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Home My WebLink AboutKozicki, Elizabeth - 2019 30-Day Post Election liii 4.-... Reset Form 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 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 4-6t"Tuesday 5-ed Friday 6-30 Day Post 7-Annual Special 2nd Friday Special 30 Day Pre Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election 1 X Date Of Election Year Amendment Termination X (MM/DD/YYYY) 11/05 2019 Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 10/22/2019 11/25/2019 A.Amount Brought Forward From Last Report $ 0 B.Total Monetary Contributions and Receipts $ 0 (From Schedule I) • C.Total Funds Available $ C 1 ^' 0 o (Sum of Lines A and B) D.Total Expenditures $ d (From Schedule Ill) 0 Z7 n E.Ending Cash Balance rb (Subtract Line D from Line C) 0 6. C_ 7 F.Value of In-Kind Contributions Received $ 942.82 — (From Schedule II) CD G.Unpaid Debts and Obligations $ • 0 (From Schedule IV) .,.j 4-- 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 o and sub•Ted bef. e me this • ". d. or,f_. .IA(IiW , 20 ( �. - . I nature of Person Submitt eport #�, •A��, r��rl I Elizabeth Kozicki Sign: I Printed Name My Commission expires D9 02.6 o24,2, 717 648-3852 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 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 Commonwealth of Pennsylvania-Notary Seal Stephen J.Bihi,Notary Public Cumberland County My commission expires September 26.2023 Commission number t 3572990 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: t 1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50:00 OR LESS PER CONTRIBUTOR I f TOTAL for the reporting period (1) $ 2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) I TOTAL for the reporting period (2) $ I3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTAL for the reporting period (3) $ 942.82 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) 942.82 SCHEDULE II • Part G In-Kind Contributions Received VALUE OVER$250 Filer Identification Number: Full Name of Contributor Date[MM/DD/YYYY] $ Camp Hill Republican Committee 942.82 11/03/2019 House# Street Address Date[MM/DD/YYYY] $ 2825 Merion Rd City State Zip Code Date[MM/DD/YYYY] $ Camp Hill PA 17011 - - Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of 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 IMM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MINI/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution