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Home My WebLink AboutTri-County FDW PAC - 2021 2nd Friday Pre-Election irPennsylvania Department of State Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.oa.7Zovfcampaignflnance • ra-stcampal$nfinance(aoa.Rov 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 Finonce 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-SOS)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 , . 'Tr i - 1 U.✓t FI V Pi\e. Reporting Cycle Name. . ❑ Cycle 1 0 Cycle 2 ❑ Cycle 3 0 Cycle 4 ' Cycle 5 6th Tuesday 2n°Friday 30 Day 6th Tuesday 2"°Friday Pre-Primary Pre-Primary Post Primary Pre-Election 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. f4"r7 f T / /c 026911 gnature of Treasu , Candid , or Lobbyist Date (DD/ M/YYYY) 2./54 4kAi 30)1..a1/4 LEinzore.-pA u6A Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible.it should be typed) Filer Identification 20180439 Report Filed By Candidate — Committee X lobbyist !-' Number (Mark X) Name of Filing Committee,Candidate or Tri-County FDW PAC Lobbyist Street Address 285 Laurel Run Road(PO.Box 212) City Landisburg State PA ZlpCode '17040-000 I Type of Report(Place x under report type) I 1-6t Tuesday 2-2nd Friday 3-30 Day Post 4-6tTuesday 5-rs Friday 8-30 Day Post 7-Annual Special?a-Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-ElectionX Date Of Election Year Amendment Termination III Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 01/01/2021 10/18/2021 A.Amount.Brought Forward From Last-Report $ 637.68 B.Total Monetary Contributions and Receipts $ 1819.15 (From Schedule I) • _ C.Total Funds Available 1 2456.83 C-, (Sum of Lines A and B) f•' r.., �.. D.Total Expenditures S 1452.22 t: (From Schedule III) r. i cn E.Ending Cash Balance 1 1004.61 .�., c-) ' (Subtract Line D from Line C) 1-- —1 F.Value of In-Kind Contributions Received 1 0.00 " N (From Schedule II) .'— G.Unpaid Debts and Obligations 1 0.00 C.) • (From Schedule IV) c) ii Affidavit Section i. - r.... -_ Part 1-It this Is a Committee report,treasurer sign here.If this is a Candidate report,candidate sign here. d • I swear(or affirm)that this report,including the attached schedules on paper,Is to the best of my knowledge end belief true,correct and con1plete Sworn to and subscribed before me this '< 18th day of October PO 21 ure / 0 Signsvig of Perso bmilting report Usa Ann Bud% Signs re Printed Name 12/31/2021 717 364-8774 My Commission expires MO. DAY YR. Area Code Daytime Telephone Number Part II-II 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 o1 the Act of June 3,1937(PL 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 / - SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number 20180439 11.Unitemized Contributions and Receipts-S50.00 or Less per Contributor Total for the reporting period (1) S 182.00 I2.Contributions of S 50.01 to S 250.00(From Part A and Part B) Contributions Received from Political Committees(Part A) 8 All Other Contributions(Part B) S 1035.00 Total for the reporting period (2) S 1035.00 I3.Contributions Over S 250.00(From Part C and Part D) Contributions Received from Political Committees(Part C) 8 252.15 All Other Contributions(Part D) 8 350.00 Total for the reporting period (3) S 602.15 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) Total for the reporting period (4) 8 0.00 Total Monetary Contributions and Receipts during this reporting period (Add and 8 enter amount totals from Boxes 1,2,3 and 4;also enter this amount on Page 1,Report Cover Page,Item B) 1819.15 PART A Contributions Received From Political Committees S 50.01 TO S 250.00 Use this Part to itemize only contributions received from Political Committees with an aggregate value from S 50.01 TO S 250.00 in the