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Home My WebLink AboutFriends of Dale Sabadish - 2021 Annual Report Pennsylvania Department of State tiff 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 Statements 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 Statements. This form must be signed by hand where a signature is required. Name of Filing Committee, Candidate, or Lobbyist reif.AMS OF b"u 544DisH Reporting Cycle Name ❑ Cycle 1 ❑ Cycle 2 ❑ 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 ❑ Cycle 9 30 Day Post-Election Annual Report 2nd 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. t/26/2.7L Signature o T asurer, Candidate, or Lobbyist Date (MM/DD/YYYY) 54ot 61 '(LLI ego HILL. /041/4f Printed Name Location (City/State/Country) DSEB-503S Updated 1/5/2022 ififPennsylvania 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 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 accompanying Campaign Finance Statement is true and correct. �.� If 2.6t2irs.L ign ture of ndidate Date (DD/MM/YYYY) r M,6 6. N Mall/WI(*vQ6/A/USA Printed Name Location (City/State/Country) DSEB-503S Updated 1/5/2022 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 $250.00 during the reporting period. FILER IDENTIFICATION 10, REPORT FILED CANDIDATE COMMITTEE LOBBYIST NUMBER ON BEHALF OF ' I. 2. 3. NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST FRIENDS aF Nix Smots1 STREET ADDRESS S 5429 ( we CITY STATE ZIP CODE Ma“ANML4346 Pd1 /7073"' TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION (CHECK ONE) MO. DAY YEAR 1. ?E0140IIh1401Y —ii INOIRLIWO (0411 6TH TUESDAY PRE-PRIMARY FOR OFFICE USE ONLY MO. DAY YEAR ' MO. OAY YEAR 2ND FRIDAY 2. DATES OF PRE-PRIMARY REPORTING 1 TO n PERIOD i't II Zoz i I ;I ?M i.t C 1 30 DAY 3. = wt., POST-PRIMARY in - ,, CASH BALANCE AT END 7:1 2 4. OF REPORTING PERIOD: N$ ZB2 iS r"'- 6TH TUESDAY C PRE-ELECTION TOTAL AMOUNT OF FILER'S 2ND FRIDAY 5` OUTSTANDING DEBTS OR LIABILITIES O ' PRE-ELECTIONAT THE END OF REPORTING PERIOD: $ 12,�c 6. N 30 DAY AMENDMENT POST-ELECTION REPORT? YES NO s. 7. ANNUAL TERMINATION REPORT A REPORT? YES NO x 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 UABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE OID NOT EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CO ECT AND COMPLETE. SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF 20 SIGNA 427 OF P N SUBMITTING REPORT CA 6t401AlilL t SIGNATURE PRINTED NAME MY COMMISSION EXPIRES tin ri6- MO. DAY YR. AREA CODE DAYTIME TELEP ONE 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 COW HAS OT VI LATED Y PROVISIONS OF THE ACT OF JUNE 3,1937(P.L. 1333,No.320)AS AMENDED. ♦ SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF 2O GNAT E O CANDIDATE a le g 64,a_ sti PRINTED NAME SIGNATURE 71 7 +•7 4 ) _ 5 75 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 • (717)787-5280 11: - - -- --- ---- - - -