HomeMy WebLinkAboutHampden Township Democratic Club - 2021 2nd Friday Pre-Election 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-stcampaignfinancePpa.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
Hampden Township Democratic Club
Reporting Cycle Name
❑ Cycle 1 ❑ Cycle 2 ❑ Cycle 3 ❑ Cycle 4 I] Cycle 5
6th Tuesday 2nd Friday 30 Day 6th Tuesday 2nd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election
❑ Cycle 6 ❑ Cycle 7 ❑ Cycle 8 ❑ Cycle 9
30 Day Post-Election
Annual Report 2nd Friday Pre-Special Election 30 Day Post-Special Election
Part 1 - 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.
4110 10/20/2021
Signat � easurer, Candidate, or Lobbyist Date (DD/MM/YYYY)
Sarah Yerger Camp Hill, PA USA
Printed Name Location (City/State/Country)
DSEB-502R
Updated 1/22/2021
MilU-- - -- - ------ -1/---:------- ---- -- -
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 20200298 (Mark X)
Name of Filing Committee,Candidate or
Lobbyist Hampden Township Democratic Club
Street Address 102 Saint Johns Church Road
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 5-2nd 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
X
Date Of Election Year Amendment Termination
(MM/DD/YYYY) 11/02/2021 2021 Report Report
Summary of Receipts and From Date To Date For Office Use Only
Expenditures
06/08/2021 10/18/2021
A.Amount Brought Forward From Last Report $ t
3259.15 t: r''"
B.Total Monetary Contributions and Receipts $ t
(From Schedule I) 100.38 f
C.Total Funds Available $ rr'"' ""'
(Sum of Lines A and B) 3359.53 N.)
D.Total Expenditures $
(From Schedule III) 2239.90 CD ➢,
E.Ending Cash Balance $ CD A
(Subtract Line D from Line C) 1119.63 C,
F.Value of In-Kind Contributions Received $ --'I IV
(From Schedule II) 0.00
G.Unpaid Debts and Obligations I (From Schedule IV) $
0.00
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
•day of_ 20 ( • �
Signa e o . n Su.mining report
• Sarah Verger
Signature r Printed Name
My Commission expires 717 856-1388
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
0
SCHEDULE I
Contributions and Receipts
Detailed Summary Page
Filer Identification Number
20200298
1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor I
Total for the reporting period (1) $ 100.00
I2.Contributions of$50.01 to $250.00(From I
Part A and Part B)
Contributions Received from Political Committees(Part A) $
All Other Contributions(Part B) $
Total for the reporting period (2) $
3.Contributions Over$250.00(From Part C and Part D)I
I
Contributions Received from Political Committees(Part C) $
All Other Contributions(Part D) $
Total for the reporting period (3) $
I4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) I
Total for the reporting period (4) $
0.38
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
100.38
Cover Page,Item B)
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:
Full Name
Members 1st Federal Credit Union
House# 6280 Street Address Carlisle Pike
City State Zip Date[MM/DD/YYYY] $
Mechanicsburg PA Code 17050 0.13
06/30/2021
Receipt Description
Dividend
Full Name
Members 1st Federal Credit Union
House# 6280 Street Address Carlisle Pike
City State Zip Date[MM/DD/YYYY] $
Mechanicsburg PA Code 17050 0.13
07/31/2021
Receipt Description
Dividend
Full Name
Members 1st Federal Credit Union
House# 6280 Street Address Carlisle Pike
City State Zip Date[MM/DD/YYYY] $
Mechanicsburg PA Code 17050 0.12
08/31/2021
Receipt Description
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/YYYY] $
Code
Receipt Description
Full Name
House# Street Address
City State Zip Date[MM/DD/YYYY] $
Code
Receipt Description
SCHEDULE III
Statement of Expenditures
Filer Identification Number:
20200298
