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Home My WebLink AboutFriends of Jake Miller - 2019 2nd Friday Pre-Election III II r Reset Form I Print 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 XNumber (Mark X) Name of Filing Committee,Candidate or -r---- c Lobbyist 'lake-Miner— v-)e%�,1G�.5 OT'(� ,.6., IAA. 1 I I'aZX' Street Address P.O.Box 872 City Mechanicsburg State PA Zip Code 17055 Type of Report(Place x under report type) 1-6`"Tuesday 2- 2"d Friday 3-30 Day Post 4-6'^Tuesday S-2"d Friday 6-30 Day Post 7-Annual Special 2"d 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) 11/5/2019 2019 1 I Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 06/11/2019 10/21/2019 A.Amount Brought Forward From Last Report $ ') *^a 3699.91 c, B.Total Monetary Contributions and Receipts $ 6623.75 (From Schedule I) Ill C, --I rtC,-t C.Total Funds Available $ r— N (Sum of.Lines A and B) 10323.66 ›. W D.Total Expenditures $ y (From Schedule III) 5077.63 C) E.Ending Cash Balance $ 0 (Subtract Line 0 from Line C) 5246.03 Z. C: .. F.Value of In-Kind Contributions Received $ --I - -- (From Schedule II) '' 2963.64 G.Unpaid Debts and Obligations $ (From Schedule IV) 654.04 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. Swornrnto and subscribed �before me this 12 l day of Oe..TUI~]k� 20 Commonwealth of P nsylvania-Notary Seal g :ture ,f'.erson S itting report � - �`�_MEGAN ORRI - otary Public [$ i r>7._. A„!�y►ti? G�Ze-Pe"" , Signature` Cumber nd County Printed me n► ,3L4 k t1 ` � �1��M,1 rmmissiot xpires Jan 14,2023 j�/ My Commi si on expires Jrt )'-t OtiO emission Number 1260066 I -/ t it —c2 / 0 -7 MO. DAY in. 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 to and subscribed before -methis 4,q3�ret day ofI t)L — 20 let (It i J 1 cSe 1,19- fi Candidate '- Signature Printed Name My Commiss n xpi t t 'j f�/! I'l -t-��— L1c r— � , MO. DAY Area 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 Her Identification,Number I I I 1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total for the reporting period (1) $ 1607.50 2:Contributions of$50.01 to $250.00(From Part A and Part B) Contributions Received from Political Committees(Part A) $ 100.00 All Other Contributions(Part B) $ 1950 Total for the reporting period (2) $ 2050.00 3.Contributions Over$250.00(From Part C and Part D) I Contributions Received from Political Committees(Part C) $ 2466.25 All Other Contributions(Part D) $ 500 Total for the reporting period (3) $ 2966.25 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) I Total for the reporting period (4) $ 0.00 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 Poge 1,Report 6623.75 Cover Page,Item B) 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 Amount Full Name of Contributing Date[MM/DD/YYYY] $ Committee100.00 Upper Allen Mechanicsburg Democratic Club 10/10/2019 House# Street Address Date[MM/DD/YYYY] $ 2138 Canterbury Drive City State Zip Code Date[MM/DD/YYYY] $ , Mechanicsburg PA 17055 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: Full Name of Contributor Date[MM/DD/YYYY] $ Rick Galena 06/21/2019 100.00 House# Street Address Date[MM/DD/YYYY] $ 58 E.North Street City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Full Name of Contributor Date[MM/DD/YYYY] $ Morgan Plant 07/23/2019 125.00 House# Street Address Date[MM/DD/YYYY] $ 322 S.West Street City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Full Name of Contributor Date[MM/DD/YYYY] $ Rich Askey 08/16/2019 125.00 House# Street Address Date[MM/DD/YYYY] $ 356 Dorward Circle City .State Zip'Code Date[MM/DD/YYYY] $ Etters PA 17319 • Full Name of Contributor Date[MM/DD/YYYY] $ Kathy L.Everett 08/18/2019 150.00 House# Street Address Date[MM/DD/YYYYJ $ 1230 White Birch Lane City 1State. Zip Code. Date[MM/DD/YYYY] $ Carlisle PA 17013 ,Full Name of Contributor Date[MM/DD/YYYY] $ Cece Viti 125.00 