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Home My WebLink AboutSmith, Emily - 2021 2nd Friday Pre-Election Pennsylvania Department of State tt, ;; 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 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), 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 Statements. This form must be signed by hand where a signature is required. ! GtEliMgCtlIMR3 Committee, Candidate,®p Lobbyist Emily Smith Reporting ❑ Cycle 1 ❑ Cycle 2 ❑ Cycle 3 ❑ Cycle 4 [ 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 I — If this form is submitted with a statement in lieu of full report by a political 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 accompanying Campaign Finance Statement is true and correct. 10/22/21 Signature of T easurer, Candidate, or Lobbyist Date (DD/MM/YYYY) Emily Smith Camp Hill, PA Printed Name Location (City/State/Country) DSEB-5035 Updated 1/22/2020 iiiitii Reset Form I Print Form 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 Emily Smith Street Address 2002 Columbia Ave City Camp Hill State T PA Zip Code 17011 Type of Report(Place x under report type) 1-6th Tuesday 2- 2"'Friday 3-30 Day Post 4 6'hTuesday 5.2"a Friday 6-30 Day Post 7-Annual Special 2"'Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election X I I _ Date Of Election Year Amendment Termination (MM/DD/YYYY) 11/2/2021 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 $ 0 B.Total Monetary Contributions and Receipts $ (From Schedule I). 75 C.Total Funds Available cn (Sum of Lines A and B) 75 �nA -rwN D.Total Expenditures $ (From Schedule III) 229.18 re") E.Ending Cash Balance $ (Subtract Une D from Une C) 154.18 I'`7 to.3 F.Value of In-Kind Contributions Received $ 196.70 (From Schedule II) G.Unpaid Debts and Obligations $ (From Schedule IV) 0 C. 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 Signature of Person Submitting report Signature Printed Name My Commission expires 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 IPA..1333.NO,3201 as amended. Sworn to and subscribed before me this f 0P-91 v 1 22 dayof October 20 21 • mil Smi DiEna y%%fled by Emily Smith V Date:2021.10 22 09:21 AS-04'00 Signature of Candidate Emily Smith Signature Printed Name 717 421-3789 My Commission expires _ MO. DAY YR. Area Codr Daytime Telephone Number SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number I1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor I Total for the reporting period (1) $ 75.00 2.Contributions of$50.01 to $250.00(From Part A and Part B)I I Contributions Received from Political Committees(Part A) $ All Other Contributions(Part B) $ Total for the reporting period (2) $ I3.Contributions Over$250.00(From Part C and Part D) 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) $ 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 75.00 Cover Page,Item B) 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: 1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the reporting period (1) $ I 2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) `I TOTAL for the reporting period (2) $ 196.70 I3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTAL for the reporting period (3) $ 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) 196.70 SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 Filer Identification Number: Full Name of Contributor Date[MM/DD/YYYY] $ Camp Hill Democrats 10/17/2021 196.70 House# Street Address Date[MM/DD/YYYY] $ PO Box 1415 City State Zip Code Date[MM/DD/YYYY] $ Camp Hill PA 17001 Description of Contribution Post-cards,post-its with all candidates Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Description of Contribution SCHEDULE III Statement of Expenditures Filer Identification Number: To Whom Paid Date[MM/DD/YYYY] $ Printful Inc. 21.40 10/12/2021 House# Street Address Description of Expenditure 11025 Westlake Dr City State Zip Charlotte, NC Code 28273 Campaign T-shirt To Whom Paid Date[MM/DD/YYYY] $ Super Cheap Signs 165.38 10/7/21 House# Street Address Description of Expenditure 9200 Wateford Center Blvd,Suite 100 City State Zip Austin TX Code 78758 Yard Signs and Stakes To Whom Paid Date[MM/DD/YYYY] $ Sticker Mule 42.40 10/7/21 House# Street Address Description of Expenditure 336 Forest Ave City State Zip Amsterdam NY Code 12010 Campaign Buttons 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