HomeMy WebLinkAboutSilcox, Nathan - 2022 2nd Friday Pre-Primary irEiPennsylvania Department of State
Bureau of Campaign Finance&Lobbying Disdosure
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 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
Nathan Silcox
_Reporting Cycle Name
❑ Cycle 1 e 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
❑ Cyde 6 ❑ Cyde 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.
Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY)
P- S 11/4-c-U-.f N 4nM1 A A. -ra 0 .P Q
Printed Name Location (City/State/Country)
DSEB-502R
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.
FAIR IDENflFICA11ON REPORT FLED 6ANINDATE I. GOMMITIE'H 3. 1 LOB = 11
WOMEN ON BERMS OF
NAME OF FLING COMMITTEE.,CANDIDATE OR LOBBYIST
STREET ADDRESS
t 3 c 3 \ -I )6, t1.c -i i- <L 17c...I 0 2—
CIY STATE ZIP CODE
Y�4F-C,Mt-r-as C- t)&. ' 1p —"Ao
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CAHMATE DISTRICT NO. PARTY DATE OF F I E C T I C I,
(CHECK ONE) )-4't (Y 9 1 'O '-pt.,ioSi4 - P MO. DAY YEAR
g17T TUESDAY T. L..-0 M M,SST�Gn c- L '7 ZOy'Z—
PRE-PRIMARY FOR OFFICE USE ONLY
MO. 'DAY YEAR MO. DAY YEAR
2. DATES OF
FRZDAY REPORTING TO
PRE-PRIMARY PERIOD L2 S i 2 S.- 2 :�2.-
30 DAY S. t 7
C.:
CASH BALANCE AT END r
6TH TUISSDAY OF REPORTING PERIOD: $ 0
rn
PRE+ELsonow
TOTAL AMOUNT OF FILER'S �.•- -C
2Tm MAY OUTSTANDING DEBTS OR LIABILITIES a)
PRE-ELECTION AT THE END OF REPORTING PERIOD: $
3
DAY AMENDMENT
e. REPORT'? YES NO _
O dT�ELECTlON
ANNUAL -TERMINATION
-TERMINATION YES NO
REPORT .REPORT'? -.. Cr)
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 Candidata 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 NG PERIOD INDICATED ABOVE DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS(S250.00)AND THIS REPORT IS,TO THE BEST OF 1III KNOWLEDGE AND BELIEF. CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS P
DAY OF 20_ SIGNATURE OF PERSON SLIBMITTRIG REPORT
tJ14-1-1-1 .....> fP. S r t,C-T->/ _
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES i? to Z DES
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 MY KNOWLEDGE AND BEUEF 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
DSEB-5O3(12 99) 210 North Office Building • Harrisburg,PA 17120-0029 • ma)7874290