reporting period. Filer Identification Number 20180439 Amount Full Name of Contributing Date[MM/DD/YYYY] S Committee House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] 8 Full Name of Contributing Date[MM/DD/YYYY] S Committee House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S Full Name of Contributing Date[MM/DD/YYYY] S Committee House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S Full Name of Contributing Date[MM/DD/YYYY] S Committee House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S Full Name of Contributing Date[MM/DD/YYYY] 8 Committee House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S Full Name of Contributing Date[MM/DD/YYYY] S Committee House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S PART B All Other Contributions S 50.01 TO 8250 Use this Part to itemize all other contributions with an aggregate value from S 50.01 TO S 250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: 20180439 Full Name of Contributor Date[MM/DD/YYYY] S Lisa Budwig 03/02/2021 25.00 House# Street Address Date[MM/DD/YYYY] S 1025A Walnut Street 05/26/2021 25.00 City State Zip Code Date[MM/DD/YYYY] 8 Lemoyne PA 17043 Full Name of Contributor Date[MM/DD/YYYY] S Rosemarie Ryder 03/02/2021 25.00 House# Street Address Date[MM/DD/YYYY] S 228 Glenn Road 07/19/2021 25.00 City State Zip Code Date[MM/DD/YYYY] S Camp Hill PA 17011 Full Name of Contributor Date[MM/DD/YYYY] S Bridget Whitley 03/02/2021 100.00 House# Street Address Date[MM/DD/YYYY] 8 1525 N Front St,Unit 20 06/18/2021 100.00 City State Zip Code Date[MM/DD/YYYY] S Harrisburg PA 17110 07/19/2021 50.00 Full Name of Contributor Date[MM/DD/YYYY] S Lindsey Drew 03/27/2021 50.00 House# Street Address Date[MM/DD/YYYY] S 73 Carousel Circle City State Zip Code-• Date[MM/DD/YYYY] S Hershey PA 17033 - - Full Name of Contributor Date[MM/DD/YYYY] S Diane Bowman 100.00 05/25/2021 House# Street Address Date[MM/DD/YYYY] S 136 Linglestown Road City State Zip Code Date[MM/DD/YYYY] S Harrisburg PA 17110 Full Name of Contributor Date[MM/DD/YYYY] S Kathleen Hooker 06/08/2021 25.00 House# Street Address Date[MM/DD/YYYY] S 1210 Waterford 100.00 7/19/2021 City State Zip Code Date[MM/DD/YYYY] 8 Camp Hill PA 17011 PART B All Other Contributions 850.01 TO 3250 Use this Part to itemize all other contributions with an aggregate value from 350.01 TO 8 250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: 20180439 Full Name of Contributor Ann Bruner Date[MM/DD/YYYY] S 100.00 06/14/2021 House# 197 Street Address S Main St,PO Box 244 Date[MM/DD/YYYY] S City Berrysburg State PA Zip Code 17055 Date[MM/DD/YYYY] 8 Full Name of Contributor Beryl Kuhr Date[MM/DD/YYYY] S 100.00 07/28/2021 House# 1431 Street Address Appletree Road Date[MM/DD/YYYY] 8 City Harrisburg State PA Zip Code 17110 Date[MM/DD/YYYY] 8 Full Name of Contributor Jenny Savino Date[MM/DD/YYYY] S 50.00 07/21/2021 House# 6627 Street Address Terrace Way,Apt B Date[MM/DD/YYYY] S City Harrisburg State PA Zip Code 17111 Date[MM/DD/YYYY] S Full Name of Contributor Carrot L.Paul Date[MM/DD/YYYY] S 60.00 09/12/2021 House# 410 Street Address S.2nd Street Date[MM/DD/YYYY] 8 City Lykens State PA Zip'Code 17048-1207 Date[MM/DD/YYYY] S Full Name of Contributor La Tasha Williams Date[MM/DD/YYYY] S 100.00 10/11/2021 House# 181 Street Address Hiddenwood Drive Date[MM/DD/YYYY] S 10/11/2021 City Harrisburg State PA Zip Code 17110 Date[MM/DD/YYYY] S Full Name of Contributor Date[MM/DD/YYYY] 8 House# Street Address Date[MM/DD/YYYY] 8 City State Zip Code Date[MM/DD/YYYY] S PART C Contributions Received From Political Committees Over S 250.00 Use this Part to itemize only contributions received from Political Committees with an aggregate value over S 250.00 in the reporting period. Her Identification