CoMMONWEALTH oF PENNSYLVANIA

AUTHORIZATION FOR A POLITICAL COMMITIEE

TO RECEIVE FUNDS ON BEHALF OF A CANDIDATE

The Pennsylvania Election Code provides that no treasurer of a political

shall receive any money on behalf of a candidate uAtil
such political committee has be8n authorized in writing by the candidate on a form designed by thO Secretary of the Commonwealih.
The written authorization shall be filed with the appropriate supervisor prior to receiving funds on behalf of the candidate.
[
I

DAYTIME TELEPHONE NUMBER

NAME OF POLITICAL COMMmEE

AREA / NUMBER

Allan Domh for Citu Counci 1

ADDRESS OF COMMITIEE

'
i'

1845 Walnut Street, Suite 2200

STATE

CITY

Philadelphia

''

ZIP PLUS FOUR

PA

'i

19103

I
I

NAME OF CANDIDATE AUTHORIZING POUTICAL COMMITTEE

ILlll

f\nmh

OFFICE SOUGHT BY CANDIDATE

I
DISTRICT NUMBER

'

NAME Of POLITICAL PARTY/BODY

I

Philadelnhia City Council at Large ..

Democractic

ADDRESS OF CANDIDATE

i
I

Philadelnhia

I
!

ZIP PLUS FOUR

STATE

CITY

PA
'

the political committee named above to receije cont?butions on behalf of my candidacy.

)\

FOR OFFICE USE ONLY

Any stbte, county, city, borough, township, ward or other regularly constituted
party committee of any political party or political body is hereby authorized to
receive money on behalf of the candidates of such political party or political
body in a general, municipal or special election without special written autho
rization from such candidate. However, authorization is required for such com
mittees to receive funds on behalf of a candidate in a primary election.

!';?;

<..r,

C)

,rng
p,;;?:

-J

"Lo

"'"

::;:1

()

,'if
f;i;:

t.v

Q[J

(::; ;.,l

?E

TJ

ps

.!.l

f17

t,,

Uepartment of State
DSEB50 I (12-99)

303 North Office Building

Bureau of Commissions, Elections and legislation

Harrisburg, PA 17120.0029

(717) 787-5280

if!'

COMMONWEALTH OF PENNSYLVANIA

POLITICAL COMMITIEE REGISTRATION STATEMENT

THIS REGlSTRATION STATEMENT IS BEING FILED ON BEHALF OF'

COMMITTEE

CONTRIBUTING LOBBYIST

NAME OF COMf>..UTrEE OR LOBBYIST

x.

1845 Walnut St., Suite 2200;

CITY

ZIP-PLUS FOUR

Philadelphia, P A 191 03

-----

CHECK BELOW:

Allan Domb for City Council

ADDRESS

DATE

INITIAL REGISTRATION
AMENDED REGISTRATION

IF THIS IS AN AMENDMENT:

:;
!i

FILER ID NUMBER

COUNTY

Philadelphia

CHECK ALL THAT APPLY:

545.1500.
faux@allandomb.com

D
D
D
D

DAYTIME TELEPHONE NUMBER:

E-MAIL ADDRESS:

IS THIS A CANDIDATE'S AliTHORIZED POLITICAL COMMITIEE?

X.. YES

No

NEW COMMITIEE ADDRESS

NEW CHAIRl'ERSON
NEW TREASURER

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 candidate's 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

Address

..

AllanDomb
-

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

TillS COMMmEE

Office Sought

Political Partyffiody.

Philadelphia
City Council at Large

SUPPORTS

OPPOSES

Democratic
..

SECTlON.

TilE FOLLOWING BALLOT QUESTION:

Not applicable.

FOR OFFICE USE ONLY

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

%5
I

ELECTION YEAR _ _ _ __cONLY

.X

lNDEFINI1ELy

Department of State Bureau of Commissions, Elections and Legislation

210 North Office Building Harrisburg, PA 17120-0029 (717) 787-5280
DSEB-500 (l2-99)W

vJ

-o

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
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.
MAILING ADDRESS AND ZIP CODE

NAME OF AFFILIATED/CONNECfED ORGANIZATIONS

RELATIONSHIP TO REGISTRANT

Not applicable.

"

APPOINTMENT AND ACCEPTANCE OF CHAIRPERSON.

FULL NAME OF CHAIRPERSON

DA

215

!f

1700 Market St., Suite 3100

Philadelphia, PA 19103

NUMBER

AREA

MAILING ADDRESS AND ZIP CODE

Henry J.

. 563.2400

1
"

;I

NUMBER .

I accept the appointment of chairperson of this committee until the fmal 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! wish to resign. I must do

'?I r I I J --

so in writing t z : : : .

DATE

APPOINTMENT AND ACCEPTANCE OF TREASURER

-.

FULL NAME 011 TREASURER.

MAILll'lG ADDRESS AND ZIP CODE

-

Nicole R. Faux
DAYriME TELEPHONE NUMBER
AREA

215

1845 Walnut St., Suite 2200

Philadelphia, PA 19103

I accept the appointment of treasurer of this committee until the final campaign fmance 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 ifl wish to resign, I must do
so in writing to the committee.

I
DATE

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

TD Bank, N .A.
PRINTED NAME OF PERSON SUBMITIING THIS STATEMENT

Gregory M. Harvey

1726 Walnut Street

Philadelphia, P A 191 03;
SlGNATURE OF PERSON SUDMITIING THIS STATEMENT

DATE