HomeMy WebLinkAboutHampden Twp. Democratic Club - 2022 2nd Friday Pre-Primary IrifPennsylvania 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
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
Hampden Township Democratic Club
Reporting Cycle Name
❑ Cycle 1 0 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.
05/03/2022
Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY)
Carol E. Thornton Mechanicsburg, PA, USA
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 10, F 7
NUMBER x/� �� ON BEHALF OF ' CANDIDATE I. COMMITTEE ZtOBBY15T
NAME OF FILING COMMITTEE,CANDID OR LOBBYIST Viet/Ka
�? /'-t-&v pc liRs�/1 �1 i-r ,-71: ( ,`(G(-k
STREET ADDRESS
CITY `STA j ZIP CODE
( 1
TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) ,/ MO. DAY YEAR
1. r
BTH TUESDAY
PRE-PRIMARY FOR OFFICE USE ONLY
MO. DAY YEAR MO. OAY YEAR
2ND FRIDAY 2 / DATES OF
PRE-PRIMARY V REPORTING /y �� TO C)
PERIOD �`T
30 DAY 3. - --- _. - - - - C
POST-PRIMARY rn p"
CASH BALANCE AT END Z "�
6TH TUESDAY 4. OF REPORTING PERIOD: $ 'I U$ 7
PRE-ELECTION
TOTAL AMOUNT OF FILER'S
5. OUTSTANDING DEBTS OR LIABIUTIES /� C 7
2ND F AT THE END OF REPORTING PERIOD: $ (J
PRE-ELECTION
ILO
s.
30 DAY I -.: a,
AMENDMENT
`/
POST-ELECTION REPORTS
7. '`YES NO J(
ANNUAL TERMINATION `/
REPORT REPORT? YES NO 'J(`
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 DID NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE.
SWORN TO AND SU CRIBED BEFORE ME THIS
DAY OF 20 SIGNATURE O SON SUBMITTI G REPORT
SI ATURE RINTED'N E
MY COMMISSION EXPIRE / —7- J
MO. DAY YR. AREA CO E AYTIME TELEPHON NUMB
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 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-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280