COMMONWEALTH OF PENNSYLVANIA

DEPARTMENT OF STATE
BUREAU OF COMMISSIONS, ELECTIONS AND LEGISLATION

TELEPHONE (717) 787-5280

210 NORTH OFFICE BUILDING

HARRISBURG, PENNSYLVANIA 17120-0029
WWW.DOS.STATE.PA.US
FAX (717) 705-0721
E-MAIL: ra-stcampaignfinance@state.pa.us

2015 ELECTION DATES

Municipal Primary Election..
Municipal Election....

...May 19, 2015

....November 3, 2015

2014 CAMPAIGN FINANCE REPORT FILING DATES

TYPE OF REPORT

COMPLETE AS OF

2014 Annual Report

Wed., December 31, 2014

FILING DEADLINE
Monday, February 2, 2015

2015 MUNCIPAL PRIMARY CAMPAIGN FINANCE REPORT DEADLINES

Sixth Tuesday Pre-Primary Cycle 1

Monday, March 30, 2015

Second Friday Pre-Primary Cycle 2

Monday, May 4, 2015

24-Hour Reporting

Daily

Tuesday, May 5, 2015 (begins)

Thirty Day Post-Primary

Cycle 3

Monday, June 8, 2015

Tuesday, April 7, 2015

Friday, May 8, 2015
(ends/includes) May 19, 2015
Thursday, June 18, 2015

2015 MUNICIPAL ELECTION CAMPAIGN FINANCE REPORT DEADLINES

Sixth Tuesday Pre-Election Cycle 4

Monday, September 14, 2015

Tuesday, September 22, 2015

Second Friday Pre-Election Cycle 5

Monday, October 19, 2015

24-Hour Reporting

Daily

Tuesday, Oct. 20, 2015 (begins)

(ends/includes) Nov. 3, 2015

Thirty Day Post-Election

Cycle 6

Monday, November 23, 2015

Thursday, December 3, 2015

Friday, October 23, 2015

2015 ANNUAL REPORT DEADLINE

2015 Annual Report

Cycle 7

Thur., December 31, 2015

Monday, February 1, 2016

POSTMARKS are acceptable as proof of timely filing when the report is postmarked by the U.S. Postal
Service no later than the day prior to the filing deadline.
(OVER)

SIXTH TUESDAY PRE-PRIMARY or PRE-ELECTION REPORTS are required to be filed only by candidates for
statewide office, their authorized candidate committees, and any political committee or lobbyist that has made an
expenditure to influence the election of a statewide candidate. In 2015, statewide offices appearing on the ballot
include the following:
JUSTICE OF THE SUPREME COURT
JUDGE OF THE SUPERIOR COURT
JUDGE OF THE COMMONWEALTH COURT
Political committees/lobbyists that have not made an expenditure to influence the election of a candidate for the
statewide offices listed above do not need to file the Sixth Tuesday Pre Primary/Election report
SECOND FRIDAY PRE- and THIRTY DAY POST-PRIMARY or ELECTION REPORTS are required to be filed
by all candidates appearing on the ballot and all political committees and lobbyists that have made expenditures to
influence the election of such candidates. In 2015, offices appearing on the ballot include:
JUSTICE OF THE SUPREME COURT
JUDGE OF THE SUPERIOR COURT
JUDGE OF THE COMMONWEALTH COURT
JUDGE OF THE COURT OF COMMON PLEAS
MUNICIPAL JUDGE (PHILADELPHIA COUNTY)
ALL LOCAL/MUNICIPAL OFFICES (FILED WITH APPROPIATE COUNTY BOARD OF ELECTIONS)
ANNUAL REPORTS must be filed by all candidates, political committees and contributing lobbyists that have not
filed a termination report.

