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Home My WebLink AboutFriends of Jean Foschi - 2021 6th Tuesday Pre-Election Pennsylvania Department of Stated , F Bureau of Campaign Finance&Civic Engagement 6.2g 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) .p www.dos.pa.Qov/campaisnfinance • ra-stcampaienfinance@pa.gov re- t-,) Ca Unsworn Statement in Lieu of Sworn Statement for Campaign Finance Statements 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 Statements. This form must be signed by hand where a signature is required. Name d ROW Committee, Candidate,Cy Lobbyist -i-tebots or Jut"? ps Reporting @igig Name i ❑ Cycle 1 0 Cycle 2 0 Cycle 5 Cycle: i ❑ Cycle S 6th Tuesday 2nd Friday 30 Day 6th Tuesday 2"d Friday Pre-Prima ry Pre-Primary Post Primary Pre-Election Pre-Election ❑ Cycle 6 ❑ 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 committee, the treasurer must sign here. If this form is submitted with a statement in lieu of a full report by a candidate, the candidate must sign here. If this form is submitted with a statement in lieu of full 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. :73(..(k) IP ow opt. q. 2021 Signature of surer, Candidate, or Lobbyist Date (DD/MM/YYYY tumiciottla SD-fah 1 e)rge,C Cam p ll , USA DSEB-503S Updated 6/24/2020 Pennsylvania 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 is submitted with a statement in lieu of full report by a Candidate's Authorized Committee, candidate sign here. I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania that the foregoing is true and correct. Signature of Candidate Date (DD/MM/YYYY) riii C�l.i lVQliit LVt.01.1ui1 tLityi. zp..,v illi_iy 4 ti+- - c� DSEB-503S InG061 I Mill j r nn'•i wow • 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) n Name of Filing Committee,Candidate or Friends oflean Foscht Lobbyist Street Address 2195 Brunswick Avenue City Mechanicsburg State PA Zip Code 17055 1 Type of Report(Place x under report type) ) 1-6th Tuesday 2- 2"4 Friday 3-30 Day Post 4-6th Tuesday 5-r'd Friday 6-30 Day Post 7-Annual Special 2ntl Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election xnn n Date Of Election Year Amendment Termination (MM/DD/YYYY) j Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 6/8/2021 9/13/2021 A.Amount Brought Forward From Last Report $ 1255.16 B.Total Monetary Contributions and Receipts $ 250.00 C") (From Schedule I) C.Total Funds Available $ 1505.16 (Sum of Lines A and B) t70 t� D.Total Expenditures $ 0.00 :O -o (From Schedule III) T'r" N l' CD E.Ending Cash Balance $ 1505.16 = (Subtract Line D from Line C) CD p F.Value of in-Kind Contributions Received $ 0.00 CD AD (From Schedule II) G.Unpaid Debts and Obligations $ 0.00 -=-i (From Schedule IV) „6 - 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 day of 20 �, = Si ture o erson Submitting report zignaiure My Commission expires 11 1 1856 ' I L753 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. Sworn to and subscribed before me this da of 20 �� S atrur�f Candidate ec ' ` 7 Sr 11( '' 5 �3 My Commission expires ✓ MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE I Contributions and Receipts Detailed Summary Page Flier Identification Number I1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total for the reporting period (1) $ 0.00 I2.Contributions of$50.01 to $250.00(From Part A and Part B) Contributions Received from Political Committees(Part A) $ 0.00 All Other Contributions(Part B) $ 250.00 Total for the reporting period (2) $ 250.00 3.Contributions Over$250.00(From Part C and Part D) I 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) I 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 250.00 Cover Page,Item 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:I I Full Name of Contributor James H.Herztler Date[MM/DD/YYYY) $ 250.00 7/31/2021 House# 920 Street Address South Humer Street Date[MM/DD/YYYYJ $ City Enola State PA Zip Code 17025-2925 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/YYYYJ $ House# Street Address Date[MM/DD/YYYYJ $ City State Zip Code Date(MM/DD/YYYY) $ Full Name of Contributor Date[MM/OD/YYYY) $ House# Street Address Date[MM/DD/YYYYJ `$ 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/YYYYJ $ Full Name of Contributor Date[MM/DD/YYYY] ,$ House# Street Address Date[MM/DD/YYYYJ $ City State Zip Code Date[MM/DD/VYYYJ $