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HomeMy WebLinkAboutFriends of Mercedes Evans - 2022 2nd Friday Pre-Primary yrdi 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/campaignflnance • 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-501), Campaign Finance Statements in lieu of. ..11 ner-o rn�f w__ nr�.-__��� .._ __...._. .,-.... (orcAP ov-r, w.,wr f.fdVrue"dui is 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 Friends of Mercedes Evans Reporting Cycle Name ❑ 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 ❑ Cycle 7 ❑ Cycle 8 ❑ Cycle 9 30 Day Post-Election Annual Report 2"d Friday Pre-Special Election 30 Day Post-Special Election Part 1 — 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. 05/06/2022 Signature of Treasurer,Candidate, or Lobbyist Date(MM/DD/YYYY) Patricia Smith Harrisburg, PA, USA Printed Name Location (City/State/Country) DSEB-503S Updated 1/5/2022 Vi" ; Pennsylvania Department of State kti, Bureau of Campaign Finance&Lobbying Disclosure qt 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. tt dV(r. 6(/'Alki/d.,---- 05/06/2022 Signature of Candidate Date(DD/MM/YYYY) Mercedes Evans Camp Hill, PA USA Printed Name Location (City/State/Country) DSEB-503S Updated 1/5/2022 1 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 0, REPORT FILEDlipi, CANDIDATE L COMMITTEE LOBBYIST 3' NUMBER (�/ //�� ON BEHALF OF HA FTiAie G d .C©DATE ORL Merudei P')(orb ADDRESS F CITY •1. �� _ STATE ZIP l i 0 I' -! e i Y 1 1,/�T\'YYPEE OF R RT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION 1 ^ A-� (CHECK ONE) •y 0 s- Li yEAR 1. � �0a 6TH TUESDAY _ -i- • '�. _. J PRE-PRIMARY J FOR OFFICE USE ONLY MO. DAY YEAR MO. DAY YEAR DATES OF 2ND PRE-PRIMARY XPERIODTING0 �q'•!I� TO I�� (�i ��PRE-PRIMARY 7..0 V cc). 30 DAY N POST-PRIMARY / /1 •/ / CASH BALANCE AT END )�A+jJf l'.�n(_�/ 6TH.TUESDAY 4' OF REPORTING PERIOD: $ r33j PRE-ELECTION T"" i TOTAL AMOUNT OF FILER'S »,1 ZND FRIDAY 5. OUTSTANDING DEBTS OR LIABILITIES PRE-ELECTION AT THE END OF REPORTING PERIOD: $ CD — 30 DAY B `, l9 POST-ELECTION REPOR MENT YES NO 7. ANNUAL TERMINATION REPORT REPORT? YES NO AFFIDAVIT SECTION PART 1- 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($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF,TRUE,CORRECT AND COMPLETE. SWORN TO AND SUBSCRIBED BEFORE ME THIS ' � DAY OF 20_ SIGNATURE OF P RSON,S rrTING REPORT pai CRIN D NAME SIGNATURE 111 Pq 0 V v 5 MY COMMISSION EXPIRES MO. DAY YR. AREA CODE DA ME TELEPHONE NUMBER PART 11- 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 DUNE 3.1937(P.L.1333,No.320)AS AMENDED. AMU/Ida' b744/Vr SWORN TO AND SUBSCRIBED BEFORE ME THIS TE DAY OF 20 M&rczdej SIGNATURE EVa •5 PRINTED NAME f� SIGNATURE � .�r 3Sq jam, MY COMMISSION EXPIRES AREA DE V 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