PENALTIES - In accordance with the Campaign Finance Reporting Law, those who file required reports after
the filing deadline are assessed a late filing fee of $20 per day for the first six days that a report is late, and $10
per day thereafter, up to a maximum penalty of $250.
SPECIAL ELECTION - In the event of any special election, candidates and committees should contact this
bureau regarding reporting requirements and filing deadlines.
POLITICAL COMMITTEE TREASURERS - It is the treasurer's responsibility to file required committee
reports. Keep this schedule available for reference prior to each reporting deadline. If you need a reporting
form, you may print one from the Departments web site (www.dos.state.pa.us) or request one from the bureau.
You may also file your report online. From the web site, select the link to Campaign Finance and then to
Online Filing for more information. Please remember that all reports must include your filer identification
number on the cover page.
24 HOUR REPORTING - Section 1628 of the Campaign Expense Reporting Law, 25 P.S. 3248, requires any
candidate or political committee, authorized by a candidate and created solely for the purpose of influencing an
election on behalf of that candidate, which receives any contribution or pledge of five hundred dollars ($500)
or more, or any person making an independent expenditure of five hundred dollars ($500) or more after the
final pre-election/pre-primary report has been deemed completed shall report such contribution or expenditure
to the appropriate supervisor. The candidate, chairperson or treasurer of the political committee shall send the
report of late contributions within twenty-four (24) hours of receipt of the contribution. The same shall apply
to persons making independent expenditures. The bureau will accept the filing of 24 Hour Reports by
facsimile at 717-705-0721, or via e-mail at: ra-stcampaignfinance@state.pa.us. The filing of reports by
facsimile or e-mail applies only to 24 Hour Reports; it does not apply to the filing of campaign finance reports.
The filing of late contribution reports does not remove the obligation to also report those contributions on the
appropriate post-election/post-primary expense report filing. Please contact our office for specific reporting
dates for late contribution reports.
QUESTIONS - If you have any questions about Pennsylvania's Campaign Finance Reporting Law or reporting
requirements, please direct them to the Campaign Finance Division of this bureau at 717-787-5280 or via email at ra-stcampaignfinance@state.pa.us.
NOTE: All dates are subject to change without notice in the event of passage of any amendatory legislation.

COMMONWEALTH OF PENNSYLVANIA

POLITICAL COMMITTEE REGISTRATION STATEMENT

THIS REGISTRATION STATEMENT IS BEING FILED ON BEHALF OF

COMMITTEE

DATE ________________

CONTRIBUTING LOBBYIST

CHECK BELOW:

NAME OF COMMITTEE OR LOBBYIST

INITIAL REGISTRATION

ADDRESS

AMENDED REGISTRATION
CITY

ZIP-PLUS FOUR

STATE

IF THIS IS AN AMENDMENT:
FILER ID NUMBER ________________

COUNTY

CHECK ALL THAT APPLY:

DAYTIME TELEPHONE NUMBER: AREA ____/_______________________

NEW COMMITTEE ADDRESS

E-MAIL ADDRESS:

NEW CHAIRPERSON

___________________________________________

NEW TREASURER
IS THIS A CANDIDATES AUTHORIZED POLITICAL COMMITTEE?

YES

NO

OTHER ________________
(SPECIFY)

SUPPORTED CANDIDATES
List below the names of candidates the committee/lobbyist intends to support, or candidates who have authorized the committee to
receive funds on their behalf. A committee that is not a candidates authorized political committee may list the offices of candidates it
intends to support (e.g., Statewide, Legislative, Judicial, Local, All) and need not list names of specific candidates.
Name of Candidate(s)

Address

Office Sought

Political Party/Body

IF THE COMMITTEE INTENDS TO SUPPORT OR OPPOSE A BALLOT QUESTION, PLEASE COMPLETE THIS SECTION.
THIS COMMITTEE

SUPPORTS

THE FOLLOWING BALLOT QUESTION:

OPPOSES

FOR OFFICE USE ONLY

HOW LONG DOES THE COMMITTEE (OR LOBBYIST) INTEND TO OPERATE:

ELECTION YEAR _____________ONLY

Department of State

INDEFINITELY

Bureau of Commissions, Elections and Legislation

210 North Office Building

DSEB-500 (12-99)W

Harrisburg, PA 17120-0029

(717) 787-5280

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SEC-1
(Rev. 01/15)
6(&5HY

COMMONWEALTH OF PENNSYLVANIA

POLITICAL COMMITTEE REGISTRATION STATEMENT

THIS REGISTRATION STATEMENT IS BEING FILED ON BEHALF OF

COMMITTEE

DATE ________________

CONTRIBUTING LOBBYIST

CHECK BELOW:

NAME OF COMMITTEE OR LOBBYIST

INITIAL REGISTRATION

ADDRESS

AMENDED REGISTRATION
CITY

ZIP-PLUS FOUR

STATE

IF THIS IS AN AMENDMENT:
FILER ID NUMBER ________________

COUNTY

CHECK ALL THAT APPLY:

DAYTIME TELEPHONE NUMBER: AREA ____/_______________________

NEW COMMITTEE ADDRESS

E-MAIL ADDRESS:

NEW CHAIRPERSON

___________________________________________

NEW TREASURER
IS THIS A CANDIDATES AUTHORIZED POLITICAL COMMITTEE?