08/20/2019 House# Street Address Date[MM/DD/YYYY] $ 133 W.Locust St,Apt 203 City State •Zip Code Date[MM/DD/YYYY] $ Mechanicsburg PA 17055 Full Name of Contributor Date(MM/DD/YYYYJ $ Mark Trautman 250.00 08/28/2019 House# Street Address Date[MM/DD/YYYYJ $ 154 W.2nd Mtn Rd City State Zip Code Date[MM/DD/YYYY] $ Pottsville PA 17901 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.) I Filer Identification Number: 1 Full Name of Contributor Date[MM/DD/YYYY] $ Brian Healey 09/13/2019 100.00 House# Street Address Date[MM/DD/YYYY] $ 305 Old Fort Road City State Zip Code Date[MM/DD/YYYY] $ Lemoyne PA 17043 Full Name of Contributor Date[MM/DD/YYYY] $ Jennifer Tulaney 09/13/2019 200.00 House# Street Address Date[MM/DD/YYYY] $ 168 West Point Drive City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Full Name of Contributor Date[MM/DD/YYYY] $ Lora Apaliski 09/19/2019 250.00 House# Street Address Date[MM/DD/YYYY] $ 192 Edenderry Way i City State Zip Code Date[MM/DD/YYYY] $ Enola PA 17025 Full Name of Contributor Date[MM/DD/YYYY] $ Maggie Ackerman 100.00 09/19/2019 House# Street Address Date[MM/DD/YYYY] $ 100 Fairway Dr City State Zip Code Date[MM/DD/YYYY] $ Camp Hill PA 17011 Full Name of Contributor Date[MM/DD/YYYY] $ Donna Williams 100.00 09/25/2019 House# Street Address Date[MM/DD/YYYY] $ 262 Walnut Street City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Full Name of Contributor Date[MM/DD/YYYY] $ Kathy Everett 10/1/2019 100.00 House# Street Address Date[MM/DD/YYYY] $ 1230 White Birch Lane City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 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.) IFiler Identification Number: I Full Name of Contributor Date[MM/DD/YYYY] $ Dr.Catherine Clay 10/01/2019 125.00 House# Street Address Date[MM/DD/YYYY] $ 103 Gilbert Rd City State Zip Code Date[MM/DD/YYYY] $ Shippensburg PA 17257 Full Name of Contributor Date[MM/DD/YYYY] $ Jean Foschi 10/10/2019 100.00 House# Street Address Date[MM/DD/YYYY] $ 2195 Brunswick Ave City State Zip Code Date[MM/DD/YYYY] $ Mechanicsburg PA 17055 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] $ 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: Full Name of Date[MM/DD/YYYY] $ Contributing Committee Carlisle Area Democratic Committee 10/01/2019 2466.25 House# Street Address Date[MM/DD/YYYY] $ P.O.Box 993 City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 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) IFiler Identification Number: I Full Name of Contributor Date[MM/DD/YYYY] $ Rick Rovegno 500.00 09/10/2019 House# Street Address Date[MM/DD/YYYY] $ 112 Spring Farm Circle City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17015 Employer Name Occupation Retired 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 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 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 IFiler Identification Number: r I1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the reporting period (1) $ 15.94 I2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART Fj TOTAL for the reporting period (2) $ 200.00 3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) 11 TOTAL for the reporting period (3) $ 2747.70 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) 2963.64 SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 IFiler Identification Number: I Full Name of Contributor Date[MM/DD/YYYY] $ Cumberland County Democratic Committee 08/25/2019 200.00 House# Street Address Date[MM/DD/YYYY] $ 46 West Louther Street City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Description of Contribution Hand out cards 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 I Filer Identification Number: I Full Name of Contributor Date[MM/DD/YYYY] $ Cumberland County Democratic Committee 1500.00 08/25/2019 House# Street Address Date[MM/DD/YYYY] $ 46 West Louther Street