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Home My WebLink AboutKozicki, Elizabeth - 2019 2nd Friday Pre-Election 111 II J L Reset Form r 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 X Committee Lobbyist Number (Mark X) Name of Filing Committee,Candidate or Lobbyist Elizabeth Kozicki Street Address 116 S 31st Street City Camp Hill State PA Zip Code 17011 Type of Report(Place x under report type) 1-6th Tuesday 2- 2nd Friday 3-30 Day Post 4-6thTuesday S-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 Amendment Termination (MM/DD/YYYY) 11/05 2019 Report Report Summary of Receipts and From Date To Date For Office Use Only i Expenditures 10/21 A.Amount Brought Forward From Last Report $ 0 B.Total Monetary Contributions and Receipts $ (From Schedule I) 0 C') o C.Total Funds Available $ w (Sum of Lines A and B) 0 Co D.Total Expenditures $ r` C`, (From Schedule III) 688.83 E.Ending Cash Balance $ CJi -688.83 (Subtract Line D from Line C) .ID F.Value of In-Kind Contributions Received $ 259.16 C7 _= (From Schedule II) . G.Unpaid Debts and Obligations $ 0 --f C" (From Schedule IV) . %.p 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 ir- 2• ,ia_ a //(�//� . . R �� ature of Person Submitting rep `i Elizabeth zicki ature/�'''�� r Printed Name My Commission expires £ IJa�J a0?I 717 7319546 M DAY Y . 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 me this day of 20 • Signature of Candidate Signature Printed Name • My Commission expires - MO. DAY YR. Area Code Daytime Telephone Number --i� manta@ta@nfl9yivania=Wary ii@ol _ Rebecca J.Zettlemoyer,Notary Public . Cumberland County My commission expires September 27,2021 Commission number 1320695 C., 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 Filer Identification Number: 1 1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the reporting period (1) $ 0 1 2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) TOTAL for the reporting period (2) $ 0 3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTAL for the reporting period (3) $ 259.16 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) 259.16 .r • e SCHEDULE II Part G In-Kind Contributions Received VALUE OVER$250 IFiler Identification Number: I Full Name of Contributor Date[MM/DD/YYYY] $ Camp Hill Republican Committee 78.05 09/30/2019 House# Street Address Date[MM/DD/YYYY] $ 2825 Merion Rd 181.11 10/17/2019 City State Zip Code Date[MM/DD/YYYY] $ Camp Hill PA 17011 Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of joint sign and mailers 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: To Whom Paid Date[MM/DD/YYYY] $ Haas Printing Co.Inc. 323.30 10/08/2019 House# Street Address Description of Expenditure 1000 Hummel Ave City State Zip Lemoyne PA Code 17043 postcards To Whom Paid Date[MM/DD/YYYY] $ USPS 7.00 10/15/2019 House it Street Address Description of Expenditure 1675 Camp Hill Bypass City State Zip Camp Hill PA Code 17011 postage To Whom Paid Date[MM/DD/YYYY] $ Staples 116.59 10/01/2019 House# Street Address Description of Expenditure 128 5 32nd Street City State Zip Camp Hill PA Code 17011 postcards To Whom Paid Date[MM/DD/YYYY] $ UZ Marketing 241.94 09/17/2019 House# Street Address Description of Expenditure 5900 Bingle Road aty Houston State TX Code 77092 yard signs To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYYJ $ 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