HomeMy WebLinkAboutGembusia for State Representative - 2016 Annual Report PAGE 1
Commonwealth of Pennsylvania 1111111111111111111111111111111111111111111111111
Campaign Finance Report 259959
(NOTE:This report must be clear and legible. It may be typed or printed in blue or black ink.)
Filer Identification 20140082 I Report CANDIDATE COMMITTEE V LOBBYIST
Number: Filed By:
Name of Filing Committee,Candidate or Lobbyist: GEMBUSIA FOR STATE REPRESENTATIVE
Street Address: PO BOX 1
City: MOUNT HOLLY SPRINGS State: PA Zip Code: 17065 ////
TYPE OF 6TH TUESDAY 1. 2ND FRIDAY PRE- 2. 30 DAY POST- 3. AMENDMENT Yes No
REPORT PRE-PRIMARY PRIMARY PRIMARY REPORT? ///
6TH TUESDAY 4. 2ND FRIDAY PRE- 5. 30 DAY POST- 6. TERMINATION Yes No ./
(place X to PRE-ELECTION ELECTION ELECTION REPORT? r
the right of
report type) ANNUAL REPORT 7.X Year 2016 FILING METHOD PAPER 1 DISKETTE
( )CHECK ONE
DATE OF ELECTION District Office Party Code County
Name of Office Sought by Candidate: Number Code Code
MO DAY YEAR 193 REP 21
11 8 20161 (SEE INSTRUCTIONS FOR CODES)
Summary of Receipts and MO DAY YEAR MO DAY YEAR FOR OFFICE USE ONLY
Expenditures from: 1 1 2016 TO 12 31 2016 C) NJ
o
A.Amount Brought Forward From Last Report $ 412.73 03
rn A
B.Total Monetary Contributions And Receipts(From Schedule I) $ 0.00 .>•7
I-- N
›
C.Total Funds Available(Sum Of Lines A and B) $ 412.73 7
Q J
D.Total Expenditures(From Schedule III) $ 0.00 j
E.Ending Cash Balance(Subtract Line D From Line C) $ 412.73 rV
7
F.Value Of In-Kind Contributions Received(From Schedule II) $ 0.00 .-• —J
G.Unpaid Debts And Obligations(From Schedule IV) 0.00
AFFIDAVIT SECTION
PART I-If this is a Committee report,treasurer sign here.If this is a Candidate rgp6rf-, +[[;��didate sign here.
I swear(or affirm)that this report,including the attached schedules filed on paper or by electrons me./
e• , - ••l. • st of my knowledge and belief,true
correct and complete. �4,0•'r
Sworn
.t'oAannd subscribed beforeme this /r
7 l'Y 1 20 /7 Signature^of.Person Submitting g Report
day of t kOS
Printed Name
/ Signature R_�tR a fir, 1�Cr
My Commission Expires C M wEA�1H AVIA i 11'1. rick Ent*?QQ
Itt1TARIAI$Flt.
MO DIMEGAN E ORRISYR Area Code Daytime Telephone Number
N,A..�P.tilt
Part II-If this is a report of I carnifiliiikEAROAIMIEMANDMIAMantidate shall sign here.
My Commission Expires Jan 14,2019
I swear(or affirm)that to the b •-• - -- - mittee has not vio d any provisio • of ct of 3 e 3,1937{P.L.1333,
No
3
w rnt asamended.
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Sworn to and subscribed before me this igna reCe
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7 day of 20 7 Q l�((,,�/✓ /1�)�f/ �J
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Notary Public
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My Commission Expires Jan 14,2019
1/27/2017 8:11:40 AM
PAGE 2
SCHEDULE I
CONTRIBUTIONS AND RECEIPTS
Detailed Summary Page
Name of Filing Committee or Candidate Reporting Period
GEMBUSIA FOR STATE REPRESENTATIVE From: 1/1/2016 To: 12/31/2016
1.Unitemized Contributions Received-$50.00 or Less Per Contributor
TOTAL for the Reporting Period (1) $ 0.00
2.Contributions Received- $50.01 To$250.00(From Part A and Part B)
Contributions Received From Political Committees(Part A) $ 0.00
All Other Contributions (Part B) $ 0.00
TOTAL for the Reporting Period (2) $ 0.00
3.Contributions Received Over$250.00(From Part C and Part D)
Contributions Received From Political Committees(Part C) $ 0.00
All Other Contributions (Part D) $ 0.00
TOTAL for the Reporting Period (3) $ 0.00
4.Other Receipts,Refunds,Interest Earned,Returned Checks, Etc.(From Part E)
TOTAL for the Reporting Period (4) $ 0.00
Total Monetary Contributions and Receipts During this Reporting Period(Add and enter amount $ 0.00
totals from Boxes 1,2,3 and 4;also enter this amount on Pagel,Report Cover Page,Item B.)
1/27/2017 8:11:40 AM
PAGE 3
PART A
CONTRIBUTIONS RECEIVED FROM POLITICAL COMMITTEES
$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.