City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Hand out cards Contribution Full Name of Contributor Date[MM/DD/YYYY] $ Miller Web Services 09/13/2019 1247.70 House# Street Address Date[MM/DD/YYYY] $ 304 Carson Street City State Zip Code Date[MM/DD/YYYY] $ Philadelphia PA 19128 Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Website and graphic design 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: I To Whom Paid Date[MM/DD/YYYY] $ Vantiv 06/11/2019 8.63 House# Street Address Description of Expenditure City State Zip Vantiv Fee May 2019 Code 1 To Whom Paid Date[MM/DD/YYYY] $ Act Blue 2.71 07/03/2019 House# Street Address Description of Expenditure P.O.Box 441146 City Summerville State MA C de 02144 June 2019 Fee To Whom Paid Date[MM/DD/YYYY] $ Vantiv 5.12 07/09/2019 House# Street Address Description of Expenditure City State Zip Vantiv Fee June 2019 Code To Whom Paid Date[MM/DD/YYYY] $ Act Blue 08/08/2019 2.03 House# Street Address Description of Expenditure P.O.Box 441146 City Summerville State MA C de 02144 July 2019 Fee To Whom Paid Date[MM/DD/YYYY] $ Vantiv 08/09/2019 2.45 House# Street Address Description of Expenditure City State Zip Code Vantiv Fee July 2019 'To Whom Paid Date[MM/DD/YYYY] $ Pittsburgh Buttoneer 88.03 08/16/2019 House# Street Address Description of Expenditure 219 Briggs Street City Zip Harrisburg State PA Code 17102 Stickers/Buttons To Whom Paid Date[MM/DD/YYYY] $ Facebook 08/19/2019 25.00 House# Street Address Description of Expenditure City State Zip Ads Code To Whom Paid Date[MM/DD/YYYY] $ Gannett Flemming 375.24 08/22/2019 House# Street Address Description of Expenditure 209 Senate Ave City State Zip - Camp Hill PA Code 17011 Handout Cards . SCHEDULE III Statement of Expenditures Filer Identification Number: To Whom Paid Date[MM/DD/YYYY] $ • Facebook 09/03/2019 25.00 House# Street Address Description of Expenditure City State Zip Code Ads To Whom Paid Date[MM/DD/YYYY] $ Act Blue 09/05/2019 11.80 House# Street Address Description of Expenditure P.O.Box 441146 City State Zip Summerville MA Code 02144 August 2019 Fee To Whom Paid Date[MM/DD/YYYY] $ Vantiv 24.52 09/10/2019 House# Street Address Description of Expenditure City State Zip Vantiv Fee August 2019 Code To Whom Paid Date[MM/DD/YYYY] $ Hampden Township Democratic Club 09/18/2019 250.00 House# Street Address Description of Expenditure 102St.Johns Church Road City State Zip Camp Hill PA Code 17011 Text Campaign To Whom Paid Date[MM/DD/YYYY] $ Just Yard Signs 1435.00 09/18/2019 House# Street Address Description of Expenditure 4880 Al Distribution Court City Zip Orlando State FL Code 32822 Yard Signs To Whom Paid Date[MM/DD/YYYY] $ • Facebook 5 09/20/2019 House# Street Address Description of Expenditure City State Zip Ads Code To Whom Paid Date[MM/DD/YYYY] $ Gannett Flemming 717.62 09/23/2019 House# Street Address Description of Expenditure 209 Senate Avenue City State Zip Camp Hill PA Code 17011 Handout Cards To Whom Paid Date[MM/DD/YYYY] $ Facebook 09/25/2019 25.00 House# Street Address Description of Expenditure City State Zip Ads Code SCHEDULE III Statement of Expenditures Filer Identification Number: I I To Whom Paid Date[MM/DD/YYYY] $ Artistic Imprints 597.84 09/26/2019 House# Street Address Description of Expenditure 823 Saint Johns Road City State Zip Camp Hill PA Code 17011 Banners To Whom Paid Date[MM/DD/YYYY] $ U.S.Postal Service 46.00 09/27/2019 House# Street Address Description of Expenditure 702 E.Simpson Street City State Zip Mechanicsburg PA Code 17055 P.O.Box Renewal Fee To Whom Paid Date[MM/DD/YYYY] $ Facebook 25.00 09/27/2019 House# Street Address Description of Expenditure City l State Zip Ads Code To Whom Paid Date[MM/DD/YYYY] $ Facebook 28.79 10/1/2019 House# Street Address Description of Expenditure City State Zip Ads Code To Whom Paid Date[MM/DD/YYYY] $ Staples 17.27 10/01/2019 