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Home My WebLink AboutCommittee to Elect Shelly Capozzi - 2019 30-Day Post-Primary Commonwealth of Pennsylvania-Campaign Finance Report . (Note:This report must be clear and legible.It should be typed) Filer Identification Report Filed By Candidate Committee `/ Lobbyist Number 833397394 (Mark X) n Name of Filing Committee,Candidate or Lobbyist Committee to Elect Shelly Capozzi Street Address 1655 Holly Pike • City Carlisle State PA Zip Code 17015 Type of Report(Place x under report type) 1-6u' Tuesday 2- 2nd Friday 3-30 Day Post 4-6thTuesday 5-2"d Friday 6-30 Day Post 7-Annual Special 2"O 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) 5/21/2019 2019 Report X Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 5/7/2019 6/10/2019 . A.Amount Brought Forward From Last Report $ 2104.72 t'. B.Total Monetary Contributions and Receipts $ 'I..;(From Schedule I) 217.73 --. C.Total Funds Available $ ► t 2322.45 (Sum of Lines A and B) r-- D.Total Expenditures $ C7 (From Schedule III) 647.66 C7 E.Ending Cash Balance $ 1674.79 jam' (Subtract Line D from Line C) C7 . F.Value of In-Kind Contributions Received $ . (From Schedule II) 0 -C -CM 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 • .1 on paper,is to the best of my knowledge and belief true,correct and complete. Sworn1Jt�o and subscribed before me this 1 j /7/ 4(._ da y of 20 &I �� 4 1 1 1 1C Signature of Per n Submitting report rti Signature 1. c. Printed Name My expires � )4 t,a2.1 .117 �4-/-7 �Z, Commission z MO. DAY YR. a. `9 2 Area Code Daytime Telephone Number 6,, P,, f Part II-If this is a report of a Candidate's Authorized Committee,,.ndf6lat• N. sign here. I swear(or affirm)that to the best of my knowledge and belief this ...•• ical committee has not violated any provisions of the Act of June 3,1937(P.L 1333,NO.320)as amended. / A Sworn to and subscribed before me this % $I. 1 N. da of n 209 _QA)011 1.11 ., 3• u i i 1 s ^ g� S•• natuyi of Ca did to C Qi o. 1 C Signature ,R c0 9 v / Printed'Name c/. . i4 ,, �° a• �I� 919-7a-o(P My Commission expires ;> 2 MO. DAY YR. N Area Code Daytime Telephone Number m 1111 III IIIIIIII IIIIIIIIIIIIII1�f I11 0Reset Form mint Form Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible. It should be typed) Filer Identification Report Filed By Candidate Committee ` Lobbyist I Number 833397394 (Mark X) n I Name of Filing Committee,Candidate or Lobbyist Committee to Elect Shelly Capozzi • Street Address 1655 Holly Pike City Carlisle State PA Zip Code 17015 Type of Report(Place x under report type) 1-6th Tuesday 2- 2nd Friday 3 30 Day Post 4-616Tuesday 5-2nd 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 AmendmentTermination (MM/DD/YYYY) 05/21/2019 2019 Report r Report Summary of Receipts and From Date To Date For Office Use Only I Expenditures 05/07/2019 06/10/2019 A.Amount Brought Forward From Last Report $ 2,104.6 B.Total Monetary Contributions and Receipts $ • (From Schedule I) 217.73 C.Total Funds Available $ (Sum of Lines A and B) 232233, . ,, ..c) D.Total Expenditures $ L (From Schedule III) 647.66 E.Ending Cash Balance $ r--• (Subtract Line D from Line C) 1,647.67 � COF.Value of In-Kind Contributions Received $ CJ — wi (From Schedule II) 0 CD 3' C) G.Unpaid Debts and Obligations $ 9;) (From Schedule IV) 0 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. Swroorrn,tg and subscribed before me this /O i day of,..Lt, 20 / l G 1 iii, c-14 �� Commonwealth of Pennsylvalia•Notary Seal �g atu,of rso Submitting report 1%L(1� EGAN -Nota ublic t / 1 Signature Cumberland Co ty Printed Name .,f M C Sion Expires an 14,2023 My Commission expire• r-1 r � sion Number 1260066 -7/ , 96 /-I/n f Z- MO. DAY Yti. Area Code Daytime Telephone 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 June 3,1937(P.L.1333,NO.320)as amended. Sworn toand subscribed before me this • � /344` day o� 20 / .41 1_`/ / ' Sig re of Candidate Signature ,-,- ,f I Print d Name My Commission expire,JEkl - /L r P-0a3 1 (--1 _ ? 1_1=7Z-42G____ MO. DAY V° A ea Code Daytime Telephone Number Commonwealth of Pennsylvania-Notary Seal MEGAN ORRIS-Notary Public Cumberland County My Commission Expires Jan 14,2023 Commission Number 1260066 SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number 1833397394 1 1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor /f Total for the reporting period (1) $ 0 I2.Contributions of$50.01 to $250.00(From Part A and Part B) Contributions Received from Political Committees(Part A) $ 217.73 All Other Contributions(Part B) $ 0 Total for the reporting period (2) $ 217.73 3.Contributions Over$250.00(From Part C and Part D) I Contributions Received from Political Committees(Part C) $ 0 All Other Contributions(Part D) $ 0 Total for the reporting period (3) $ 0 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC(From Part E) I Total for the reporting period (4) $ 0 Total Monetary Contributions and Receipts during this reporting period(Add and $ enter amount totals from Boxes 1,2,3 and 4;also enter this amount on Page 1,Report Cover Page,Item B) 217.73 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. Filer Identification Number 833397394 Amount Full Name of Contributing Date[MM/DD/YYYY] $ Committee Gembusia for State Representative 217.73 05/10/2019 House# Street Address Date[MM/DD/YYYY] $ P.O.Box 1 City State Zip Code Date[MM/DD/YYYY] $ Mount Holly