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Republican Assoc. - 2019 6th Tuesday Pre-Election VIII IIIIIIIIIIII II II Reset Form 1 Print Form III 6iII83000581I 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 8300058 (Mark X) Name of Filing Committee,Candidate or Lobbyist Hampden Township Republican Assoc Street Address PO Box 283 City Camp Hill State PA Zip Code 17011 Type of Report(Place x under report type) 1-6th Tuesday 2- 2"d Friday 3-30 Day Post 4 6th Tuesday 5-2nd Friday 6 30 Day Post 7-Annual Special 2""Friday Special 30 Day Pre Primary Pre-Primary PrimaryPre-Election Pre-Election Election Pre-Election Post-Election X Date Of Election Year Amendment Termination (MM/DD/YYYY) 11/21/19 2019 j Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures • 06/11/2019 09/16/2019 A.Amount Brought Forward From Last Report $ 3,972.13 B.Total Monetary Contributions and Receipts $ 800 (From Schedule I) C.Total Funds Available- $ C (Sum of Lines A and B) 4"722.13 -- D.Total Expenditures $ .63 .as 4,558 (") (From Schedule III) m rn E.Ending Cash Balance $ 214.13 r!'— h? (Subtract Line D from Line C) ,'' CM F.Value of In-Kind Contributions Received $ C~7 (From Schedule II) 0 C) G.Unpaid Debts and Obligations $ 0 (From Schedule IV) . _ Affid.. Section --I C" Part 1-If this is a Committee report,treasurer sign here.If this is a Candidate •Re, - didate sign here. , I swear(or affirm)that this report,including the attached schedules on pap- `jeto the b- of my knowledge and belief true,correct and'complete. Sworn to and subscribed before me this 4'1,4. .� j�j c�a Q� ti�ti C� _day of 'e�)/ 20�/— 4a 6 ,c4+ h, w cyi p<6 4'4-....t. Sign�r�-ef Person bmitting report Signature �`�C��a�+QJ�pec Printed Name I76My Commission expires (0 — ', oe..0-t., .4) (• 76— 3-v MO. DAY Y' • `04- `o4'4'' Area Code Daytime Telephone Number •f\ Lo Part II-If this is a report of a Candidate's Authorized Co ittee,ca date shall sign here. I swear(or affirm)that to the best of my knowledge andf thi. .olitical committee has not violated any provisions of the Act of June 3,1937(P.L.1333,NO.320)as amended. Sworn to and subscribed before me this day of 20 • I . Signature of Candidate Signature I Printed Name My Commission expires MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number 8300058 11.Unitemized Contributions and Receipts-$50.00 or Less per Contributor I Total for the reporting period (1) $ 12.Contributions of$50.01 to $250.00(From I Part A and Part B) Contributions Received from Political Committees(Part A) $ 0 All Other Contributions(Part B) $ 500 Total for the reporting period (2) $ 500 13.Contributions Over$250.00(From Part C and Part D) I Contributions Received from Political Committees(Part C) $ All Other Contributions(Part D) $ 300 Total for the reporting period (3) $ 300 14.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) 800 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 I I Amount 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 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] $ 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: 8300058 Full Name of Contributor Date[MM/DD/YYYY] $ ERIK HUME 07/17/2019 100 House# Street Address Date[MM/DD/YYYY] $ 473 ADAM LANE 07/19/2019 200 City State Zip Code Date[MM/DD/YYYY] $ MECHANICSBUG PA 17050 Full Name of Contributor Date[MM/DD/YYYY] $ SAM GIANNELLI 07/19/2019 100 House# Street Address Date[MM/DD/YYYY] $ 405 SPRING HOUSE RD City State Zip Code Date[MM/DD/YYYY] $ CAMP HILL PA 17011 Full Name of Contributor Date[MM/DD/YYYY] $ MICHELLE NESTOR 07/17/2019 100 House# Street Address Date[MM/DD/YYYY] $ 1014 BAYTHORNE DR City State Zip Code Date[MM/DD/YYYY] $ MECHANICSBURG PA 17050 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/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] $ 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. Filer Identification Number: 8300058 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/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/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/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] $ 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 Filer Identification Number: I 8300058 Full Name of Contributor Date[MM/DD/YYYY] $ MICHELLE NESTOR 300 07/19/2019 House# Street Address Date[MM/DD/YYYY] $ 1014 BAYTHORNE DR City State Zip Code Date[MM/DD/YYYY] $ MECHANICSBURG PA 17050 Employer Name TEAMPETE REALTY Occupation REALTOR Employer Mailing Address/ Principal Place of Business 15 CENTRAL BLVD,CAMP HILL,PA 17011 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/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/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. I Filer Identification Number: I 8300058 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/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[MM/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[MM/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 Identification Number: 8300058 f1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the reporting period (1) $ 0 I2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) TOTAL for the reporting period (2) $ 0 I3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTAL for the reporting period (3) $ 0 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) 0 SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 Filer Identification Number: 8300058 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/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/YYYY] $ Description of Contribution SCHEDULE II Part G In-Kind Contributions Received VALUE OVER$250 Filer Identification Number: 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 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 SCHEDULE III Statement of Expenditures Filer Identification Number: 8300058 To Whom Paid Date[MM/DD/YYYY] $ SPEED PRO IMAGING 3,500 06/28/2019 House# Street Address Description of Expenditure 312 S 10TH STREET City State Zip LEMOYNE PA Code 17043 CAMPAIGN SIGNS&HANDOUTS To Whom Paid Date[MM/DD/YYYY] $ SPEED PRO IMAGING 1,058 07/19/2019 House# Street Address Description of Expenditure 312 5 10TH STREET City State Zip LEMOYNE PA 17043 CAMPAIGN SIGNS&HANDOUTS 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 State Zip Code . 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 I 8300058 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/YYYY] 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/YYYY] 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/YYYY] City State Zip Code Description of Debt