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HomeMy WebLinkAboutCumberland County Republican Women - 2022 6th Tuesday Pre-Primary Pennsylvania Department of State g2.77 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. Committee, Candidate,pP Lobbyist Clio/660-44Y140 CahtiC Y - L/c.1✓ 6V 2(Pa y3 Reporting C Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5 6th Tuesday 2nd Friday 30 Day 6th Tuesday 2"d Friday Pre-Primary Pre-Primary Post Primary Pre,Election Pre-Election ❑ Cycle 6 0 Cycle 7 ❑ Cycle 8 0 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. y/94Z--- Signature of Treasurer, Candidate,or Lobbyist Date (MM/DD/YYYY) eei,e4f/N7 Printed Name Location (City/State/Country) DSEB-5035 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 $250.00 during the reporting period. FILER IDENTIFICATION ©�$O913 REPORT FILED CANDIDATE `I COMMITTEE. , ' LOBBYIST 3' NUMBER ��/�J/� �0,.BEHALF OF NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST �--7`�v'C/`_/C%I/'`/ ������� Cvuti 611/ WJ COOIVT7 STREET ADDRESS 2 Ceoktif £ 4U2* /u CITY C'�,,ca /06 L STATE ZIP CQD/ CV TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION (CHECK ONE) //j/� � MO. ' DAY YEAR TUESDAY �L� 1( J ( C-' PRE-PRIMARY FOR OFFICE USE ONLY MO„ DAY YEAR MO. DAY YEAR - - 2ND FRIDAY 2' DATES OF PRE-PRIMARY REPORTING i TO .. . PERIOD / ' 30 DAY a (_ t • POST-PRIMARY � P�J CASH BALANCE AT END 4' OF REPORTING PERIOD: l j 3�� 6TH TUESDAY PRE-ELECTION 7:1 - TOTAL AMOUNT OF FILER'S r-"' I 2ND FRIDAY. 5. OUTSTANDING DEBTS OR LIABILITIES - . - PRE-ELECTION AT THE END OF REPORTING PERIOD: S CI s. 30 DAY AMENDMENT C) co POST-ELECTION REPORT? 7 1:111111 Nq RENORL - TERMINATION 1:1111 NO N. REPORT?EPOR77 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 LIABILITIES INCURRED CURtI:3 TIE REPORTING PERIOD INDICATED ABOVE DID NOT EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF 1.1Y KNO'd:LECGE AND BF ,TRU CORRECT AND,COMPLETE. SWORN TO AND SUBSCRIBED BEFORE ME THIS • DAY OF 20 ATURE OF PERS N SUBMITTING REPORT SIGNATURE `PRINTEEDD NNA?E MY COMMISSION EXPIRES 712 7' , aoo MO. 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 LN.KNOWLEDGE AND BELIEF THIS POLITICAL COM',UUTTEE HAS NOT VIOLATED ANY PROVISIONS OF THE ACT OF JUNE 3,1937(Pl. 1333,No.320)AS AMENDED. SWORN TO AND SUBSCRIBED BEFORE ME THIS SIGNATURE OF CANDIDATE DAY OF 20_ PRINTED NAME SIGNATURE. MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER . . . MO. DAY YR. - - Department of State • Bureau of Commissions,Elections and Legislation DSEB-503(I2-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280