House# ____ Street Address Description of Expenditure 128 S 32nd Street City State Zip Camp Hill PA Code 17011 Cardstock To Whom Paid Date[MM/DD/YYYY] $ Amazon Marketplace online 38.95 10/03/2019 House# Street Address Description of Expenditure City f State Zip Mutts for Miller supplies Code To Whom Paid Date[MM/DD/YYYY] I $ Act Blue 10/04/2019 20.77 House# Street Address Description of Expenditure City State Zip September 2019 Fee Code To Whom Paid Date[MM/DD/YYYY] $ Amazon Marketplace online 39.61 10/4/2019 House# Street Address Description of Expenditure City State Zip Mutts for Miller supplies Code SCHEDULE III Statement of Expenditures Filer Identification Number: I To Whom Paid Date[MM/DD/YYYY] $ John Alosi 22.00 10/7/2019 House# Street Address Description of Expenditure 108 S.Prince Street City State Zip Shippensburg PA Code 17257 Shippensburg Dems Dinner To Whom Paid Date[MM/DD/YYYY] $ Facebook 35.00 10/7/2019 House# Street Address Description of Expenditure City State Zip Code Ads To Whom Paid Date[MM/DD/YYYY] $ Artistic Imprints 852.16 10/07/2019 House# Street Address Description of Expenditure 823 • Saint Johns Road City State Zip Camp Hill PA Code 17011 Shrits/Banners/Magnets To Whom Paid Date[MM/DD/YYYY] $ Facebook 50.00 ' 10/09/2019 House# Street Address Description of Expenditure City State Zip Code Ads To Whom Paid Date[MM/DD/YYYY] $ Lowes Home Centers,LLC 82.43 10/11/2019 House# Street Address Description of Expenditure 5500 Carlisle Pike City State Zip Mechanicsburg PA Code 17050 Posts To Whom Paid Date[MM/DD/YYYY] $ Lowes Home Centers,LLC 12.21 10/11/2019 House# Street Address Description of Expenditure 5500 Carlisle Pike City State Zip Cable Ties Mechanicsburg PA Code 17055 To Whom Paid Date[MM/DD/YYYY] $ Subway 15.77 10/15/2019 House# Street Address Description of Expenditure City State Zip Enola PA Code 17025 working lunch To Whom Paid Date[MM/DD/YYYY] $ Wegmans 41.92 10/15/2019 House# Street Address Description of Expenditure 6416 Carlisle Pike City State Zip Mechanicsburg 1 PA Code 17050 Campaign lunch meeting SCHEDULE III Statement of Expenditures Filer Identification Number: I I To Whom Paid Date[MM/DD/YYYY] $ Pittsburgh Buttoneer 27.56 10/21/2019 House# Street Address Description of Expenditure 219 Briggs Street City State Zip buttons Harrisburg PA Code 17102 To Whom Paid Date[MM/DD/YYYY] $ Lowes Home Centers,LLC 10/21 48.08 House# Street Address Description of Expenditure 5500 Carlisle Pike City State Zip Mechanicsburg PA Code 17050 Posts To Whom Paid Date[MM/DD/YYYY] $ Lakeside Food Mart 30.00 10/21/2019 House# Street Address Description of Expenditure 101 West 1st Street City I State Code Zip Boiling Springs 17007 Fuel while canvassing To Whom Paid Date[MM/DD/YYYY] $ Vantly43.12 10/9/2019 House#' Street Address Description of Expenditure City State Zip Sept 2019 Vantiv fee 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. IFiler Identification Number: Name of Creditor Jake Miller Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ 3824 Carriage House Drive [MM/DD/YYYY] 02/11/2019 City State Zip 500.00 Camp Hill PA Code 17011 Description of Debt Open PNC Bank Account for Friends of Jake Miller Name of Creditor Jake Miller Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ 3824 Carriage House Drive [MM/DD/YYYY] 02/05/2019 City State Zip 5 Camp Hill PA Code 17011 Description of Debt BOE CD v Name of Creditor Jake Miller Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ 3824 [MM/DD/YYYY] Carriage House Drive 03/08/2019 City State Zip 100.00 Camp Hill PA Code 17011 - Description of Debt BOE Filing Fee Name of Creditor Jake Miller Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ 3824 Carriage House Drive [MM/DD/YYYY] 03/25/2019 • City State Zip 49.04 Camp Hill PA Code 17011 Description of Debt Team Meeting-Dinner 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