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Home My WebLink AboutColleen for PA - 2021 30-Day Post-Primary ThiPennsylvania 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 Unsworn Declaration 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), Non-Bid Contract Reporting Form (DSEB-504) 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 Colleen for PA Reporting Cycle Name ❑ Cycle 1 ❑ Cycle 2 (] Cycle 3 0 Cycle 4 0 Cycle 5 6th Tuesday 2"d Friday 30 Day 6th Tuesday 2"d Friday Pre-Election Pre-Primary Pre-Primary Post Primary Pre-Election ❑ Cycle 6 0 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 accompanying Campaign Finance Report is true and correct. 0(•?--'(--64-e/V 11-61 11 Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) a—/ C - RA- Printed Name Location (City/State/Coup (-S( DSEB-502R Updated 1/22/2021 yfiiPennsylvania 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!!- 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 accompanying Campaign Finance Report is true and correct. G (0 06 :=201 Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) Ca I(efl 6-ak Alo en b-1A , f� I 03/- Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 Commonwealth of Pennsylvania PAGE 1 OF 7 Campaign Finance Report (NOTE: This report must be clear and legible. It may be typed or printed in blue or black ink.) Filer Identification Report Candidate ' Committee 2. Lobbyist s. Number: 20210153 Filed By: ❑ ❑ ❑ Name of Filing Committee,Candidate or Lobbyist: Colleen for PA ' Street Address: 1750 Yorkshire Place City: State: Zip Code: Enola PA 17025 6th Tuesday 1.❑ 2nd Friday 2.❑ 30 Day 3. a Amendment Yes No ❑✓ TYPE OF Pre-Primary Pre-Primary Post Primary Report? ❑ REPORT 6th Tuesday 4.❑ 2nd Friday 5. 30 Day 6. ❑ Termination Yes ❑ No 0 Pre-Election Pre-Election ❑ Post Election Report? Other 7. Annual Report ❑ YEAR 2021 Name of Office Sought by Candidate: ;1I1 JE ]? "o " District Number: Office Code: Party Code:: County Code: Representative in the General 11/08/2022 087 STH DEM 21 Assembly Summary of Receipts and From Date To Date FOR OFFICE USE ONLY Expenditures 05/04/2021 06/07/2021 C) :-... $0.00 K� r sa A. Amount Brought Forward From Last Report --: c_ B. Total Monetary Contributions and Receipts(From Schedule I) $2,116.98 'n C. Total Funds Available(Sum of Lines A and B) $2,116.98 - 1 D. Total Expenditures(From Schedule III) $350.17 E. Ending Cash Balance(Subtract Line D from Line C) $1,7 6 6.81 C, 27. F. Value of In-Kind Contributions Received(From Schedule II) $O.00 -< CO G. Unpaid Debts and Obligations(From Schedule IV) $0.00 Affidavit Section PART I-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 or by electronic medium,are to the best of my knowledge and belief true,correct,and complete. Sworn to and subscribed before me this j 9 d f 20 a /S krr.--le -!"_ Si nature f Person Submitting Report Sig to Printed Nam My commi • n expires l7 Li 5 MO. DAY YR. Area Code Daytime felephone N er 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. 3 as amended. Sworn to and subscribe efore me this day of 20 C> C Signature of Person Submitting Report ('a I(e-e ii G ,ttipi t--y-e nted Signature Pri me My commi sion expires --1, /. 1-7 11"l- 3-7 1 MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE I PAGE 2 OF 7 Contributions and Receipts Detailed Summary Page Filer Identification Number: 20210153 1. UNITEMIZED CONTRIBUTIONS AND RECEIPTS -$50.00 OR LESS PER CONTRIBUTOR TOTAL for the Reporting Period (1) $765.00 2. CONTRIBUTIONS$50.01 TO$250.00 (FROM PART A AND B) Contributions Received from Political Committees (Part A) $101.98 All Other Contributions (Part B) $1,250.00 TOTAL for the Reporting Period (2) $1,351.98 3. CONTRIBUTIONS OVER$250.00 (FROM PART C AND D) Contributions Received from Political Committees (Part C) $0.00 All Other Contributions (Part D) $0.00 TOTAL for the Reporting Period (3) $0.00 4. OTHER RECEIPTS -REFUNDS, INTEREST