Number: 20180439 Full Name of Date[MM/DD/YYYY] 8 Contributing Committee Friends of Jody Rebarchak 02/23/2021 252.15 House# Street Address Date[MM/DD/YYYY] S 3529 North 4th St. City State Zip Code Date[MM/DD/YYYY] S Harrisburg PA 17110 - Full Name of Date[MM/DD/YYYY] S Contributing Committee House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY]. S Full Name of Date[MM/DD/YYYY] S Contributing Committee House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S Full Name of Date[MM/DD/YYYY] S Contributing Committee House# Street Address Date[MM/DD/YYYY] 8 City State Zip Code Date[MM/DD/YYYY] 8 Full Name of Date[MM/DD/YYYY] S Contributing Committee House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S Full Name of Date[MM/DD/YYYY] 8 Contributing Committee House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S PART D All Other Contributions Over S 250.00 Use this Part to itemize all other contributions with an aggregate value over S 250.00 in the reporting period. (Exclude contributions from political committees reported in Part C) Filer Identification Number: 20180439 Full Name of Contributor Date[MM/DD/YYYY] 8 Phyllis Skok 100.00 03/02/2021 House# Street Address Date[MM/DD/YYYY] $ 353 N 25th Street 06/08/2021 100.00 City State Zip Code Date[MM/DD/YYYY] 8 Camp Hill PA 17011 150.00 07/19/2021 Employer Name Occupation Retired Employer Mailing Address/ Principal Place of Business Full Name of Contributor Date[MM/DD/YYYY] 8 House# Street Address Date[MM/DD/YYYY] 8 City State Zip Code Date[MM/DD/YYYY] 8 Employer Name Occupation Retired Employer Mailing Address/ Principal Place of Business Full Name of Contributor Date[MM/DD/YYYY] S House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] 8 Employer Name Occupation Employer.Mailing Address Principal Place of Business Full Name of Contributor Date[MM/DD/YYYY] S House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] 8 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: 20180439 Full Name House# Street Address City State Zip Date[MM/DD/YYYY] S Code Receipt Description Full Name House# Street Address City State Zip Date[MM/DD/YYYY] S Code Receipt Description Full Name House# Street Address City State Zip Date[MM/DD/YYYY] S Code Receipt Description" Full Name House# Street Address City State Zip Date[MM/DD/YYYY] S Code Receipt Description Full Name - House# Street Address City State Zip Date[MM/DD/YYYY] S Code Receipt Description Full Name House# Street Address City State Zip Date[MM/DD/YYYY] S 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: 20180439 I1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the reporting period (1) $ I2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) TOTAL for the reporting period (2) $ I3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER S250.00(FROM PART G) TOTAL for the reporting period (3) $ TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING S PERIOD(Add and enter amount totals from boxes 1,2,and 3;also enter on Page 1,Report Cover Page,Item F) SCHEDULE II PART F In-Kind Contributions Received VALUE OF S 50.01 TO S 250 Filer Identification Number: 20180439 Full Name of Contributor Date[MM/DD/YYYY] S House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] S House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] S House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] 8 House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] 8 Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] S House# Street Address Date[MM/DD/YYYY] S City State Zip Code Date[MM/DD/YYYY] S Description of Contribution SCHEDULE II Part G In-Kind Contributions Received VALUE OVER S 250 Filer Identification Number: 20180439 Full Name of Contributor Date[MM/DD/YYYY] S