To Whom Paid Date[MM/DD/YYYY] $
ActBlue 2.00
06/03/2021
House# Street Address Description of Expenditure
366 Summer Street
City State Zip
Somerville MA Code 02144 Fee
To Whom Paid Date[MM/DD/YYYY] $
Vantiv eCommerce 7.40
06/09/2021
House# Street Address Description of Expenditure
900 Chelmsford Street
City State Zip
Lowell MA Code 01851 Fee
To Whom Paid Date[MM/DD/YYYY] $
Members 1st Federal Credit Union 4.95
06/30/2021
House# Street Address Description of Expenditure
6280 Carlisle Pike
City State Zip Fee
Mechanicsburg PA Code 17050
To Whom Paid Date[MM/DD/YYYY] $
Wegmans 124.02
07/08/2021
House# Street Address Description of Expenditure
6416 Carlisle Pike
City State Zip
Mechanicsburg PA Code 17050 Volunteer Picnic
To Whom Paid Date[MM/DD/YYYY] $
Vantiv eCommerce 2.97
07/09/2021
House# Street Address Description of Expenditure
900 Chelmsford Street
City State Zip
Lowell MA Code 01851 Fee
To Whom Paid Date[MM/DD/YYYY] $
Wegmans 96.22
07/11/2021
House# Street Address Description of Expenditure
6416 Carlisle Pike
City State ' Zip
Mechanicsburg PA Code 17050 Volunteer Picnic
To Whom Paid Date[MM/DD/YYYY] $
Jessica Beamesderfer 22.28
07/20/2021
House# Street Address Description of Expenditure
3819 Hearthstone Drive
City State Zip Reimbursement for Event Su lies
Camp Hill PA Code • 17011 PP
To Whom Paid Date[MM/DD/YYYY] $
, „ Members 1st Federal Credit Union 4.95
07/31/2021
House# Street Address Description of Expenditure
6280 Carlisle Pike
City State Zip
Mechanicsburg PA Code 17050 Fee
SCHEDULE III
Statement of Expenditures
Filer Identification Number:
20200298
To Whom Paid Date[MM/DD/YYYY] $
Vantiv eCommerce 08/10/2021 2.97
House# 900 Street Address Description of Expenditure
Chelmsford Street
City State Zip
Lowell MA Code 01851 Fee
To Whom Paid Date[MM/DD/YYYY] $
Jenna Behringer 08/13/2021 44.82
House# Street Address Description of Expenditure
888 Mandy Lane
City State Zip
Camp Hill PA Code 17011 Reimbursement for eBallot
To Whom Paid, Date[MM/DD/YYYY] $
Members 1st Federal Credit Union 4.95
08/31/2021
House# Street Address Description of Expenditure
6280 Carlisle Pike
City State Zip
Mechanicsburg PA Code 17050 Fee
To Whom Paid Date[MM/DD/YYYY] $
Friends of Dr.Ryan Argot 09/07/2021 500.00
House# Street Address Description of Expenditure
1034 Chelmsford Drive
City State Zip
Mechanicsburg PA Code 17050 Donation
To Whom Paid Date[MM/DD/YYYY] $
Friends of David Fish 09/07/2021 500.00
House# Street Address Description of Expenditure
405 Lamp Post Lane
City State Zip -..
Camp Hill PA Code 17011 Donation
To Whom Paid• Date[MM/DD/YYYY] $
Vantiv eCommerce 09/09/2021 2.98
House# Street Address Description of Expenditure
900 Chelmsford Street
City State Zip
Lowell MA Code 01851 Fee
To Whom Paid Date[MM/DD/YYYY] $
Members 1st Federal Credit Union 4.95
09/30/2021
House# Street Address Description of Expenditure
6280 Carlisle Pike
City State Zip
-- Mechanicsburg PA Code—' 17050 Fee
To Whom Paid Date[MM/DD/YYYY] $
'''' ""• Maurice Reeves
10/04/2021 190.68
House# Street Address Description of Expenditure
3805 Bellows Drive
City State Zip
Camp Hill PA Code 17011 Reimbursement for Zoom
SCHEDULE III
Statement of Expenditures
Filer Identification Number:
20200298
To Whom Paid Date[MM/DD/YYYY] $
Vantiv eCommerce 2.97
10/12/2021
House# Street Address Description of Expenditure
900 Chelmsford Street
City State Zip
Lowell MA Code 01851 Fee
To Whom Paid Date[MM/DD/YYYY] $
Cheltenham Printing 10/14/2021 720.80
House# Street Address Description of Expenditure
518 Ryers Avenue,#2 First Floor
City State Zip
Cheltenham PA Code 19012 Literature
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
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