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributing Committee
MO DAY YEAR
Mailing Address
$ 0.00
City State Zip Code(Plus 4)
PAGE TOTAL
Enter Grand Total of Part A on Schedule I, Detailed Summary Page, Section 2. $ 0.00
1/27/2017 8:11:40 AM
PAGE 4
PART B
ALL OTHER CONTRIBUTIONS
$50.01 TO $250.00
Use this Part to itemize all other contributions with an aggregate value from
$50.01 to $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part A)
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributor
MO DAY YEAR
Mailing Address
$ 0.00
City State Zip Code(Plus 4)
PAGE TOTAL
Enter Grand Total of Part A on Schedule I, Detailed Summary Page,Section 2. $ 0.00
1/27/2017 8:11:40 AM
• PAGE 5
PART C
Contributions Received From Political Committees
OVER $250.00
Use this Part to itemize only contributions received from Political committees
with an aggregate value from Over $250.00 in the reporting period.
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributing Committee
MO DAY YEAR
Mailing Address
$ 0.00
City State Zip Code(Plus 4)
PAGE TOTAL
Enter Grand Total of Part C on Schedule I, Detailed Summary Page,Section 3.
$ 0.00
1/27/2017 8:11:40 AM
PAGE 6
PART D
ALL OTHER CONTRIBUTIONS
OVER $250.00
Use this Part to itemize all other contributions with an aggregate value of
over $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C.)
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributor
MO DAY YEAR
Mailing
Address $ 0.00
City State Zip Code(Plus 4)
Employer Name Occupation
Employer Mailing Address/Principal Place of City State Zip Code(Plus 4)
Business
PAGE TOTAL
Enter Grand Total of Part C on Schedule I, Detailed Summary Page,Section 3.
$ 0.00
1/27/2017 8:11:40 AM
• PAGE 7
PART E
OTHER RECEIPTS
REFUNDS, INTEREST INCOME, RETURNED CHECKS, ETC.
Use this Part to report refunds received, interest earned, returned checks and
prior expenditures that were returned to the filer.
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name
MO DAY YEAR
Mailing Address $ 0.00
City State Zip Code(Plus 4)
Receipt Description
PAGE TOTAL
Enter Grand Total of Part E on Schedule I, Detailed Summary Page,Section 4.
$ 0.00
1/27/2017 8:11:40 AM
. PAGE 8
SCHEDULE II
IN-KIND CONTRIBUTIONS AND VALUABLE THINGS RECEIVED
USE THIS SCHEDULE TO REPORT ALL IN-I¢ND CONTRIBUTIONS OF VALUABLE THINGS
DURING THE REPORTING PERIOD.
Detailed Summary Page
Name of Filing Committee or Candidate Reporting Period
GEMBUSIA FOR STATE REPRESENTATIVE From: 1/1/2016 To: 12/31/2016
1.UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR
TOTAL for the Reporting Period (1) $ 0.00
2.IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F)
TOTAL for the Reporting Period (2) $ 0.00
3.IN-KIND CONTRIBUTION RECIEVED-VALUE OVER$250.00(FROM PART G) •
TOTAL for the Reporting Period (3) $ 0.00
TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING PERIOD(Add and enter $ 0.00
amount totals from Boxes 1,2,and 3;also enter on Page 1,Reports Cover Page,Item F.)
1/27/2017 8:11:40 AM
PAGE 9
SCHEDULE II
PART F
IN-KIND CONTRIBUTIONS RECEIVED
VALUE OF $50.01 TO $250.00
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributor
MO DAY YEAR
Mailing Address $ 0.00
City State Zip Code(Plus 4)
Description of Contribution:
Enter Grand Total of Part F on Schedule II,In-Kind Contributions Detailed Summary Page, PAGE TOTAL
Section 2.
$ 0.00
1/27/2017 8:11:40 AM
• PAGE 10
SCHEDULE II
PART G
IN-KIND CONTRIBUTIONS RECEIVED
VALUE OVER $250.00
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributor
MO DAY YEAR
Mailing Address
$ 0.00
City State Zip Code(Plus 4)
Employer of Contributor Occupation
Employer Mailing Address/Principal Place of City State Zip Code(Plus Description of Contribution
Business 4)
PAGE TOTAL
Enter Grand Total of Part G on Schedule II,In-Kind Contributions Detailed
Summary Page,Section 3. 0.00
1/27/2017 8:11:40 AM
PAGE 11
SCHEDULE III
STATEMENT OF EXPENDITURES
Name of Filing Committee or Candidate Reporting Period
From To:
DATE AMOUNT
To Whom Paid
MO DAY YEAR
Mailing Address
$ 0.00
City State Zip Code(Plus 4) Description of Expenditure
PAGE TOTAL
Enter Grand Total of Expenditures on Page 1, Report Cover Page,Item D.
$ 0.00
1/27/2017 8:11:40 AM