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HomeMy WebLinkAboutFriends of Jim Massey - 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. Name of Film. Committee, Candidate, or Lobb ist ,ends „Pm fY7 tS s e- Re •ortin: Cycle Name ❑ Cycle 1 ❑ Cycle 2 EiCycle 3 ❑ 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 ❑ 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. 41-t)11-Nklei /r2/ Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY) 66' 4 . Efloia , o4 as4 Printed Name Location (City/State/Country) DSEB-503S Updated 1/5/2022 0 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 Part 11 - 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 iik it _f 4 Al Laws, . 0 06 0o 1 Signature of Ca * date Dat (DD/ M/YYYY) aznt.e/j___.d 4 .5•Se " Tr, (Gl/ry /V-fi /°X/ R-Si Printed Name Location (City/State/Country) C) r^N„ CIO c. rr' c CA) -17 C) r 0 N Cr; DSEB-503S Updated 1/5/2022 Cyr M3v.i..=A :LT PENNSYL. ...e'A 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. F1I"!*ER EIOPE NT'ICATiON ' J C?! 0,.... . 7 6 ipRNAT FIF'EODF r> CANDIDATA COMMITTEE -1/ LOBBYIST NAME OF(RUNG CON4"l7EE,CA\D:OAT_OR.OSSYIST Fr. Pell fps OK J14n filfec 5-e y STREET AOORESS Pa el x y 71 CITY STATE ZIP CODE En 0-/6, Pet ) 7 0 2_s- ____ TYPE OF REPORT NAME OF OFFICE SOUGHT SY CANDIDATE !DISTRICT NO. PARTY 'DA :O a C;�bN S�"�„�'ft}s (CHECK ONE) l f �-t 4 I 3 //EM MO. E DAY YEAR -- 6TH TUESDAY J ./ /i II - O2- • 7- PRE-PRIMARY 1 FOR OFFICE USE ONLY MO. DAY ' YEAR I MO. • OAT ! YEAR I fl 12 DATES OF 2:aD FRIDAY • REPORTING y e /' 2 PRE-PRIMARYi — PERIOD ©� �� i!/L J ') ✓ CJ (/'� 30 DAY POST-PRIMARY 1i I CASH BALANCE AT END ,- 6TH TUESDAY I2, OF REPORTING PERIOD: t PRE-ELECTION I TOTAL AMOUNT OF FILER'S OUTSTANDING DEBTS OR LIABILITIES C:" 2ND FRIDAY � C .., AT THE END OF REPORTING PERIOD: S 0 y•"„ PRE-ELECTION •-�-» 313 DAY 1'7 C' POST-ELECTION ' MENT YES NO 1 -REPORT? — I ^..,... --�» ANNUAL I f � TERMINATIONt REPORT I ` YES I NO I .. I REPORT? 1! CD f,( AFFIDAVIT SECTION;.rdlQil,„ w*v,,,,.Y..,`,,,4,D4.....'f,,...�,,Nti[.iT.T. 4 .,.::.,•�C.j .. : - . d„ ..... ,...3r�;Y ai4-+ . i ,— i. *LL, r.__ GN.,err;.'..:., ,i . ...r,.e,....�.�.r.-.� ,.. w�:rk ...✓, a� _.K�'xs�lea„�{. PARTI - If statement is filled 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. r If statement is filed on behalf of a Co itributino Lobbyist, the Lobbyist must sign here. _• -_== . - - - - _ -=. 1S2.5C- 9; ._ - - - - -___- : - • _- - _. = _ E. SWORN TO AND SUBSCRIBED BEFORE ME T,-,S DAY CF 20 SIG i,:TCRE CT PERSON SUEAIITTIW.G REPORT Pali 64/4am ilk_ PRINTED NAVE \A-U RE 1, MY COMMISSIO'1 EXP RES 7/7 _ 4J .R© - 05 p�'7 MO. DAY YR. AREA CODE DAYTIME TELEPHONE NUMBER i PART II - If statement is filed on behalf of a Candidate's Authorized Committee. Candidate must sign here. S. -, J .�3, 1� 7 P.L.( 1 — NO. EEY E. = ._E E -_.__ -. -: -_ __ . .--_---_ .- - -=_ - -=--- -_. _ SWORN TO AND SUBSCRIBED BEFORE ME-,S S ------- SiGNATURE OF CANDIDATE DAY OF 20 ,...7.�ar a f 9"/0-24.z PRINTED d NAME C s'GNATURE 7 9 7.S1-6 MY CO."MISS ON EXP:RES _AREACODE , DAYTIME TELEPHONE NUMBER ".'G. DAY Y3. • Department of State 0 Bureau of Commissions. Elections and Legislation