House# Street Address Date[MM/DD/YYYY] 8 City State Zip Code Date[MM/DD/YYYY] 8 Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution Full Name of Contributor Date[MM/DD/YYYY] 8 House# Street Address Date[MM/DD/YYYY] 8 City State Zip Code Date[MM/DD/YYYY] S Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution Full Name of Contributor Date[MM/DD/YYYY] 8 House# Street Address Date[MM/DD/YYYY] 8 City State Zip Code Date[MM/DD/YYYY] S Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution Full Name of Contributor Date[MM/DD/YYYY] 8 House# Street Address Date[MM/DD/YYYY] 8 City State Zip Code Date[MM/DD/YYYY] 8 Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution SCHEDULE III Statement of Expenditures Filer Identification Number: 20180439 To Whom Paid ACTBLUE Date[MM/DD/YYYY] 8 4.66 04/05/2021 House# Street Address Description of Expenditure City State Zip Platform fee Code To Whom Paid VANTIV ECOMMERCE CCD Date[MM/DD/YYYY] $ .9.71 04/09/2021 House# Street Address Description of Expenditure City State Zip ActBlue bank transfer fee Code To Whom Paid ACTBLUE Date[MM/DD/YYYY] 8 .38 05/11/2021 House# Street Address Description of Expenditure City State Zip Platform fee Code To Whom Paid VANTIV ECOMMERCE CCD Date[MM/DD/YYYY] S .50 05/11/2021 House# Street Address Description of Expenditure City State Zip ActBlue bank transfer fee Code To Whom Paid VANTIV ECOMMERCE CCD Date[MM/DD/YYYY] S 1.80 06/09/2021 House# Street Address Description of Expenditure City State Zip ActBlue bank transfer fee Code To Whom Paid ACTBLUE Date[MM/DD/YYYY] S 4.52 07/06/2021 House# Street Address Description of Expenditure City State Zip Platform fee Code To Whom Paid VANTIV ECOMMERCE CCD Date[MM/DD/YYYY] S 9.48 07/09/2021 House# Street Address Description of Expenditure City State Zip ActBlue bank transfer fee Code To Whom Paid ACTBLUE Date[MM/D'D/YYYY] 8 6.38 08/05/2021 House# Street Address Description of Expenditure City State Zip Platform fee Code SCHEDULE III Statement of Expenditures Filer Identification Number: 20180439 To Whom Paid VANTIV ECOMMERCE CCD Date[MM/DD/YYYY] S 11.46 08/10/2021 House# Street Address Description of Expenditure City State Zip ActBlue bank transfer fee Code To Whom Paid VANTIV ECOMMERCE CCD Date[MM/DD/YYYY] S .64 08/26/2021 House# Street Address Description of Expenditure City State Zip ActBlue bank transfer fee Code To Whom Paid VANTIV ECOMMERCE CCD Date[MM/DD/YYYY] S 1.00 09/09/2021 House# Street Address Description of Expenditure City State Zip ActBlue bank transfer fee Code To Whom Paid COMMITTEE TO ELECT LATASHA C WILLIAMS Date[MM/DD/YYYY] S 800.00 09/20/2021 House# Street Address P.O.BOX 5262 Description of Expenditure City HARRISBURG State PA Zip 17110 CAMPAIGN DONATION Code To Whom Paid FRIENDS OF KAREN OVERLY SMITH Date[MM/DD/YYYY] S 300.00 09/20/2021 House# 855 Street Address OAK OVAL Description of Expenditure City MECHANICSBURG State PA Zip 17055 CAMPAIGN DONATION Code To Whom Paid FRIENDS OF MARIAN URRUTIA Date[MM/DD/YYYY] 8 300.00 09/20/2021 House# 3824 Street Address BRYTTON LANE Description of Expenditure City HARRISBURG State PA Zip 17110 CAMPAIGN DONATION Code To Whom Paid VANTIV ECOMMERCE CCD Date[MM/DD/YYYY] S 1.69 10/12/2021 House# Street Address Description of Expenditure City State Zip ActBlue bank transfer fee Code To Whom Paid Date[MM/DD/YYYY] 8 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: 20180439 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 8 [M M/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED 8 [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED 8 [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED 8 [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED 8 [M M/DD/YYYY] City State Zip Code Description of Debt