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HomeMy WebLinkAboutLeading Hampden's Success Committee - 2021 2nd Friday Pre-Election Pennsylvania Department of State fol Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.cov/campaienfinance • ra-stcampalenfinancet Da.xov 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 unworn 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 L&Ac -}a-awl MCA -vl's S(,lce-e55 Omvytt-N-ee_, Reporting Cycle Name ❑ Cycle 1 Cyde 2 0 Cycle 3 0 Cycle 4 E ' Cycle 5 6th Tuesday 2"d Friday 30 Day 6t Tuesday 2nd 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. °Lc V4-I lok411. I Signature of Treasurer, Candidate, or Lobbyist Date(DD/MM/YYYY) N . 14 A.,1j)f.0 Ev c.V•i. l c)b r\,,P+P „NcJM t1 Printed Name Location (City/State/Country) v S DSEB-502R Updated 1/22/2021 ttes•Q[fYl Ul VII Commonwealth of Pennsylvania.Campaign Finance Report (Note:This report must be dear and legible.It should be typed) Filer Identification Report Filed Iiy Candidate Number (Martz X) 1lSiiiillIllalha II Name of Nine Committee,Candidate at Lobbyist Leading Hampden'Success Committee Street Address P.O.!oa 213 City Camp Nal iliaPA ZIP .• 17001 Type of Report(Place x under report type) 3.6s Tuesday 2. 2"Friday 3-30 Day Post 4.60Tuesday S-2r o Friday f-30 Day Post 7-Annual Special 2 Friday Sped2130 Dp Foe-Primary Pre-Primary Primary Pre.Election Pre-Election Election Pre-Election Post 13ectlon a : n n ❑ ❑ a ; o �0 oat*Oi Election Year Amendment (� Termination (� (fNMfDO/YYyY) Report u Reportu Summary of Receipts and From Date To Date for Office We Only Expenditures 9112021 10ROR021 A.Amount Drought Forward From Last Report $ 0 IL Total Monetary Contributions and Receipts 1 7.ZOD 00 (From Schedule I) �-•; C.Total Funds Available $ (Sum of Unes A and II) 7.200.00 Ni 0.Total Expenditures $ 1,078 ---: (From Schedule III)E.Ending Cash Ratans* $ 5331.1s > 1\2 {Subtract Une 0 from Une C)F.Value of In•Kind Contributions Received Sr 3�OA0 'cur (From Schedule II) G.Unpaid Debts and Oblldatlone $ -."t(From Schedule IV) i Ail'davit SettWOn ...,, , Part 1-tf this is s Colrlmltte*report.treasurer sign here if this is a Candidate report,candidate sip here. , I swear(or affirm)that this report,including the attached schedules on paper.Is tome best of my knowledge and banal Cave,correct and complete. Sworn to and subscribed before me this , — —claYof m Sta'a omft 1tt11tttort4 (�i J'�/C hWedName 1" Siensture • —1 f 3tC -5y\-1-O My Canrolsslon expires_..---- MO. DAY YR. Area Code Daytime Telephone Number Part It-If this+s a report of a Candidate's Authorized Committee,c nd.date shah sign here. I swear for affirm)that to the best of my snowledge and beef this postiod committee has not%notated any provisions of the Act June 3,1937(P.L 1333,N0.310)as amended. Sworn to and subscribed before me this Alilf d 20... • Signature of Candidate Printed Name Signature MD. DAT YR. Ares Code Daytime Telephone Number i Commonwealth of Pennsylvania-Campaign Finance Report fifer Identification (Note_This report must be Clear and legible.It should be typed) Number Repon Filed R w••� (Mark It) y CjnmitI.e 151 tobb'ilsl t Name of filing Committee.Candidate or lobbyist Leading N,mpdens 1 t Street Address SuccestCorxrnittet PA loxLel City r, ._, Camp MiffY - State PA Code Type of Report(Place a under report t t7001 i' wwwwweasse, j 1.6" Tuesday 2. 