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Home My WebLink AboutTake Back Our Schools PAC - 2022 30-Day Post-Primary tiiitkr Pennsylvania Department of State 4,11 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. Glikag CO Filing Committee, Can.idate, CIY Lobbyist —rake- :6tck_ 014.r &hcI5 Reporting cycle u - ❑ Cycle 1 ❑ Cycle 2 /1 Cycle 3 ❑ Cycle 4 ❑ 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 ti 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 accom anying Campaign Finance Statement is true and correct. (;14e1/47.4 /l � l z Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY) / Of k ,eSii /4 / r616 Printed Name Location (City/State/Country) DSEB-503S Updated 1/5/2022 1 II Reset Form Print Form Commonwealth of Pennsylvania-Campaign Finance Report / 614 (Note:This report must be clear and legible.It should be typed) Filer Identification Report Filed By Candidate { committee 7 Lobbyist ^n Number (Mark X) j��✓ryl �` Name of Filing Committee,Candidate or i &tie i v V ,�nLobbyist N�— Street Address �� !3 4/t�j aii J ^Aa�� ] �j 7 ' City c�i44-'`� /!Q /� State s Zip Code ! (`�� 1 Type of Report(Place x under(report type) iJ`) ;.6th Tuesday 2- 2nd Friday 3-30 Day Post 4-6t Tuesday 5.2nd Friday 6-30 Day Post 7-Annual Special 2"tl Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election . / Date Of Election Year Amendment Termination (MM/DD/YYYY) ,Q?jlj Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 5 o3—V- 6-06-zZ A.Amount Brought Forward From Last Report $ �rjeit )3 C o B.Total Monetary Contributions and Receipts $ �i (From Schedule I) / (/ , C.Total Funds Available rn'n C-- (Sum of Lines A and B) 30/ 3 7 b 4 /330 IC D.Total Expenditures $ ) al (From Schedule III) / 2 7.D, CD E.Ending Cash Balance $ (Subtract Line D from Line C) �� 5r 3,b 0 p� F.Value of In-Kind Contributions Received $ N (From Schedule II) 0 ? -i C....)G.Unpaid Debts and Obligations $ -'� (From Schedule IV) 0 Affidavit Section Part 1-If this is a Committee report,treasurer sign here.If this is a Candidate report,candidate sign here. I swear(or affirm)that this report,including the attached schedules on paper,is to the best of m knowledge and belief true,c rrect and complete. Sworn to and subscribed before me this day of 20 )/016 I �aa(r�of qG 5 giMPt l Signature r l/� (Printed Name p • My Commission expires 6I J �01—V 0`/ MO. DAY YR. Area Code Daytime Telephone Number Part II-If this is a report of a Candidate's Authorized Committee,candidate shall 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 and subscribed before me this day of 20 • • an I ate Signature Printed Name My Commission expires MO. YR. Area Code Daytime Telephone Number SCHEDULE I Contributions and Receipts zo$ ,, Detailed Summary Page Filer Identification Number 1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total for the reporting period (1) $ / 2.Contributions of$50.01 to $250.00(From Part A and Part B) Contributions Received from Political Committees(Part A) $ 6 2- 07) All Other Contributions(Part B) $ Total for the reporting period (2) $ ,h r) 3.Contributions Over$250.00(From Part C and Part D) Contributions Received from Political Committees(Part C) $ 0 All Other Contributions(Part D) $ / i V Total for the reporting period (3) $ / 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) I Total for the reporting period (4) $ r \ i Total Monetary Contributions and Receipts during this reporting period(Add and $ enter amount totals from Boxes 1,2,3 and 4;also enter this amount on Page 1,Report I r 5 St) Cover Page,Item B) PART A Contributions Received From Political Committees10 03 16 $50.01 TO$250.00 Use this Part to itemize only contributions received from Political Committees with an aggregate value from$50.01 TO$250.00 in the reporting period. Filer Identification Number Amount Full Name of Contributing Date[MM/DD/YYYY] I $ Committee � _ f House# Street Address Da...i,vilVODD/YYYY] $ r City [ t&] .f Zip Code Date[MM/DD/YYYY] $ MIIIIIIIIIIIII Full Name of Contributing bate[MM/DD/YYYY] $ Committee /( j //v-?_z_. i/,lm House# Street Address , Date MM DD Z/(/ / /YYl(1�j $ q))D CIAA1Val City � �� bliti( State n� Zip Code �� Date[MM/DD/YYYY] $ IfJ i Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] A $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ PART B All Other Contributions $50.01 TO$250 Use this Part to itemize all other contributions with an aggregate value from $50.01 TO$250 in the reporting period. �J (Exclude contributions from political committees reported in Part A.) Filer Identification Number: 1 Full Name of Contributor Date[MM/DD/YYYYJ $ k1flhi �w S/r7,/z, House# 150 50 Street Address �d (4 /' Date[MM/DD/YYYY] $ frue; Citysl State Zip Code Date[MM/DD/YYYY] $ cim(10 H 1 Full Name of Contribu or Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYYJ $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date(MM/DD/YYYYJ $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date(MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYYJ $ House# Street Address Date(MM/DD/YYYYJ $ City State Zip Code Date[MM/DD/YYYYJ $ i Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYYJ $ PART D All Other Contributions Over$250.00 V P Use this Part to itemize all other contributions with an aggregate value over$250.00 in the reporting period. (Exclude contributions from political committees reported in Part C) Filer Identification Number: Full Name of Contributor Ha Date[MM/DD/YYYY] $ AlAe & i' d i Lie Haa J/161 Z Z Jib` House# Street Address' Date[MM/DD/YYYY] $ City State Zip Code Date(MM/DD/YYYY] $ C�l/11 s �� )) a /3 Employer Name Occupation _/ Employer Mailing Address/ � �/ Principal Place of Business Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/ Principal Place of Business Full Name of Contributor Date(MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/ Principal Place of Business Full Name of Contributor Date(MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/ Principal Place of Business SCHEDULE III Statement of Expendituresf) ki' 0 I Fiier Identification Number: I To Whom Paid bate[MM/DD/YYYY) $ frtA4 / M h /3 lz, 2-‘ , ZS House# /0.7 I Street Address A 71 J a Description of Expenditure City ^ I ,,State Zip fl�Y V l 1 r-e V/ L-u v.(! /jis V �� Code To Whom Paid Date[MM/DD/YYYY] $ a'S,O/A,54(1/W 4/ t 1/1-& eK6/ C2-- House# g 1 orStreet Address P roc_`- �/ / Description of Expenditure Cityvs_is State �� Zip Co ! v 25 V th'1P1 7L D /Jt/ / rP)6� �e Code ( 4 To Whom Paid Date[MM/DD/YYYY) $ /fie`i-e House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY) $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid ' Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY) $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code