The URL can be used to link to this page

Home My WebLink AboutFriends of Nicole Miller - 2020 Annual Report ir Pennsylvania Department of State if Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@pa.gov Unsworn Statement in Lieu of Sworn Statement for Campaign Finance Reports Note: Per Act 2020-15, which was signed into law on April 20, 2020 and allows for unsworn declarations, Campaign Finance Reports(form DSEB-502), Campaign Finance Statements In lieu of full reports(form DSEB-503), and Independent Expenditure Reports(form DSEB-505)need not be notarized. Instead, the filer may file with each report or statement the corresponding version of this form signed by the required individual(s). This particular form is to be used only for Campaign Finance Reports. This form must be signed by hand where a signature is required. Name of Filing Committee, Candidate, or Lobbyist Ise—riots OP /V1cole- /U,'l (e-r Reporting Cycle Name ❑ Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5 6th Tuesday 2nd Friday 30 Day 6a'Tuesday 2nd Friday Pre-Election Pre-Primary Pre-Primary Post Primary Pre-Election • 0 Cycle 6 )g4(Cycle 7 0 Cycle 8 0 Cycle 9 30 Day Post-Election Annual Report 2"d Friday Pre-Special Election 30 Day Post-Special Election Part I- if this form is submitted with a Committee report, the treasurer must sign here. If this form is submitted with a Candidate report, the candidate must sign here. If this report is submitted with a report by a contributing lobbyist, the lobbyist must sign here. I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania that the foregoing is true and correct. �1,N ,t� Ca'7& vwL Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) Cvwi OCk---16 IN i A ( (th4e ti U I TA Os-ik Location (City/State/Country) Printed Name DSEB-502R Updated 6/24/2020 YrPennsylvania Department of State Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@pa.gov Part II if this form is submitted with a report by a Candidate's Authorized Committee,the candidate must sign here. I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania that the foregoing is true and correct. (AIL actirr, i/ttyk--t . (aim j la ,4_ 1 Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) ti\ \ od(f Mi\(ev' Me than ( c 3h;r 0 -flit tit* Printed Name Location (City/State/Ceuntry) DSEB-502R Updated 6/24/2020 llC 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 Number 20190394 (Mark X) n Name of Filing Committee,Candidate or Lobbyist Friends of Nicole Miller Street Address • PO Box 934 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 4-6th Tuesday 5. Friday 6-30 Day Post 7-Annual Special 21°Friday Special 30 Day Pre-Primary. Pre-Primary Primary _ • Pre-Election .Pre-Election. Election . Pre-Election Post-Election , II x Date Of Election Year Amendment Termination (MM/DD/YYYY) 11/03/2020 2020 Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures • 11/24/2020 12/31/2020 A.Amount Brought Forward from Last Report $ 2462.12 C) N . B.Total Monetary Contributions and Receipts . $ C — (From Schedule l) 38.29 t.3 "r1 C.Total Funds Available $ r I rn (Sum of lines A and B) 2500.41 } cr D.Total Expenditures $ 38.16 "' (From Schedule ill) V. E.Ending Cash Balance $ -. (Subtract line D from line C) 2462.25 �, F.Value of in-Kind Contributions Received $ rJ (From Schedule I1) . . 0 -- CM G.Unpaid Debts and Obligations $ -< (From Schedule IV) 0 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 77l( day of 20 • Ik�Lt/i.,- ,remit r a u opfPeru mit iiic Signature Printed Name f� My Commission expires ✓`'� �v 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 r^ • day of 20 • 1 . (Ai tA..4.---)\.p. Ki{l toi(7 soul t Candi to Signature Printed Name My Commission expires 1 i] t-t ` - 3C S3 MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE I Contributions and Receipts petalled Summary Page filer Identification Number 20190394 Ior Less° per Contributor 1.Unitemized Contributionsand Receipts,$50:00 .. Total for the reporting period (1) $ 38.00 I2.Contributions of$50.01 to $250.00(From Part A and Part S) Contributions Received from Political Committees(Part A) $ 0 All Other Contributions(Part B) $ 0 Total for the reporting period (2) $ 0 ' 3.Contributions Over$250.00(From Part C and Part D) Contributions Received from Political Committees(Part C) $ 0 All Other Contributions(Part D) $ 0 Total for the reporting period (3) $ 0 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part.E) I Total for the reporting period (4) $ .29 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) 38.29 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 ' 20190394 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/OD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ II AIM 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/OD/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 20190394 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/YYYYj $ 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/YYYYJ $ 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: 20190394 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) filer Identification Number: 20190394 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 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,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. filer identification Number. 20190394 Full Name Members 1st House# Street Address 3512 Market St City State Zip Date[MM/DD/YYYY] $ Camp Hill PA Code 17011 11/30/2020 .17 Receipt Description Deposit Dividend Full Name Members 1st House# Street Address 3512 Market St City State Zip Date[MM/DD/YYYY] $ Camp Hill PA Code 17011 .12 12/31/2020 Receipt Description Deposit Dividend 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/YYYYj $ Code Receipt Description. Full Name House# Street Address City State Zip Date[MM/DD/YYYY] $ Code.. Receipt Description Full Name House 4 Street Address City State Zip Date[MM/DD/YYYY] $ Code Receipt Description 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: 20190394 I1. 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) I 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) $ 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: 20190394 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/DDJYYYY] $ 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/YVYY] $ Description of Contribution full Name of Contributor Date[MM/DD/YYYY] .$ House# Street Address Date[MM/DD/YYYY] $ City State ZipCode Date[MM/DD/YYYY] $ Description of Contribution SCHEDULE II Part G In-Kind Contributions Received VALUE OVER$250 Filer tdentfflcationtiumber: 20190394 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. 20190394 To Whom Paid Date[MM/DD/YYYY] $ ActBlue Donate 8.44 12/03/2020 House# Street Address Description of Expenditure PO Box 441146 City State. Zip West Somerville MA Code 02144 Processing Fees To Whom Paid Date[MM/DD/YYYY] $ Vantiv Ecommerce 19.82 12/09/2020 House# Street Address Description of Expenditure 8500 Governors Hill Rd City State Zip Symmes Twp OH Code 45249-1384 Fees for e-commerce To Whom Paid Date[MM/DD/YYYY] $ Members First Credit Union 4.95 12/31/2020 House# Street Address Description of Expenditure PO Box 40 City State Zip Bank fees Mechanicsburg PA Code. 17055 To Whom Paid Date[MM/DD/YYYY] $ Members First Credit Union 4.95 11/30/2020 House# Street Address Description of Expenditure PO Box 40 City State Zip Mechanicsburg PA Code 17055 Bank fees 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. 20190394 Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYYJ 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