2"r Friday 3.3ppry Post 4 6+Tuesd, ' i pre•Primary he-primary 3 30D 4- y 5.2"dFriday 6-30DayPost 7•Annual lSpectate.frlday Special 30Dry Section Pr Election Election Pre-Election Post-Elecdon . _ ri ----n-- El ---r. IR - EJ 7.7-F71 7.77-, Date Of Election t (MM/00YY) i Year /YY Amendment 0 Tetrnlnatlon Report Report / Summary of Receipts and From D ate Expenditures io da1e for Office Use Only A.Amount iron t Forwar d F �f tR02t `r lorzo"2021 ran last Report $ 0 r S.Total Monetary Contributions and Receipts $ ' (horn Schedule 1) 7,200-00 C.Total Fund s Mali able - _ -- — $ (Sum of tines A and d) - 7.20000 D.Total Expenditures - $ (From Schedule III) 1,071.62 E.Ending Cash Balance ' ` - $ (Subtract tine D from line f:) 532144 F.Value of In-Kind Contributions Received (From Schedule 11) 340.00 . G.Unpaid Debts and Obligation* $ - - (From Schedule IV) t-- - , __ . . AN.dawit Section Part 1•If this is a Committee report,treasurer urn here It tho is a Candidate report,canddale sign here. - I swear for affirm)that this report,including the attached schedules on paper,is to the best of my anowtedge and belief tsue,conect and complete. Sworn to and subscribed before me this r 'day of 20_ ' r. ) Sijtsi}nre? e s 4u inlrieport- 1 } .i /t Signature �- 1 Printed Name ty �^J (4'1 My Commission expires • 1 (1 31 q -5 yti1-0 No. DAY Y11, Area Code Daytime Telephone Number Part Il 11 this is a report of a Candidate's Authorised Committee,candidate shall pen here. .1 swear(or affirm)that to the best of my knowledge and belief this political committee has not violated any provisions of the Act of 1 ne 3 937(P.1.1333,N0.320)as amended. Sworn to and subscribed before me this 5 s' ' day of 20 F Sl nature of Cardiditt v,. I . ? r Signature Name My Commission expires - - - -i 'f ' M0, DAY YR. Area Code Daytime Telephone N ber a/`5-r64 TryPennsylvania Department of State Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.Bov/campalenfinance • ra•stcampaignfinance@oa.gov Part II-if this form is submitted with a report by a Candidate's Authorized Committee, the candidate 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. jo aa1a I Signature of Treasu er,Candidate,or Lobbyist Date(DD/MM/YYYY) 614 0 z4-tX-n/f!L— Nle c �.. �� ����� el v Printed Name Location (City/State/Country) DSE8-502R Updated 1/22/2021 r1C4el f Vl lrr 111 Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be dear and legible.It should be typed) ZMt IdentificationReport Filed ByCandidate Committee Lle"" !III Number (Mark X) Name of Filing Committee.Candidate or lobbyist trading Nampden%Success Committee Street Address .....— CO.Ilya NU art Camp Ms iiii111:1111116611 MI Type of Report(Plate s under report type) 1-6"Tuesday 2. 2ie Friday 3-30 Day Post 4-6*Tuesday 5.2"Friday 6-30 Day Post 7-Annual Specie 2 Friday Spedal30 Day Pee-Primary IrsAtnhary Primary Ire-Election Pre-Election Election Pre-Electiontoss-Election 11 I-1 Li El © ' 0 TJ TJ Oats Of Election (Year Amendment ❑ Termination (MM/DD/f ref► Report Report Summary of Receipts and From Date To DateOffice Use Only Expenditures 911/2021 10r2012021 .