HomeMy WebLinkAboutGembusia for State Rep - 2019 30-Day Post-Primary PAGE 1
Commonwealth of Pennsylvania I1Il0lllll]l1lllllllllll111111 INIIIJ ft
Campaign Finance Report 307429
(NOTE:This report must be clear and legible. It may be typed or printed in blue or black ink.)
Filer Identification 20140082 Report CANDIDATE COMMITTEE 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.X 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?
the right of
report type) ANNUAL REPORT 7. Year 2019 FILING METHOD PAPER leej DISKETTE
( )CHECK ONE
DATE OF ELECTION District Office Party Code County
Name of Office Sought by Candidate: Number Code Code
MO DAY YEAR REP 21
11 5 2019 (SEE INSTRUCTIONS FOR CODES)
Summary of Receipts and MO DAY YEAR MO DAY YEAR FOR OFFICE USE ONLY
Expenditures from: 5 7 2019 TO 6 10 2019
A.Amount Brought Forward From Last Report $ 412.73 N
0
B.Total Monetary Contributions And Receipts(From Schedule I) $ 0.00 „Jr,
:i.7 c---
C.Total Funds Available(Sum Of Lines A and B) $ 412.73 3 a
r- _.
D.Total Expenditures(From Schedule III) $ 412.73 " ,&-"
CD
E. Ending Cash Balance(Subtract Line D From Line C) $ 0.00 -'U
C) =
F.Value Of In-Kind Contributions Received(From Schedule II) $ 0.00 C fV
G.Unpaid Debts And Obligations(From Schedule IV) $ 0.00 -i
{TSV
AFFIDAVIT SECTION
PART I-If this is a Committee report,treasurer sign here.If this is a Candidate report,candid e sign here.
I swear(or affirm)that this report,including the attached schedules filed on paper or by electronic a iu ar t the bes f my knowledge and belief,true.
correct and complete.
S� to and subscribed beforg me this Signature of Person Submitting Report
`�1 day of `1., ,. 20 /3ommonwealth of Pennsylvania-Notary Seal <6i ( C. C. i.Rais
c — �1fi�ts�l�l.X� r MEGK-Notary Public r
�'� L4��T � —� CiKRbeelond County Printed Name
signatureMy Commission Expires Jan 14,2023 -�AiS �� T
My Commission Expires it /4, 2, 3 Commission Number 1260066 1(1 Email4, .Z42.%
MO DAY YR 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 viol ed any provi ns act of 3 e 3,19 1333,
No 320)as amended.
Sworn to and subscribed beforea this
7J�� q1� Signa re of didate /
_fes
‘4,iday of 1 p i �_ 20 Ot &VIA!1/ a (C' b ,► ,! I
Printed Name
4L.(,.00.1/..-4-4--9---- Commanwpalth of Donn,ylvania-Notary Se �,- f��/ ,v CS-, C6
Signature MEGAN ORRIS-Notary Public /E,,,, I
My Commission Expires Cumberland County � �O I^ �� L/
J . /q( 3y Commission Expires Jan 14,2023 / l
CUmmisslon Number 1260066
MO DAY KP ea Code Daytime Telephone Number
6/11/2019 11:17:10 AM a
PAGE 2
SCHEDULE I
CONTRIBUTIONS AND RECEIPTS
Detailed Summary Page
Name of Filing Committee or Candidate Reporting Period
GEMBUSIA FOR STATE REPRESENTATIVE From: 5/7/2019 To: 6/10/2019
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.)
6/11/2019 11:17:10 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
6/11/2019 11:17:10 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
6/11/2019 11:17:10 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
6/11/2019 11:17:10 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
6/11/2019 11:17:10 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
6/11/2019 11:17:10 AM
•
PAGE 8
SCHEDULE II
IN-KIND CONTRIBUTIONS AND VALUABLE THINGS RECEIVED
USE THIS SCHEDULE TO REPORT ALL IN-KIND CONTRIBUTIONS OF VALUABLE THINGS
DURING THE REPORTING PERIOD.
Detailed Summary Page
Name of Filing Committee or Candidate Reporting Period
GEMBUSIA FOR STATE REPRESENTATIVE From: 5/7/2019 To: 6/10/2019
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.)
6/11/2019 11:17:10 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
6/11/2019 11:17:10 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)
Enter Grand Total of Part G on Schedule II, In-Kind Contributions Detailed PAGE TOTAL
Summary Page, Section 3. 0.00
6/11/2019 11:17:10 AM
PAGE 11
SCHEDULE III
STATEMENT OF EXPENDITURES
Name of Filing Committee or Candidate Reporting Period
GEMBUSIA FOR STATE REPRESENTATIVE From 5/7/2019 To: 6/10/2019
DATE AMOUNT
To Whom Paid
MO DAY YEAR
Friends of Kelly Neiderer
Mailing Address P.O. Box 1 5 11 2019
$ 200.00
City Carlisle State Zip Code(Plus 4) Description of Expenditure
PA 17015 Campaign Donation
To Whom Paid
MO DAY YEAR
Commettee to elect Shelly Capozzi
Mailing Address 1536 Holly Pike 5 11 2019 $ 212.73
City Carlisle State Zip Code(Plus 4) Description of Expenditure
PA 17013 Campaign Donation
PAGE TOTAL
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D.
$ 412.73
6/11/2019 11:17:10 AM