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Home My WebLink AboutBasom, Patrick - 2021 2nd Friday Pre-Election 110 _ Reset Form 1 Print Form ff Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible.It should be typed) Filer Identification Report Filed By Candidate X Committee Lobbyist Number (Mark X) Name of Filing Committee,Candidate or Lobbyist Patrick Basom Street Address 103 N.21 St Street City Camp Hill State PA Zip Code 17011 Type of Report(Place x under report type) 1-6`h Tuesday 2- 2nd Friday 3-30 Day Post 4-6th Tuesday 5-2"d Friday 6-30 Day Post 7-Annual Special 2"d Friday Special 30 Day Pre-Primary Pre-Primary Primary. Pre-Election Pre-Election Election Pre-Election Post-Election • Date Of Election Year Amendment Termination (MM/DD/YYYY) Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 06/01/2021 10/18/2021 A.Amount Brought Forward From Last Report $ -0.00 C) B.Total Monetary Contributions and Receipts $ (From Schedule I) 0.00 C.Total Funds Available r l $ fi"f 0.00 tp-) (Sum of Lines A and B) :ZJ ry D.Total Expenditures $ (From Schedule III) 0.00 N E.Ending Cash Balance $ C3 (Subtract Line D from Line C) 0.00 C) F.Value of In-Kind Contributions Received $ Q (From Schedule II) 603.05 G.Unpaid Debts and Obligations $ '"1 .... (From Schedule IV) 0.00 •f 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 wledge and belief true,correct and complete. Sworn todpd subscribed before me this ,��.r [ri C�*-dray of OC t06131€ 20a l . I email� 1O/M �j_ /��, - __ Signature of Person Submitting report (�.i� �/71 ;{'iew r PATRICK BASOM \\SiRnafiup I Printed Name Commonwealth of Pennsylvania-Notary Seal My CooA Esil�frcchq'014-otar�'�i bli9Oa.3 717 317-1492 • Cumberlangi&younty DAy Y. Area Code Daytime Telephone Number My commission expires December 7,202 Part II-If tdr1is `Of 73 • Committee,candidate shall sign here. I f t arbt r f ff rif)*YzLrtd fhk5g05W4n' E3(6(01e 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 0�day of I0 C.)f3c� 20 i g 'y1/ C3X P—egAx/n 49 r^,'t_ PATRICK BASOMSignature o Candidate l eC� Signature Printed Name My Commission expires U7•• U Da'- 717 317-1492 MO. DAY YR. Area Code Daytime Telephone Number , Commonwealth of Pennsylvania-Notary Seal _ x Alan McCullough,Notary Public Cumberland County - My oommisslon.expires December 7,2023 Commission number 1296073 Member,Pennsylvania Aosociatlon Of Naterlee e SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number Patrick Basom • I 1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total for the reporting period (1) $ ' 2.Contributions of$50.01 to 5250.00(From Part A and Part 8) Contributions Received from Political Committees(Part A) $ All Other Contributions(Part B) $ Total for the reporting period (2) $ 0.00 I 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 .09 Total for the reporting period (3) $ 0.00 1 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) I Total for the reporting period (4) $ 0.00 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) 0,00 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: Patrick Basom I1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR I 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) $ 129.95 3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTAL for the reporting period (3) $ 473.11 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) 603.05 SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 Filer Identification Number Patrick Basom Full Name of Contributor Date[MM/DD/YYYYJ $ Camp Hill GOP Committee 07/22/2021 129.95 House# Street Address Date(MM/DD/YYYYJ $ 105 N.21st St City State Zip Code Date[MM/DD/YYYYJ $ Camp Hill PA 17011 Description of Contribution Literature Full Name of Contributor Date(MM/DD/YYYYJ $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYYJ $ Description of Contribution Full Name of Contributor Date(MM/DD/YYYYJ $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYYJ $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYYJ $ City State Zip Code Date[MM/DD/YYYY] $ Description of Contribution Full Name of Contributor Date(MM/DD/YYYYJ $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYYJ $ Description of Contribution SCHEDULE II Part G In-Kind Contributions Received VALUE OVER$250 Filer Identification Number: Patrick Basom Full Name of Contributor Date[MM/DD/YYYY] $ Camp Hil GOP Committee 473.11 10/18/2021 House# Street Address Date[MM/DD/YYYYJ $ 105 N.21 st St. City State Zip Code Date[MM/DD/YYYY] $ Camp Hill PA 17011 Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Signs and delivery 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/YYYYJ $ City State Zip Code Date IMM/DD/YYYYJ $ Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution Full Name of Contributor Date(MM/DD/YYYYJ $ House# Street Address Date[MM/DD/YYYYJ $ City State Zip Code Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution