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Home My WebLink AboutFriends of Jim Massey - 2022 2nd Friday Pre-Primary 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 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 ��C►� S do J;w• NvAssay Reporting Cycle Name 0 Cycle 1 C►f Cycle 2 0 Cycle 3 0 Cycle 4 ❑ Cycle 5 6th Tuesday 2"d Friday 30 Day 6th Tuesday 2nd 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 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. Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY) AA' 14 L 61964 PA Printed Name Location (City/State/Country) DSEB-503S Updated 1/5/2022 JPennsylvania 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/cameaignfinance • 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 eV9 ia.-,_v Ny Jam/ 0 J120 Signature of Candidate\ Date (DD/MM/YYYY) \\,.,, •:\' \" ,`�rN,5 -\ fl J Printed Name Location (City/State/Country) DSEB-503S Updated 1/5/2022 c4Pl,MONWEALTH 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 19EliTtFiCATION �j`� j"� /�y 47 REPORT FILED I Nl1Lc8ER ' _/ e� [�/ / ON BENALF OF G4ND+DATE CG:.ix1T;EE �, LOBBYIST NAME OF FILING COADA TTEE,CANDIDATE OR LOBBYIST .Ff'Ieetid.5 0c T+no 1l'1Ct5 e y STREET ADDRESS PO I5 cc)Q, K 7 ti- CITY y� STATE (/�� ZIP CODE �/ f d PA /-7O c TYPE OF REPORT NAME OF OFFICE SOUGHT BY /�,CANDIDATE 1D'STRICT JJJNO. PARTY / -DATE:OF ELECTION (CHECK ONE) Ste, < ,1 I ' �`� �-} i�Ci' �+� .MD. I DAY I 1YE/?AR . 6TH TUESb0.Y 1 ` - J/L- Y C) 1 / I g v an.' PRE=PRIMARY / FOR OFFICE IJAE ONLY I IP.O. + DAY YEAR MO. I OAY 1 YEAR 1-7 ZND FRIDAY 2" DATES OF in Ij F,�1 L` N PRE-PRIMARY 1. - REPORTING v 1 Jo i TO Q 5...11� V d. p� t"'iJ l I f 11 ,,, 30Dav ' - , - POST-PRIMARY I )' ~� CASH BALANCE AT END C.)14. OF REPORTING PERIOD: S O _ l.:5 T, 6TH TUESDAY PRE-ELECTION t TOTAL AMOUNT OF FILER'S « a 2N6.FRIDAY 5- OUTSTANDING DEBTS OR LIABILITIES Q AT THE END OF REPORTING PERIOD: S . { PRE-ELECTION W 5. PODAY AMENDMENT I J POST-ELECTION NO ;/ REPORT? ANNUALT. ' TERMINATION ` N REPORTRT REPORT? 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 CR s IAEiUTIES I!:,CURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT EXCEED TWO HUNDRED AND FIFTY DOLLARS(S250.00)AND TI-SS REPORT IS,TO THE EEST OF MY ti;JOF,LEDGE AND BE;IEF,TRUE,CORRECT AND COMPLETE. SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF 20 SIGNATURE OF PERSON SUBMITTING REPORT P a-'-1 4 . 6, wifk`r PRINTED NAME SIGNATURE MY COMMISSION EXPIRES 7 / 7 - 6 Q Q cay MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER PARTII - If statement is filed on behalf of a Candidate's Authorized Committee.Candidate must sign here. i SWEAR(OR AFF:P14)THAT TO THE BEST OF MY KNO>:*,n EOOGE AND EELIEF TatS POLITICAL COMMITTEE'4AS 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 7 7 9 7 (i)- Ls-Fro MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER MO. DAY YR. Department of State • Bureau of Commissions,Elections and Legislation