------ A.Amount elougt t Forward From Last Repoli S 0 S.Total Monetary Contributions and Receipts S 7,IOanO (From Schedule I) C.Total Funds Avaliabie S 7,20000 (Sum of Lines A and II) D.Total Expenditures $ 1,078.82 (From Schedule III) E.Ending Cash eatana $ 5321.18 (Subtract Une D from tins Q F.Value of In-Kind Contributions Received $ .00 _(From Schedule Il) $ G.Unpaid Debts and Obligations (From Schedule M .,ram enrrr�� Affidavit sedlon cart 1-If this is s Ccrwlitte•report.treasurer tqn here If this is a Candidate report.andelate shin here. I swear for affrro)that this repot,Indudrni the attuned schedules on paper,is to the best of my tho+vri edte and belief true.correct and compete. Sworn eo and subscribed before me this -.) JJ sntrevire.4. korp7tHJoy NI.1). /4." Printed Name : --� fl 3 l a —5 L0410 MU GomfMstfon erpMts MOi, OAT YR. Area Code Daytime Telephone Number Pat II-if this a a report of a Candidates Authortred ComMtee,candidate shalt skin here. I s rear(o►aMunr)that to the best of my Mnowledan and belief this political committee has not violated any provisions of the Act°t line 3.1W(I .1333,140.320)as f amended b.a� TD Sin to ind 7 "'id�01e rll! T• �( �..----MY of . �� / '4 �d Y /aMC � , Pmtea Nam! Silenitlite / not Dominion ma, OAT YR. Area tale Daytime Telephone Number Writ/ Pan neul.—_• irw Pennsylvania Department of State Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.oa.Rov/campaignfinance • ra.stcampafanfinancei )pa.gov Part i!*If this form is submitted with a report by a Candidate's Authorized Committee, the candidate 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. i r L.-: R Q,L4 0 \Op a j A\ Signature of Treasurer,Candida e,or Lobbyist Date(DD/MM/YYYY) \te*14?-(NA Z. Q.,\;,8 l k.A5 Pt- Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 (Note:This report must be dear and legible.It should be typed) 11..iiii ern Name of FUYtg Committee,Condl ate Or tobtfrist Wafts Hampden Success Committee ,.,—.—, Street Address — ' P.O.lb.7s3 AL . —Camp sill PA Z'1►t ---1 17001 type of Report(Place a under report type) Il•i�Tuesday 2. 2'~Friday 3.30 Day Post S-2/e Friday i-30 Day Post 7-Annual Special 2 Fria/ Spsdat 30 De/ Prs'P,lmary Pta.refmary Primary Pre-Election Election Pre-VINon Post-Election . LD ,..- NI ■ ■ ITO'71 lillar-1 Date Of Election Year Amendment Terhnllutiot ❑ (MM/DD/1fYY� Repoli ❑ Report r wwmawnesmosonaweiseinwol Summary of Receipts and ‘I Rom Date To to For Office Use Only Esrmatditurea W12021 102012021 A.Amount Brought Forward From last Report `S 0 D.Total Monetary Contributions and Receipts S- (From Schedule I) 7.200.00 C.Total Funds Available S 7.3�00 (Sum of lines A and I) D.Total Expenditures $ (From Schedule Ill) 1.678.112 E.Ending Cash Balance S (Subtract line D from tine C) 6.321.11 F.Value of In•klnd Contributions Received S I (From Schedule n) 40 G.Unpaid Debts and Obligations S (From Schedule IV) Affidavit Section Part 1.If this Is a CaanrWnee repot.treasurer sign here.If this Is a Oneidas►epos.candidate sign here. I swear(or aHwm)that the report Including the attuned scheduleson paper,Is tothe best of my knowledge and kfel OW.corteCt and complete. Sworn to and subscribed bdort me tds —) L. m.�•.