YES

NO

OTHER ________________
(SPECIFY)

SUPPORTED CANDIDATES
List below the names of candidates the committee/lobbyist intends to support, or candidates who have authorized the committee to
receive funds on their behalf. A committee that is not a candidates authorized political committee may list the offices of candidates it
intends to support (e.g., Statewide, Legislative, Judicial, Local, All) and need not list names of specific candidates.
Name of Candidate(s)

Address

Office Sought

Political Party/Body

IF THE COMMITTEE INTENDS TO SUPPORT OR OPPOSE A BALLOT QUESTION, PLEASE COMPLETE THIS SECTION.
THIS COMMITTEE

SUPPORTS

THE FOLLOWING BALLOT QUESTION:

OPPOSES

FOR OFFICE USE ONLY

HOW LONG DOES THE COMMITTEE (OR LOBBYIST) INTEND TO OPERATE:

ELECTION YEAR _____________ONLY

Department of State

INDEFINITELY

Bureau of Commissions, Elections and Legislation

210 North Office Building

DSEB-500 (12-99)W

Harrisburg, PA 17120-0029

(717) 787-5280

AFFILIATED AND CONNECTED ORGANIZATIONS

Affiliated means (1) authorized committees of the same candidate, and (2) committees, including separate segregated funds, established, administered, maintained or
controlled by the same corporation, unincorporated association, person or group of persons, including a parent, subsidiary, branch, division, dept. or local unit.
Connected means an organization which is not a political committee but which directly or indirectly establishes, maintains, controls or administers the registrant, such
as a corporation, an unincorporated association, a membership organization, a cooperative or a trade association.
NAME OF AFFILIATED/CONNECTED ORGANIZATIONS

MAILING ADDRESS AND ZIP CODE

RELATIONSHIP TO REGISTRANT

APPOINTMENT AND ACCEPTANCE OF CHAIRPERSON

FULL NAME OF CHAIRPERSON

MAILING ADDRESS AND ZIP CODE

DAYTIME TELEPHONE NUMBER

AREA _________ NUMBER ___________________________________________

I accept the appointment of chairperson of this committee until the final campaign finance report is filed, or until my successor is duly chosen and the
appropriate supervisor is notified. I understand the campaign finance reporting law requirements. I also understand that if I wish to resign, I must do
so in writing to the committee.
__________________________________________________________

___________________________

SIGNATURE OF CHAIRPERSON

DATE

APPOINTMENT AND ACCEPTANCE OF TREASURER

FULL NAME OF TREASURER

MAILING ADDRESS AND ZIP CODE

DAYTIME TELEPHONE NUMBER

AREA _________ NUMBER ___________________________________________

I accept the appointment of treasurer of this committee until the final campaign finance report is filed, or until my successor is duly chosen and the
appropriate supervisor is notified. I understand the campaign finance reporting law requirements. I also understand that if I wish to resign, I must do
so in writing to the committee.
__________________________________________________________
SIGNATURE OF TREASURER

___________________________
DATE

LIST BELOW NAMES OF BANKS, SAFETY DEPOSIT BOXES OR OTHER FINANCIAL REPOSITORIES
NAME OF BANKS, REPOSITORIES, ETC.
MAILING ADDRESS

PRINTED NAME OF PERSON SUBMITTING THIS STATEMENT

SIGNATURE OF PERSON SUBMITTING THIS STATEMENT

DATE

STATEMENT OF FINANCIAL INTERESTS INSTRUCTIONS

Please print neatly in capital letters. If you require more space than has been provided, please
attach an 8 X 11 piece of paper to the form. Blocks 01 through 06 are for current information.

List a business, governmental and/or home address and daytime telephone number.
Block 1

Please fill in your last name, first name, middle initial and suffix (if applicable) in the boxes provided. Public office candidates should use the
exact name used on official nomination petition or papers.

Block 2

List an office (business or governmental) or home address and daytime telephone number.

Block 3

Please check the block or blocks to indicate your status. See definitions on page 1. If you are correcting a prior filing, please check the block,
designating an amended form.

Block 4

Please check the appropriate block (seeking, hold, held) for each position you list in the blocks below. List all of the public position(s) which
you are seeking, currently hold, or have held in the prior calendar year. Please be sure to include job titles and official titles such as
member or commissioner (even if serving as an alternate/designee).

