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Home My WebLink AboutFriends of Mercedes Evans - 2022 30-Day Post-Primary irPennsylvania Department of State I 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 Filing Committee,Candidate, or Lobbyist.. Friends of Mercedes Evans Reporting Cycle Name ❑ Cycle 1 ❑ Cycle 2 El Cycle 3 El Cycle 4 ❑ Cycle 5 6th Tuesday 2nd 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 2"d Friday Pre-Special Election 30 Day Post-Special Election Part 1 — 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. 06/15/2022 Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY) Patricia Smith Harrisburg, PA, USA Printed Name Location (City/State/Country) DSEB-503S Updated 1/5/2022 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 Part I! - 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. 4.171"Vi vide 06/15/2022 Signature of Candidate Date (DD/MM/YYYY) Mercedes Evans Camp Hill, PA USA Printed Name Location (City/State/Country) • DSEB-503S Updated 1/5/2022 COMMONW`EACTH 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. vim/ FILER IDENTIFICATIONlip REPORT FILED ® I CANDIDATE COMMITTEE j� LOBBYIST NUMBER ON BEHALF OF 1/ NAME OF FILING COMMITTEE,CANDIDATE OR LO BYIST &11 ul 6 of; 2t'C(c<.S &-VG 25 STR ADDRESS Pod M 3)-l5 n qqqiCITY ��p STATE �0f i_ i/TTYYPyEE OF REPORT NNAME OF OFFICE SOUGHT BY CANDIDATE DISTRICT/( NO. PARTY ''DATE OF ELECTION (CHECK ONE) MDAY YEAR I o3 ./ 1 10 b V ,P-01--2-• 6TH TUESDAY PRE-PRIMARY FOR OFFICE USE ONLY MO. DAY YEAR MO. DAY YEAR 2ND FRIDAY 2. DATES OF /- t !T ` /.�/ /� PRE-PRIMARY REPORTING r-)4, t ly 9 TO ye 1 to in_ PERIOD �/V) l/✓ �"� V 1`C(/ l4VJ/ (/ 30 T-P 3;/ w � POST-PRIMARY /�(` CASH BALANCE AT END "////�� i 16 J�0E ISM oaa 4. OF REPORTING PERIOD: $ 6TH TUESDAY PRE-ELECTION 3' 5o P t vx TOTAL AMOUNT OF FILER'S 2ND FRIDAY s. OUTSTANDING DEBTS OR LIABILITIES PRE-ELECTION AT THE END OF REPORTING PERIOD: $ o. 30 DAY AMENDMENT POST-ELECTION REPORT? YES NO 7. ANNUAL TERMINATION yEs NO A REPORT REPORT? 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. I SWEAR(OR AFFIRM)THAT THE AGGREGATE RECEIPTS OR DISBURSEMENTS OR LIABIUTIES INCURRED DURING THE REPORTING PERIOD INDICATED ABOVE DID NOT EXCEED TWO HUNDRED AND FIFTY DOLLARS($250.00)AND THIS REPORT IS,TO THE HEST OF MY KNOWLEDGE ANO BELIEF,TRUE,CORRECT AND COMPLETE, SWORN TO AND SUBSCRIBED BEFORE ME THIS DAY OF 20__. SIGNATURE OF P RSON SUWMITTING REPORT PCI�r aci i'n ii PRINTED NAME ,.••� SIGNATURE 1'1..1 /1\n-* i)•5 4, ✓ MY COMMISSION EXPIRES I (J'`f 711i' 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(Rt.. 1333,No.320)AS AMENDED. �,/pdig- /fSWORN TO AND SUBSCRIBED BEFORE ME THISI-010 V✓ '�L' �G/� �DAY OF 20 M'erc d,es t/v CANDIDATE OF �--••--'�""J� PRINTED NAME \/' SIGNATURE i 30 ,-19-- MY COMMISSION EXPIRES AREA CODE D YTIMLEPHONE NUMBER MO. DAY YR. Department of State • Bureau of Commissions,Elections and Legislation DSEF3-503(12-99) 210 North Office Building • Harrisburg,PA 17120-0029 • (717)787-5280