N p0$T ELEDTION f2Elriol1Tz
the right of AN r, .
7V YEAR 2021 FILING'MET[fIS)
report type) RPO T._ ( v }east-K eNE PAPERDISKETTE
IF 1
Name of Office Sought by Candidate: DATE OF ELECTION District Office Party County
Number Code Code Code
•
Ma DAY YEAR
11 32 •' 1
(SEE INSTRUCTIONS FOR CODES)
Summary of Receipts MO. _DAY YEAR Ma. DAY YEAS FOR t�;FF.iCE USE ONLY
and Expenditures from: Ifir 11 23 2021 TO )1 21 2022
c)
A.Amount Brought Forward From Last Report $ 1,139.88 C rwa
14.1
B.Total Monetary Contributions and Receipts(From Schedule I) $ 0.00
C.Total Funds Available Sum of Lines A and B
D.Total Expenditures(From Schedule Ili) $ 1,139.88 d
E.Ending Cash Balance(Subtract Line D from Line C) $0.00 C) =
F.Value of In-Kind Contributions Received(From Schedule II) $0.00 C C)
C..
G.Unpaid Debts and Obligations(From Schedule IV) $0.00
AFFADAVIT SECTION
,P'AKr,i ,.Ifthis is a COSMIlltteEr ci6p0r,t,IrOasuretEign here. if this is a CAndidate.repott„candidate Sign hers... . . . .
I swear(or affirm)that this report,including the attached schedules,on paper or computer diskette,are to the best of my knowledge and belief true,correct end complete.
Sworn to and subscribed before me this !1 !
day of 20 fP Person
Signature of P�r/s�on�Sou �,[hng� epori
Signature /a.lt. c 1 v @-4)Rel
Printed Name
My commission expires � Li 0'7 L IS- C)
MO. DAY YR. Area Code Daytime Telephone Number
PART 11—If this is,a re{,x rt pf a'Candidate's APthorized Committee,candidate shell sign hare....
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.920)as amended.
1 Sworn to and subscribed before me this i.
day of 20
1 Signature of Candidate
Signature
Printed Name
My commission expires
MO. DAY YR. Area Code Daytime Telephone Number
•
Page 2„,.of-.7
SCHEDULE III
STATEMENT OF EXPENDITURES
Name of filing committee or Candidate Reporting Period
Keystone Taxpayers Unite From 1 1123/2 0 21 To
To Whom Paid atUAt °Y` .A Amount
lake Rack Our Schools PAC ,arc „xQ a'Z $1139.88
Mailing Address Description of Contribution
390s Primrose Road donation
City State Zip Code(Plus 4)
Enola Pa
To Whom Paid (tt£ >+ [ A4 l Amount
Mailing Address Description of Contribution
City State Zip Code(Plus 4)
To Whom Paid ;=` vf�t' #` ". 'Y Amount
s
Mailing Address Description of Contribution
City State Zip Code(Pius 4)•
To Whom Paid =7 Ae :lifiyeAmil Amount
$
Matting Address Description of Contribution
City State Zip Code(Pius 4)
To Whom Paid Amount
� $
Mailing Address Description of Contribution
City State Zip Code(Plus 4)
To Whom Paid ,": l iX.W r AY.' ', Amount
Mailing Address Description of Contribution
City State ' Zip Code(Plus 4)
To Whom Paid `MiO:,: ,..`' ikt3VOOYS.WitRge Amount
Mailing Address. Description of Contribution
City State Zip Code(Plus 4)
To Whom Paid k 'SAY,7,7011 Amount
$
L �
Meiling Address Description of Contribution
City State Zip Code(Plus 4)
PAGE TOTAL
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D. $ ) 1 3q,$g
DSEB-502(7-gg)