Block 5

Please list all political subdivision(s) agency(ies) as to which you: (1) are presently seeking a public position or public office as a candidate
(incumbent or non-incumbent) or nominee; (2) presently hold a public position or public office; and/or (3) previously held a public position or
public office during all or any portion of the calendar year listed in block 7. (The term political subdivision includes a county, city, borough,
incorporated town, township, school district, vocational school, county institution, district, and any authority, entity or body organized by the
aforementioned.)

Block 6

List the calendar year for which you are filing this form. For Example, if this form is being completed in the calendar year 2014,
Please
your current
occupation
Thisininformation
have already
beenrepresent
stated in block
4.
block
07 list
should
read 2013
and or
allprofession.
information
blocks 08may
through
15 should
financial
interests for calendar year 2013.

Block 7

List the calendar year for which you are filing this form. For example, if this form is being completed in the calendar year 2015, block 07
should read 2014 and all information in blocks 08 through 15 should represent financial interests for calendar year 2014.

Block 8

REAL ESTATE INTERESTS: This block contains the address of any property which was involved in transactions (leasing, purchasing, or
condemnation proceedings of real estate interests) with the Commonwealth or any other governmental body within the Commonwealth. If you
have no direct or indirect interests in such a property, then check NONE.

Block 9

CREDITORS: This block contains the name and address of any creditor and the interest rate of any debt over $6,500 regardless of whether
such debt is held solely by you or jointly by you and any other individual, including your spouse, where each obligor is fully responsible for the
obligation. A joint obligation with other persons, for which the filer is responsible only for a proportional share that is less than the reporting
threshold, is not required to be reported. Do not report a mortgage or equity loan on your home (or secondary home), or loans or credit
between you and your spouse, child, parent or sibling. Car loans, credit cards, personal loans and lines of credit must be listed on the form if
the balance owed was in excess of $6,500 at any time during the calendar year. If you do not have any reportable creditor, then check
NONE.

Block 10 DIRECT OR INDIRECT SOURCES OF INCOME: List the name and address of each source of $1,300 or more of gross income regardless of
whether such income is received solely by you or jointly by you and another individual such as a spouse. Income includes any money or
thing of value received or to be received as a claim on future services or in recognition of services rendered in the past, whether in the form of
a payment, fee, salary, expense, allowance, forbearance, forgiveness, interest, dividend, royalty, rent, capital gain, reward, severance
payment, proceeds from the sale of a financial interest in a corporation, professional corporation, partnership or other entity resulting from
termination/withdrawal therefrom upon assumption of public office or employment or any other form of recompense or combination thereof.
The term refers to gross income; it includes prize winnings and tax-exempt income but does not include gifts, governmentally mandated
payments or benefits, retirement, pension or annuity payments funded totally by contributions of the public official or employee, or
miscellaneous, incidental income of minor dependent children. If you do not have ANY reportable source of income, then check NONE.
Block 11 GIFTS: For each source of gift(s) valued at $250 or more in the aggregate, list the following information: the name and address of the source;
the circumstances, including a description, of each gift; and the value of the gift(s). Do not report political contributions otherwise reportable as
required by law, gift(s) from friends or family members (although the term friend does not include a registered lobbyist or employee of a
registered lobbyist), or any commercially reasonable loan made in the ordinary course of business. If you did not receive any reportable gift,
then check NONE.
Block 12 TRANSPORTATION, LODGING, OR HOSPITALITY EXPENSES: List the name and address of each source and the amount of each
payment/reimbursement
by the source
transportation, lodging
or hospitality
youand
received
in connection
with and
your the
public
position
if the payTRANSPORTATION,
LODGING,
ORfor
HOSPITALITY
EXPENSES:
List thethat
name
address
of each source
amount
of each
aggregate amount of such
by the
source
$650that
for you
the calendar
for which you
areyour
reporting.
not
ment/reimbursement
by thepayments/reimbursements
source for transportation,
lodging
orexceeds
hospitality
receivedyear
in connection
with
publicDo
position
if
reimbursements
by a governmental body or byby
anthe
organization/association
officials/employees
of political
subdivisions
thereport
aggregate
amount ofmade
such payments/reimbursements
source exceeds $650 of
forpublic
the calendar
year for which
you are
reporting. Do
you serve
in an official capacity.
you do not havebody
any reportable
expense payments/reimbursements,
check NONE. of political subnotthat
report
reimbursements
made by Ifa governmental
or by an organization/association
of publicthen
officials/employees

you serve in an
official
capacity. IfINyou
doBUSINESS
not have any
reportable
expense
payments/reimbursements,
thenentity
check

