HomeMy WebLinkAboutMassey, Jim - 2022 2nd Friday Pre-Primary 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 1110,, REPORT L. / y
NUMBER ON BEHALF � ' CANDIDATE I/.."*.
///f COMMITTEE L088YIS7'"
NAME OF FlLDNG COMMITTEE,CANDIDATE OR LOBBYIST
Si rn. DNA sS , i'
STREET ADDRESS
c-j 2 i 6 1 �I ) N p,
car STATE ZIP CODE
CA m� p it l C-L-. p A 17 6 I I
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE' /� DISTRICT NO. PARTY}^ /�pp� DATE OF ELECTION
'MO
DAY YEAR
(CHECK ONE) / l W Vr v I 1♦ /.S I �T(J_p�,
6TH TUESDAY
1. C\J lJ
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. DAY I YEAR
DATES OF
ZND FR1OAY 2. REPORTING Of f O f Z� TO D� V't� ^T
�
PRE-PRIMARY PERIOD i'
30 DAY 3.
POST-PRIMARY
CASH BALANCE AT END 0
4. OF REPORTING PERIOD: $ Co
-.0,.
bin TUESDAY _..t
PRE-ELECTIONrm
f _
TOTAL AMOUNT OF FILER'S ,. G7
5. OUTSTANDING DEBTS OR LIABILITIES
2ND PRIORY AT THE END OF REPORTING PERIOD: $ C" __
PRE-ELECTION
6. , C`>
30'DAY AMENDMENT C.:POST-ELECTION REPORT? ' NO =„
7. C.A.)
ANNUAL TERMINATION
REPORT REPORT? YES NO /
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 DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS(S250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLE I t.
SWORN TO AND SUBSCRIBED BEFORE ME THIS
DAY OF 20 SIGNATURE OF PERSON SUBMITTING REPORT
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES -7/ ' 9,7 9-- u S tO
MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER
PARTII-
IIf 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.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
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
•
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.govjcam pa ignfi nance • 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
Reporting Cycle Name
❑ Cycle 1 I.VCycle 2 0 Cycle 3 ❑ Cycle 4 0 Cycle 5
6th Tuesday 2nd Friday 30 Day 6th Tuesday 2'Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election
0 Cycle 6 ❑ Cycle 7 ❑ Cycle 8 0 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 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.
"0-&-24 0 .510 3 6.0 aa-
Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY)
Alt/ A
Printed Name Location (City/State/Country)
DSEB-5035
Updated 1/5/2022
s
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
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.
/// 1(/
j f 7/?-
Signature of Candidate/
J Date (DD/MM/YYYY)
t}(/ r.� 11,4 sscs/ Cam \A,i )R1 t�—
. / 1 \ /
Printed Name Location (City/State/Country)
DSEB-503S
Updated 1/5/2022