EARNED, RETURNED CHECKS, ETC. (FROM PART E) TOTAL for the Reporting Period (4) $0.00 TOTAL MONETARY CONTRIBUTIONS AND RECEIPTS DURING THIS REPORTING PERIOD (Add and enter amount totals from $2,116.98 Boxes 1,2,3 and 4;also enter this amount on Page 1,Report Cover Page,Item B.) PAGE 3 OF 7 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: 20210153 Full Name of Contributing Committee MO. DAY YEAR Friends of Shanna Danielson 5 7 2021 $101.98 Mailing Address 170 Martel Cir City State Zip Code(Plus 4) Dillsburg PA 17019-8717 Enter Grand Total of Part A on Schedule I,Detailed Summary Page,Section 2. PAGE TOTAL $101.98 PAGE 4 OF 7 PART B All Other Contributions $50.01 TO$250.00 Use this Part to itemize all other contributions with an aggregate value from $50.01 to$250.00 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: 20210153 Full Name of Contributor MO. DAY YEAR Jason Beers 6 4 2021 $150.00 Mailing Address 935 Mcclellan St City State Zip Code(Plus 4) Philadelphia PA 19148-1610 Full Name of Contributor MO. DAY YEAR Eugene DePasquale 6 4 2021 $100.00 Mailing Address 1360 N George St Apt 2 City State Zip Code(Plus 4) York PA 17404-2065 Full Name of Contributor /MO. DAY YEAR Beth Finn 5 27 2021 $100.00 Mailing Address 604 S Washington Sq Apt 1216 City State Zip Code(Plus 4) Philadelphia PA 19106-4124 Full Name of Contributor MO. DAY YEAR Danielle Gross 5 26 2021 $100.00 Mailing Address 650 Diane Dr City State Zip Code(Plus 4) Etters PA 17319-8909 Full Name of Contributor MO. DAY YEAR Kathleen Hooker 5 26 2021 $100.00 Mailing Address 1210 Waterford City State Zip Code(Plus 4) Camp Hill PA 17011-9003 Full Name of Contributor MO. DAY YEAR Kevin Mahoney 6 7 2021 $100.00 Mailing Address 431 Dorchester Ln City State Zip Code(Plus 4) Perkasie PA 18944-1886 Full Name of Contributor MO. DAY I YEAR Alissa Packer 5 25 2021 $250.00 Mailing Address 501 Arlington Rd City State Zip Code(Plus 4) Camp Hill PA 17011-2110 Full Name of Contributor /MO. DAY YEAR Kristen Shelton 5 25 2021 $250.00 Mailing Address 1908 Lincoln St City State Zip Code(Plus 4) Camp Hill PA 17011-3839 Enter Grand Total of Part B on Schedule I,Detailed Summary Page,Section 2. PAGE TOTAL $1,150.00 PAGE 5 OF 7 PART B All Other Contributions $50.01 TO$250.00 Use this Part to itemize all other contributions with an aggregate value from $50.01 to$250.00 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: 20210153 Full Name of Contributor MO. DAY YEAR Ann Shroyer 5 25 2021 $100.00 Mailing Address 476 Bellfrey Dr City State Zip Code(Plus 4) Westerville OH 43082-6358 Enter Grand Total of Part B on Schedule I,Detailed Summary Page,Section 2. PAGE TOTAL $100.00 SCHEDULEPAGE 6 OF 7 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: 20210153 1.UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the Reporting Period (1) $0.00 2.IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) TOTAL for the Reporting Period (2) $0.00 3.IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTAL for the Reporting Period (3) $0.00 TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING PERIOD (Add and enter amount totals from Boxes 1, 2, $0.00 and 3;also enter on Page 1. Report Cover Page, Item F.) Schedule III PAGE 7 OF 7 Statement of Expenditures Filer Identification Number: 20210153 0Whom ai MO. nAY- WAR ActBlue 6 I 1 12021 $19.77 Mailing Address PO Box 441146 City State Zip Code(Plus 4) West Somerville MA 02144-0031 Description of Expenditure Service Fee To Whom Paid MO._ nAY VFAR Colleen Gray Nguyen l30I20211 $171.40 Mailing Address 1750 Yorkshire P1 City State Zip Code(Plus 4) Enola PA 17025-2745 Description of Expenditure Reimburse for Zippity Print To Whom Paid MO My YEAR NGP VAN 6 I 7 12021 $159.00 Mailing Address PO Box 392264 City State Zip Code(Plus 4) Pittsburgh PA 15251-9264 Description of Expenditure Online software fee Enter Grand Total of Expenditures on Page 1,Report Cover Page,Item D. PAGE TOTAL $350.17