�- • .J i� ± --deT� SVpa�rt�""r 1"M(`') -. it t J dal NI.ikj/Zt� SI 1 ��- Printed Name _l —1 (-1 3t9 —59%410 my Convolute epees Area Code Daytime Telephone Number Ma DAY Y . Part II-Q the is a report of a Candidate's Authotred Cmm huff candidate shall sign here. 1 swear(or affirm)that to the best d my knowledge and bdlef the political committee has not violated any provisions of the Act shuns 3.1937(►.L 1333,NO.320 a• amended. Sworn to and subscribed bdore me this / ��—dgaf g tune eta miry 11 rmtedN sOs—i sew MO. DAT YR. Area Code Daytime Telephone N TOPennsylvania Department of State Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.aov/campaignfinance • ra-stcampai nfinancet a.aov Part!I If this form is submitted with a report by a Candidate's Authorized Committee, the candidate must sign here. 1 declare under penalty of perjury under the law of the Commonwealth of Pennsylvania that the accompanying Campaign Finance Report is true and correct. WI roe IV/ • _ - ure of Treasure ,Can.ida -,or Lobbyist Dat (DD/MM/YYYY) JG iZ— 614.9(.0, Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 Nr . Commonwealth of.Fennsylyanta..Campaign.:finance M.Report (Note:.Thts rep�<must be Clear and':Ie0Ible It thould be typed) Vic+identil carton Ilt port Filed,t�i ap . ,. > . Mat, r.ii''. l ,'t dindldittar llill fe e . tea!ainp eljmpdeet•Suctus.Coinutitte, '3aei,taikadraz. P.O.$o*2 Gtrlq.Wll atria fir► > ct s o.,f,Report;(P�e.ittinder report type) . . . . . . . . . . • i.;7 Tiit*iiday 2 1~Fi 44.Y. ;330D01iPost 4-661.0esdail►':8..t..'Fddiy 40:b.. •Post :7=AMw.et :5 . iI.2 Fr.. •.. it: ,SOtdal! Dsr 'tea. .Pr4' wy .041.0401. Pre..Electlon lrra.Elettlon tiitstiioie :Prt-FleNOd 1' st=decti° • • : ®� gut of Elicgon .. Year Aniembna.t. Teminadoa (il..6 1 .i+ iii • .• Su °f:lt.. from.pliE •' 141.4.ToOM forOltiu:us+ed+lr • eallpls•sod tars • 01112021 teRbl2 1' f .AAnitlutu.tiiqu *.fti o. .F port $ • 4.0-$ l.mon tat oet' assod l't apes $ t . �omSdt.du s;i) 7.T40.44 C Tot 0 Funds Apa lW I $' 1 tn1 Llne4:And.:i l . 40:4O F`om`Se ledule;iiI 1. ( vT, E,E£.dIn coo.paI na •$ JS :user Une b feoni tliit`t cj ,-MO. F'vaptt b7le4rind Ceiitritnitioret RIAlynd :$ . Fro nt-3ti; Co 11I..:.: • • .. 340/0 • 6u :Debts ifideblipitioiei . . $ . (Ffotif diieddle IA • r . -. Ay1WailtSV Aso . flyt16 04tettOi MNlrlii lepwt;tt#1Mret itn WO u tMtl a;lan4irwseporl.and to slin We. . ef`Ot' kxn 1A�thli'rlpoR,lndl�MljtAe s tgc siAaEd' �.piipet {stkiht'.'Oestnlmykndi•(ad�:nel t etwe egier4ryR, 10.ctr!"WRu�. 3.rom:ain su cr t !►itiiie+ teiis m. —.. ".". •.., . . .. " ,sin-t . . turport. , • • : - .:T.. ... ..1..: .... ,.... ...-1—,•:•..i70.1..44.)zitz• . • - S'isttA. r�rdaeu�r» . .0. Ni. MvCa nnd*,e pins /seR Code • 0rlytbnrtflepho eNumber MAt7,, DAY 1fR. • 1;i t;({�d'.Ihis'is.s RV?rt Of,/Candidate^, •-Agatha' + ed Comm•lette elM date 311 lfl We: . t.sr*esr.lor aNirm� of to :l begot. myincoo a and belief W s•po OWw ....... -. mOl any..• oft the•Act o•dune S,•. (r G Ian"1,3211 as •nileadl: "-1.7;4.-<‘•'..fa„s fr_ tirrofi. 