Block 13divisions
OFFICE,that
DIRECTORSHIP
OR
EMPLOYMENT
ANY
ENTITY:
List both
the name
and address of the business
forNONE.
any
office that you hold (for example, President, Vice President, Secretary, Treasurer), any directorship that you hold (through service on a
governing board such as a board of directors), and any employment that you have in any capacity whatsoever as to any business entity. This
block focuses solely on your status as an officer, director or employee, regardless of income. If you do not have any office, directorship or
employment in any business entity to report, then check NONE.
Block 14 FINANCIAL INTERESTS: List the name and address and interest held in any business for profit of which you own more than 5% of the equity
or more than 5% of the assets of economic interest in indebtedness. If you do not have any such financial interest to report, then check
NONE.
Block 15 TRANSFERRED BUSINESS INTERESTS: List the name and address of any business as to which you transferred a financial interest (as
defined in Item 14) to a member of your immediate family (parent, spouse, child, brother or sister), as well as the interest held, relationship to
the individual, and date of transfer. If you did not transfer any such business interest, then check NONE.
Please sign the form and enter the current date. Do not back date your signature.

SEC-1 (Rev. 01/15)



01/15

ADDRESS office (business or governmental) or home

Indicate calendar year for which form is being filed. SEE INSTRUCTIONS.

DIRECT OR INDIRECT SOURCES OF INCOME including (but not limited to) all employment.

THIS FORM IS CONSIDERED DEFICIENT IF ANY BLOCK ABOVE IS NOT COMPLETED. MAKE A COPY FOR YOUR RECORDS.

ORIGINAL COPY

ADDITIONAL FILINGS

No additional
copy required

State Ethics Commission

Additional copy is not required to

be filed (unless serving in
multiple capacities, then file with
each entity as required)

No additional copy required

Additional copy is not required to

be filed (unless serving in
multiple capacities, then file with
each entity as required)

* FILER IS RESPONSIBLE FOR MAKING ANY ADDITIONAL COPIES.

AFFILIATED AND CONNECTED ORGANIZATIONS

Affiliated means (1) authorized committees of the same candidate, and (2) committees, including separate segregated funds, established, administered, maintained or
controlled by the same corporation, unincorporated association, person or group of persons, including a parent, subsidiary, branch, division, dept. or local unit.
Connected means an organization which is not a political committee but which directly or indirectly establishes, maintains, controls or administers the registrant, such
as a corporation, an unincorporated association, a membership organization, a cooperative or a trade association.
NAME OF AFFILIATED/CONNECTED ORGANIZATIONS

MAILING ADDRESS AND ZIP CODE

RELATIONSHIP TO REGISTRANT

APPOINTMENT AND ACCEPTANCE OF CHAIRPERSON

FULL NAME OF CHAIRPERSON

MAILING ADDRESS AND ZIP CODE

DAYTIME TELEPHONE NUMBER

AREA _________ NUMBER ___________________________________________

I accept the appointment of chairperson of this committee until the final campaign finance report is filed, or until my successor is duly chosen and the
appropriate supervisor is notified. I understand the campaign finance reporting law requirements. I also understand that if I wish to resign, I must do
so in writing to the committee.
__________________________________________________________

___________________________

SIGNATURE OF CHAIRPERSON

DATE

APPOINTMENT AND ACCEPTANCE OF TREASURER

FULL NAME OF TREASURER

MAILING ADDRESS AND ZIP CODE

DAYTIME TELEPHONE NUMBER

AREA _________ NUMBER ___________________________________________

I accept the appointment of treasurer of this committee until the final campaign finance report is filed, or until my successor is duly chosen and the
appropriate supervisor is notified. I understand the campaign finance reporting law requirements. I also understand that if I wish to resign, I must do
so in writing to the committee.
__________________________________________________________
SIGNATURE OF TREASURER

___________________________
DATE

LIST BELOW NAMES OF BANKS, SAFETY DEPOSIT BOXES OR OTHER FINANCIAL REPOSITORIES
NAME OF BANKS, REPOSITORIES, ETC.
MAILING ADDRESS

PRINTED NAME OF PERSON SUBMITTING THIS STATEMENT

SIGNATURE OF PERSON SUBMITTING THIS STATEMENT

DATE