HomeMy WebLinkAboutSilcox, Nathan - 2022 30-Day Post-Primary lirPennsylvania 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 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 P. Silcox
Reporting Cycle Name
❑ Cycle 1 0 Cycle 2 ® 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
❑ Cycle 6 0 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 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.
60 i 16 l Zo 2-2-
Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY)
1� ..7-1--4-'►a. ) (9 .SI c..C'_G� i kra rn P Q e.yJ TO V 4.1 .P 0,
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.
FILER IDENTIFICATION ].
NUMBER ON aetALF rottr F OF ' CANDIDATE I.� COMMITTEE. �' L06EYLyT
NAME OF FUND COMMITTEE.CANDIDATE OR LOBBYIST
c c-r-►-1 a...D (7. Sl L.c_a�
STREET ADDRESS
1313 K I,: gr,az-T-w, a --Do_
CITY
STATE p�� VP CODE
r-s.?Gtl/�N'C: L're.G 1 '1 7,SD "_
'TYPE OF REPORT NAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT NO. PARTY DATE OF ELECTION
(CHECK ONE) nP n Q MO. DAY YEAR
6TH TUESDAY. M I Ste, S i 7 ZZ
PRE-PRIMARY FOR OFFICE USE ONLY
MO, DAY YEAR MD. DAY YEAR
2N0 FRIDAY 2. DATES OF
REPORTING
PRE-PMARY PERIODIOD Z.2
RI TD 6, It/
30 DAY 3.
POST-PRIMARY >4 J 1.1 n1 f` aa o a
CASH BALANCE AT END i�O
6111 TUESDAY 4' OF REPORTING PERIOD: $ d ^ ,/y�
PRE-ELECTION ply' O I�` - `
TOTAL AMOUNT OF FILER'S
5. OUTSTANDING DEBTS OR LIABILITIES
PND
PRE=El.EC71LECTI 0N AT THE END OF REPORTING PERIOD: $
•
3O DAY S
POST•ELECTION AMENDMENT YES NO
REPORT?
7
ANNUAL TERMINATION
REPORT REPORT? YES 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.
SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABILITIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE 010 NOT
EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE BEST OF MY KNOWLEDGE AND BELIEF CORRECT AND COMPLETE.
SWORN TO AND SUBSCRIBED BEFORE ME THIS ^"1
DAY OF 20 SIGNATURE OF PERSON SUBMITTING REPORT
1 C.. C'x
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES I ? (9 It f - Z o
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 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 ANO SUBSCRIBED BEFORE ME THIS
SIGNATURE OF CANDIDATE
DAY OF 20__,_
PRINTED NAME
SIGNATURE
MY COMMISSION EXPIRES AREA CODE DAYTIME TELEPHONE NUMBER
MO. DAY YR.