76117/atP, r. 1,-. . titntid time • III itco .. keir.00e • Qi lelekptipitie Niintbet ' � rNo. QI►� re. • 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/camaaignfinance • ra-stcamaaignfinance(aaa.tov Part II-if this form is submitted with a report by a Candidate's Authorized Committee, the candidate 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. o / 7/ Signature of Tre urer, Candidate,or Lobbyist Date (DD/MM/YYYY) c ,/ /`�• X0$5 to f { Apii e 1 zif 4 Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 raReset Form f Print form 1 •: ' Y -Campaign Finance Report Commonwealth of Pennsylvania ' (Note:This report must be clear and legible.it should be typed) Flier Identification , : Number Report Filed By Candidate Ell. Committee al lobbyist II Name of Filing Committee,Candidate or in (Mug x} lobbyist leading NampdensSuccessCommittee Street Address . P.O.cox 213 City ----, ?i Camp Rill State Zip' -- i ►A 11001 Type of Report(Place x under report type) 1-6*Tuesday 2. 2'1 Friday 3.30 Day Post 4-611 Tuesday 5. Friday i 30 Day Post 7-Mnual Special . friday Special 30 Davy ''. Pre-Primary Pre-primary Primary Pre-Election Pre-Election Election Pre-El 'Jon Post-Election n n - 0 r:i , o -n-1:7 ci _ - t Date Of Election +Year Amendment ;erminadon (MM/00/YYYY) Report Report ;,• Summary of Receipts and From Date Date For Office Use Only Esipendltures • 9itf2021 10J20f2021 A.Amount Brought Forward From test Report $ 0 B.Total Monetary Contributions and Receipts $ (From Schedule I) 7,200.03 C.Total Funds Available $ • (Sum of tines A and B) 7,20000 D.Total Expenditures $ i (From Schedule ill) 1,B7e•82 E.Ending Cash Balance $ - :� (Subtract Line D from Line C) 5,3211t s F.Value of In-Kind Contributions Received $ (From Schedule II) 340.00 l G.Unpaid Debts and Obligations $ -.4 (From Schedule IV) Affidavit Section Part 1-If this is a Committee report.treasurer sign here If Ns is a Candidate report,candidate sign here. I swear for affirm)that this report,Including the attached schedules on paper,is to the best el my know—leddge a wild true,correct and complete. Sworn to and subscribed before me this day of 20 sktreptnt ittirJgep14.)1' s /i-� Signature Printed Name �`' . ( 1 31 °t -5y0-1-0 My Commission expires MO. DAY YR. Area Code Daytime Telephone Number Part II-if this is a report of a Candidates Authorised 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.1.1333,NO.320)as amended. Sworn to and subscribed before me this n✓ day of 20111---- Snature of Candidate 0L� -a, �. S1Lco/ Signature Printed Name I g My Commission expires MO. DAY YR. Area Code Daytime Telephone Number 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.aov/campaignfinance • ra•stcampaignfinance@pa.eov Part II-if this form is submitted with a report by a Candidate's Authorized Committee, the candidate 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. ___ D i o 12 1 / 21 Signature of Treasurer,Candidate,or Lobbyist Date(DD/MM/YYYY) 1.DA-1-1-1--,,.,.. p .51 u ce% i NA.tcrt-+aa,,cult) , PA t 7C Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 PART B SCHEDULE Contributions and Receipts Detailed Summary Page I Filer Identification Number I 1 11,Unitemlzed Contributions and Receipts-$50.00 or less per Contributor Total for the reporting period (1) II $ I f 1250.00 2.Contributions o7$50.01 to$250.00(From IIII Part A and Part B) Contributions Received from Political Committees(Part A) $ 100.00 All Other Contributions(Part B) $ 1,aso.00 Total for the reporting period (2) $ - 1,950.00 1 3.Contributions Over$250.00(From Part C and Part 0) l Contributions Received from Political Committees(Part C) $ ■ 500.00 All Other Contributions(Part 