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HomeMy WebLinkAboutGossert, Michael - 2017 30-Day Post-Primary Reset Form r Print Form II II Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible.It should be typed) Filer Identification Report Filed By Candidate X Committee ri Lobbyist ri Number (Mark X) Name of Filing Committee,Candidate or Lobbyist Michael Gossert Street Address 690 Crooked Stick Dr. City Mechanicsburg State PA Zip Code 17050 Type of Report(Place x under report type) eh Tuesday 2- 2"d Friday 3-30 Day Post 4-6t Tuesday 5-2"d Friday 6-30 Day Post 7-Annual Special 2"Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election X Date Of Election Year • Amendment Termination (MM/DD/YYYY) Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 5/1/2017 6/5/2017 A.Amount Brought Forward From Last Report $ 0 C7 0 B.Total Monetary Contributions and Receipts $ (From Schedule I) 0 m c_ C.Total Funds Available $ rn (Sum of Lines A and B) 0 _ D.Total Expenditures $ C.e.) (From Schedule III) 0 C� 3,13 E.Ending Cash Balance $ n (Subtract Line D from Line C) 0 Cj F.Value of In-Kind Contributions Received $ Q �- (From Schedule II) a ( �• U --< -GCn G.Unpaid Debts and Obligations $ 0 (From Schedule IV) .. Affidavit Section Part 1-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 day of .:tur of Pers • ittin t I dpi? Sp—rt Signature Printed Name (/,, My Commission expires " (7y= `" C MO. D• YR. Area Code Daytime Tele• one 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 lune 3,1937(P.L.1333,NO.320)as amended. Cprnmorlw ea.l Lin of P'ennsy1V4.11j : Cumberland erlard Ca ri y Sworn to and subscribed before me this 51.11 day of `J(.(.n� 20 / ,C,„atprg of Signature �f ^/� Printed Name My Commission expires c2 -� I -OL VI3 l� 303 /�O y 6 MO. DAY YR. Area Code Daytime Telephone Number NOTARIAL SEAL Kathleen T.Milone,Notary Public Sd.er Spring Twp.,Cumberland County My Commission Expires Feb.24,2018 YYEiR, PENNSYLVANIA ASSOCIAtION OF NOTARIES SCHEDULE II IN-KIND CONTRIBUTIONS AND VALUABLE THINGS RECIEVED USE THIS SCHEDULE TO REPORT ALL IN-KIND CONTRIBUTIONS OF VALUABLE THINGS DURING THE REPORTING PERIOD DETAILED SUMMARY PAGE Filer Identification Number: I1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the reporting period (1) $ `. I2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) TOTAL for the reporting period (2) $ 3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) f TOTAL for the reporting period (3) $ TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING $ PERIOD(Add and enter amount totals from boxes 1,2,and 3;also enter on Page 1,Report Cover Page,Item F) SCHEDULE II Part G In-Kind Contributions Received VALUE OVER$250 Filer Identification Number: Full Name of Contributor Date[MM/DD/YYYY] $ �s Hampden Township Republican Association 5-/i L j i 7, ttt��� k ` (� House# Street Address Date[MM/DD/YYYY] $ P.O.Box 283 City State Zip Code Date[MM/DD/YYYY] $ Camp Hill PA 17011 Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Mailer/Flyer Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY], $ City State Zip Code Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution