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HomeMy WebLinkAboutMassey, Jim - 2022 30-Day Post-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. r Name of Fil�rt Committee, Candidate, or Lobbyist ___� Jim ✓V)as RciPorting Cycle Name ❑ Cycle 1 ❑ Cycle 2 IlCycle 3 ❑ Cycle 4 ❑ Cycle 5 6th Tuesday 2"d 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 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. At_A/1)&11 / Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY) 66' 4 , C:114-C' En e/a , P'�f1 u s4 Printed Name Location (City/State/Country) DSEB-503S Updated 1/5/2022 z Pennsylvania Department of State u '}`:; 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 Ca paign Finance Statement is true and correct. '),„.,„ , 0 iN\ cog a j oii,_— Signature of Ca . date Date (DD/ M/YYYY) Tazinft,Zj_d fa.s.s-e Tr, (C;( 11,3 Al-f0.- i°A1 R.S41 Printed Name Location (City/State/Country) C) ,., r--- _ 8 0 c iv --4 c,.r, -‹ io DSEB-503S Updated 1/5/2022 COP.IMONWEALTH OF PEVNSYLVANIA 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 110 REPORT FILED I CANDIDATE COMMITTEE LOBBYIST NUMBER ON BEHALF OF '/ NAME OF FILING COMMITTEE,CANDIDATE OR LOBBYIST /� STREET ADDRESS Ca/ 6/enin Rd CITY STATE ZIP CODE 42t )41 i70 // TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY . - DATE Of ELECTION (CHECK ONE) ' I D r MO. i DAY YEAR 6TH TUESDAY ✓j /� ! o /+� PRE-PRIMARY FOR OFFICE USE ONLY MO. i DAY i YEAR MO. i DAY I YEAR 2ND FRIDAY 2. DATES OF1 PRE-PRIMARY PER REPORTING7 d S 1 O? .2Z. TO d6 I a ; .� 30 DAY 3 I POST-PR7A9ARY CASH BALANCE AT END O c.. 6TH TUESDAY " OF REPORTING PERIOD: S C,3 _ PRE-ELECTION ) .- ' TOTAL AMOUNT OF FILER'S _ A OUTSTANDING DEBTS OR LIABILITIES © --,,, CO 2ND FRIDAY ,**-- PRE-ELECTION AT THE END OF REPORTING PERIOD: S .D 6. 1� 30 DAY `-) AMENDMENT N POST-ELECTION REPORT? YES NO 7. ANNUAL TERMINATION YES NO REPORT REPORT? I VI 1 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. IS:.c.-R(OR AFFIF.;)THAT Tr._ RECE,2TS _RSE`.EY ,_ , T R_.C.` 7'a_ tttt � � L r - rEP'C.-,"'n.LATE�1. :+oG�IE�.iC'10T „XCE.ED ,NC`HUNDRED AND F ,I 0 ._r. J(S250.00) .D T,..S ._ \'S. _EES, E- ..__-G_ ..•B___F, -P:uE,CORRECT A..D CO;`.-AETE. SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF 20 SIGNATURE OF PERSON SUBMITTING REPORT .Ta-' es Ma ss-e y PRINTED NAME SIGNATURE MY COMMISSION EXPIRES `7/ 7 9 7 9- ei j MO. DAY YP.. AREA CODE DAYTIME TELEPHONE NUMBER PART II - If statement is filed on behalf of a Candidate's Authorized Committee, Candidate must sign here. I sv.g,R(c .P':S)THAT TO 7,E FSES7K'I:i'A_ELSE ..7 EEL.E.Tr-,S�C. .. EE.:A ,.lOT ni n ' -vl CF JUNE 3 1937(P.L. 1333, No.320) _ .E 'L _ s vl..� -_ = �P:Jrl:;v,s OF- .ACT :JEC 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 oar,.I._-il- I•.u:__ o...l..-_ - .,.-_---'—.-- .,. ........ ........ . .,.... _,._