Springs PA 17065 Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/OD/YYYY] $ City State Zip Code Date[MM/DD/YYYYj $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ , Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City 1 State Zip Code Date[MM/DD/YYYY] $ PART B All Other Contributions $50.01 TO$250 Use this Part to itemize all other contributions with an aggregate value from $50.01 TO$250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: I 833397394 Full Name of Contributor Date[MM/DD/MY] $ House# Street Address Date[MM/DD/YYYY] $ City State Trp Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY) $ City State Zip Code Date[MM/DD/YYYY] $ 1 Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/00/MY] $ City State Zip Code. Date[MM/DD/YYYY] $ Full Name of Contributor Date(MM/DD/YYYY) $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date:[MM/DDJYYYYj $ Full Name of Contributor Date[MM/DDJYYYYJ $ House# Street Address Date[MM/DD/YYYY) $ City State Zip Code Date[MM/DDJYYYY] $ 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 over$250.00 in the reporting period. Flier Identification Number: I 833397394 Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date[MM/DDJYYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date IMM/DD/YYYY] $ Contributing Committee House# Street Address Date[MM/DDJYYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date jMM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date(MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DDJYYYY] $ Contributing Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ PART D All Other Contributions Over$250.00 Use this Part to itemize all other contributions with an aggregate value over$250.00 in the reporting period. (Exclude contributions from political committees reported in Part C) I Fifer Identification Number: I 833397394 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 Place of Business Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYYj $ City State Zip Code Date[MM/DD/YYYY] $. Employer Name Occupation Employer Mailing Address/ Principal Place of Business 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 Place of Business Full Name of Contributor Date[MM/DD/YYYY] $ House If Street Address Date(MM/DD/YYYY) $ City State Zip Code Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/ Principal Place of Business PART E Other Receipts REFUNDS,INTREST INCOME,RETURNED CHECKS, ETC. Use this Part to report refunds received,interest earned,returned checks and prior expenditures that were returned to the filer. Filer Identification Number: I 833397394 Full Name House# Street Address City State Zip Date[MM/DD/YYYY] $ Code Receipt Description Full Name House# Street Address City State Zip Date[MM/DD/YYYYj $ Code Receipt Description Full Name House# Street Address City State Zip. Date[RAM/DD/YYYY] $ Code Receipt Description Full Name House# Street Address City State Zip, Date[MM/DD/YYYY] $ Code Receipt Description Full Name House# Street Address City State Zip Date[(VIM/DD/YYYYj $ Code Receipt Description Full Name House# Street Address City State Zip Date[MRA/DD/YYYY] $ Code Receipt Description 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 Identificatitirr Number:: I 833397394 OR I.E$S PER`CONTRIBUTOR p g period (1).. . `.. �$_ ^. I. UNITEMIZED 1N-1C}ND CONTRIBUTIONS RECEIVED VACLIE OE$50.�(1 TOTAL for the re ortin 2. •IN-KIND CONTR,113UtIONS RECE}VED4ALUE'OE$5041 TO$2SO.D IPROM PART F) - i' ',. - ' ' ': ',''. ' : ! TOTAL for the reporting period (2) $ - 3. ' iN=K1AtC7 CONTRIBUTION RECEIVEDNALUE OVER$2SQOO(ffi OM'PART.G) 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 's on Page 1,Report Cover Page,Item F) 0 f SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 Filer Identification Number: I I 833397394 Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[IVIM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ . City State Zip Code Date[MM/DDJYYYYJ $ Description 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] $ Description 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] $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/MY] $ Description of Contribution SCHEDULE II Part G In-Kind Contributions Received VALUE OVER$250 I Filer Identification Number: I 833397394 N 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/YYYYJ $ House#i Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYYJ $ Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution Full Name of Contributor Date[MM/DD/MY] $ 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 SCHEDULE III Statement of Expenditures Flier Identification Number: 833397394 To Whom Paid Date[MM/DD/YYYY] .$ Shelly Capozzi 647.66 05/08/2019 House# Street Address Description of Expenditure 1655 Holly Pike City State Zip Reimbursement for printing Carlisle PA Code 17015 p 8 To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City I State l I Zip Code J SCHEDULE IV Statement of Unpaid Debts Use this Section to itemize all unpaid debts and obligations which are outstanding at the end of the reporting period. Filer Identification Number: I 833397394 Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MAA/DD/YYYYJ City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYYI City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYYJ City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYYJ City State Zip Code Description of Debt