HomeMy WebLinkAboutFriends of Nate Silcox - 2022 30-Day Post-Primary Pennsylvania Department of State
Bureau of Campaign Finance&Lobbying Disdosure
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 unworn
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
Friends of Nate Silcox
Reporting Cycle Name
❑ Cycle 1 0 Cycle 2 ® Cycle 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-Electron
❑ Cycle 6
❑ Cycle 7 0 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 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.
ezintf, 6/16/2022
Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY)
Craig Mellott Mechanicsburg/PA/USA
Printed Na me Location (City/State/Country)
DSEB-502R
Updated 1/5/2022
Pennsylvania Department of State
fay Bureau of Campaign Finance&Civic Engagement
500 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@pa.gov
Part It-If this form is submitted with a report by a Candidate's Authorized Committee, the
candidate 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.
L Ila1 Z o Z 2
Signature of Treasurer,Candidate,or Lobbyist Date (MM/DD/YYYY)
Ch.<1 -a. ,.? P S t G.p,t 1-A r>.n. P -r • P t
Printed Name Location (City/State/Country)
DSEB-502R
Updated 1/5/2022
�� ( ..•. rsrvotaictt ,;, i. T?nyarvurr".,
Commonwealth of Pennsylvania-Campaign Finance Report
(Note:This report must be clear and legible.It should be typed)
Fi1b'r Me>ttiHcation Report Ftled 20200372 • Sy. Candidate Contm)ttee igbbytst
Number " (Mark;X}
Name of lrlling Corrtrtrittee,Candidate or
1Abbybt Friends of Nate Silcox
Street Address P.O.Box 882
Camp Hiil " PA 'Ztp Cod@ 17011
Type of Report(Place x under report type) ,
X z >2 Frrday 3 3a ipeyfost a-�►+Tuesday 5 �'a Fria>;ty so oay:>?ose 7-_annual; spit 2""Friday sdeclsl 3a,Qay
1=8 Tuesda
Electio» Pre-Erection PostEi@ctldn Pre-Pdmery Pre-Primary Primary Pre-Erection ::Pre Election ,,
Date Of Election Year Amendment Termination 05/17/2022 --
R(MM/DD/YY1fX) eport .. ftepoit
Summaryof Receipts end Firom;Date >> `.,To Dote For Office:Use Only
Expenditures
05/o2/22 06/06/22
A<Amount:9wught'•Forward Frottt test Repoli $ 1,640.53
B Total Monetary Coe ibutions and:Receipts -„` $
(From Schedule i) 0
C Total andsAvailitble $ J 1L E i(a r aeaa.
1,640.53
(Sum Of Lrees A artd;B}
D:Total Expenditures $ I a 3 O P d A
0
tFrom Sthedule:ill) ;
Endingi tsh Balance $
(Subtract line Q from Una C) 1,640.53 -
F Value.of.lit-Kind':Conttibutlons Received $ .
(From Sdiedule tt} :. 0
to Unpaid`Debts and Obttgatlons $
0
(From Schedule. `>
Affidavit Section
Part I-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 my knowledge and belief true,correct and complete.
Sworn to and subscribed before me this ,
da of 20 g Slgnat rR. f pf r>on Submitting report
Craig �IVV�I L
Signature 71 7 Printed Name
• 234-1430
My Commission expires
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 ..
of 20 •
Signature of Candidate
Signature Printed Name
•
My Commission expires i
MO. DAY YR. Area Code Daytime Telephone Number