0) '$ 4,500,00 Total for the reporting period (3) $ 5,000.00 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) I Total for the reporting period (4) $ 0 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) 7.200 PART 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: 1 Full Name of Contributor Date[MM/DD/YYYYJ $ Keith 0.Brennnman 9/22/2021 250.00 House M Street Address' 1Date[MM/DD/YYYtI $ 44 W.Main Street 'rt., .4i -City ,State lZlpCode .'' Date(MM/DD/YYYYJ $. Mechanicsburg PA ' 17055 Full Name of Contributor Date(MM/DD/YYYYJ $ Robert Blidcey 100.00 9/22/2021 House a 'Street Address /Date(MM/DD/YYYY) $ 3970 Brookridge Drive ,-, c aN State Zip Code .Date[MM/DD/yYYYJ $ Mechanicsburg PA 17050 Full Name of Contributor 'Date(MM/DD/YYYY) $ Vince DiFlllippo 9/22/2021 75.00 e. House Jf Street Addr Date[MM/DD/YYYYJ $ 91 j Margaret Drive City 'State' Zip Code ' -;Date(MM/DD/YYYYJ $ ' Mechanicsburg PA 17050 Full Name of Contributor Date(MM/DD/YYYYJ $ Kelly Brent 9/22/2021 150.00 House a Street Address ,,Date[MM/DD/YYYYJ $ 501 Brenneman Drive City State Zip Code • Date(MM/DD/YYYYJ $ ' Lewisberry PA 17339 Full Name of Contributor Date[MM/DD/YYYYJ t$ Alexander and Sarah Langan 9/22/2021 250.00 House 4 Street Address 'Date[MM/DD/YYYYI $ 140 Bryce Road _ t, , City State Zip Code —=Date(MM/OD/YYYYJ $ Camp Hill PA 17011 / — Full Name of Contributor Date[MM/DD/YYYYJ $ Donald McCallin 9/22/2021 75.00 House I Street Address Date[MM/DD/YYYYJ $ 501 Lamp Post Lane City State Tip Code ' •Date[MM/DD/YYYY1 $ Camp Hill PA 17011 PART 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.) Flier Identification Number. Full Name of Contributor Date IMM/DD/YYYYJ $ John and Judy Thomas 9/22/2021 75.00 House K Street Address' Mate(MM/OD/YYYY] • S 407 Pawnee Drive iU.. _ • .A'' City :State /Zip Code , `'Date(MM/OD/YYYYJ $ Mechanicsburg PA 1 T050 Full Name of Contributor Date IMM/DD/YYYYJ $ Beverly 0'Neal 9/22/2021 100.00 House M Street Address :Date(MM/DD/YYYY[ ' $ 5271 Strathmore Drive City State PA Zip Code t 17050 e,Date(MM/DD 1fYYY( Mechanicsburg Full Name of Contributor Date IMM/DD/YYYYJ $ Thomas and Bethany Mullen 9f42/Y021 100.00 House N street Addr Date(MM/DD/YYYYJ $ 215 1 St.James Court City State" •Zlp Code''r -'Date(MM/DD/YYYYJ $ Mechanicsburg PA 17050 1 Full Name of Contributor ��— Date(MM/DD/YYYYJ $ Robert Walker 9/22/2021 250.00 House I Street Addre1 _Date(MM/DD/YYYYJ $ 23 Irongate Court City State PA Zip Code 1 T050 Date(MM/DD/YYYYJ $ Mechanicsburg Full Name of Contributor —r Date(MM/DD/YYYY) $ 250.00 Michael Pion 9/22/2021 —e ,Date[MM/DD/YYYY] $ House N Street Address 2101 Market Street City State Zip Code •Date(MM/DD/YYYY) $ Camp Hill PA 17011 r Full Name of Contributor Date[MM/DD/YYYY] $ 100.00 Richard Stewed 9022/2021 House N Street Address .Date(MM/DD/YYYY] $ 1811 Warren Streey City State Zip Code Date(MM/OD/YYYYJ S New Cumberland PA 17070 PART 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. Full Name of Contributor Date[MM/DD/YYYYj $ Chrisopher d.Ynlguez 9/22/2021 75.00 House I Street Address feDate(MM/DD/YYYYI '$ 6293 Harvest Lane City HarrisburgState PA Zip Code ,. 