HomeMy WebLinkAboutFriends of Jeffrey Filler - 2021 Annual Report viPennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
www.dos.pa.gov/campaignfinance • ra-stcampaienf'inance@pa.gov
Unswom Statement in Lieu of Sworn Statement for
Campaign Finance Reports
Note: Per Act 2020-15, which was signed into tow on April 20, 2020 and allows for unworn
declarations, Campaign Finance Reports(form DSEB-502), Campaign Finance Statements In lieu
of full reports(form DSEB-503),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
F icAder O F`11er
Reporting Cycle Name
0 Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5
6th 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 0 Cycle 8 0 Cycle 9
30 Day Post-Election
Annual Report 2d 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.
1 declare under penalty of perjury under the law of the Commonwealth of Pennsylvania
that the foregoing is true and correct.
p B 16 / 1f / ao�)._
Signa ure of Treasurer,Candidate,or Lobbyist Date(DD/MM/YYYY)
. A„ ,6,55 Col, )I,'11/ P4/ U.sA
Printed Name Location(City/State/Country)
DSEB-502R
Updated 6/24/2020
.. ...
. .
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 IDENTWMATION go.
EMBER REPORT FILE0 k I, . . ,,unnlypsti
ON BEHALF OF pl'afiE.tr;iie----' ' . I .-._
NAME OF RUNG COMMITTEE.CANOMATE OR WEBVIST -r ,
Fri e AA c a 1 c.,/ )-re-- rei 6 i)er
STREET ADDRESS .
Po_ gox 1-1.3 12
MY STATE KIP CODE
Ca M.." 1-1,1) PA I 1 o 0 I —
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) .
-ff1:6TIIiii-Edikilf . I 1 0 2 2 I
'FOR OFFICE:USE ONLY - , ••••••,,
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OF thiPTIIMATV:-:';2,-i . DATES , .
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CASH BALANCE AT END 0• 0 0
tTICIPispAif 4.,....,
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OF REPORTING PERIOD: $'
'-?•rft...g.f467114*54-':;±,
TOTAL AMOUNT OF FILER'S fTI Zo•
:.e.-,,R:::,.;:-t,--:,:',.•.).s,,,,,. .iF....:::...5. =
git-NotiA: i::1 .,:: OUTSTANDING DEBTS OR LIABILITIES "
-,•:,.efatiettitoolicw-z:-., AT THE END OF REPORTING PERIOD: $ > CA
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--,-,40-ftikict:::',-...f,-,
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REPORT? =
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_ AFFIDAVIT SECTION
PART I-
If statement is fled on behalf of a Political Commiltee 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 LIANUTIES INCURRED DURING THE REPORTING PERIOD INDICATES)ABOVE DID NOT
EXCEED TWO HUNDRED AND ART pou.ARS($250.00)AND THIS REPORT is,To THE BEST OF MY KNOWLEDGE AND BEUEC.TRUE,CORRECT AND COmPLErE..
SWORN TO AND SUBSCRIBED BEFORE ME THIS • le49k) o ` -A
DAY OF 20 siejTuRE OF PERSON SUOM.IIWK REPORT
j;A t) P. i765-A4_SIGNATURE PRINTED NAME _
MY COMMISSION EXPIRES (Y70) qqg -3'18'7
MD. 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 TAY 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
SIGNATURE OF CANDIDATE
- 20
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES MO. DAY AREA CODE DAYTIME TELEPHONE NUMBER
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