17111 Date[MM/DD/YYYY) ' $ Full Name of Contributor Date(MM/DD/YYYYJ '$ Debbie Keys 100.00 House I Street Address Date IMM/DD/YYYY) " $ Devonshire Square City State r -Zip Code , Date(MWOD/YYYY] $ Mechanicsburg PA 17050 Full Name of Contributor Date(MM/DD/YYYYJ r$ House N Street Addrs) ;Date(MM/DDIYYYYI $' City 'State 'Zip Code Mate(MM/DD/YYYY] $ r I 1 Full Name of Contributor Date(MM/DD/YYYY] $ House N Street Address 'Date(MN) DD/YYYY) -$ -City - State 'Zip Code 4 :Date(MM/DD/YYYYJ ' $ Full Name of Contributor - Date(MM/DD/YYYY( $ House N Street Address Date(MM/DD/YYYY( $ City State` Zip Code r'" Date(MM/DD/YYYY] '$ . Full Name of Contributor Date IMM/DD/YYYY] $ House N Street Address ,Date(MM/DD/YYYYI $ -City State - Zip Code Date[MM/DD/YYYY] $ s PART C Contributions Received From Political Committees Over$250.00 Use this Part to itemize only contributions received from Political Committees with an aggregate value over$250.00 in the reporting period. Filer Identification Number: T 1 Full Name of Date(MM/DD/YYYYJ $ Contributing Committee Eckert Seaman's Cherie&Mellott,LLC Government PAC 500.00 9l2212021 House C Street Address 'Date(MM/DD/YYYYJ $ 600 Grant Strret,44th Fl _,. City State' .Zip Code '� Date jMM/DD/YYYY] $ Pittsburgh PA 15219 full Name of Date(MMJDDJYYYYJ r$1 Contributing Committee House 0 Street Address Date(MM/DD/YYYYJ 4 $ City State' Zip Code ' 'Date jMM/DDf*YYYI -$ Full Name of Date[MM/DD/YYYY] $ Contributing Committee House N Street Addrel Date 1MMT0/YYYY] $ City State Zip Code ',Date jMM/DD/YYYYJ $ - - - A 11 Full Name of Date(MM/DD/YYYY] $ Contributing Committee House N ' Street Address Date 1MM/DD/YYYY1 $ City State' Zip Code Date(MM/DD/YYYYJ $ Fug Full N e of Date[MM/DD/YYYYJ $ Contributing Committee House K Street Address Date(MM/DD/YYYYJ $ City State Zip Code Date[MM/DD/YYYYJ $ 1. 1 Full Name of - - Date IMM/DD/YYYY) $ Contributing Committee House S ' Street Address Date[MM/DD/YYYYJ $ City State Zip Code Date jMM/DD/YYYY] $ PART D All Other Contributions Over$250.00 Use this Part to itemize all other contributions with an aggregate value over$250.00 in the reporting period. (Exclude contributions from political committees reported in Part C) Flier Identification Number. I Full Name of Contributor Date(MM/DD/YYYYJ $ Corey Basehore 9/22/2021 500.00 House N Street Address (Date IMM/DD/YYYYI $ 4000 Market Street I. _ _ City State Zip Code '' 'Date IMM/ODIYYYYJ $ Camp Hlil PA 17011 Employer Name "" 'Occupation Polaris Advisors Employer Mailing Address/ 4000 Market Street.Camp Hill,PA 17011 Principal Place of Business Full Name of Contributor Date(MM/DD/YYYYI $ 500.00 Lisa Coyne 9/22/2021 House N Street Address ';Date[MM/DD/YYYY] . $ 1618 W.Lisburn Road City `State Zip Code }' Date[MM/DO/YYYYJ $ Mechanicsburg PA . 17055 Employer Name ' ' - Occupation Coyne A Coyne Employer Mailing Address/ 1618 W.Lisburn Road,Mechanicsburg,PA 17050 Principal Place of Business Full Name of Contributor Date(MM/ODJYYYYI $ Glenn Grail 9/22/2021 , 500.00 House N Street Address ;Date[MM/DD/YYYY] '$ 17 Devonshire Square �, City - State Zip Code Date(MM/DD/YYYYJ '$ Mechanicsburg PA 17050 Employer Name ''n Occupation Employer Mailing Address/ Principal Place of Business , Full Name of Contributor Date(MM/DD/YYYYJ $ John K.Murphy 9122/2021 500.00 House N Street Address Date(MM/DD/YYYYI $ 565 Brentwater Drive City State 'Zip Code - Date[MM/DD/YYYYI $ Camp Hill PA 17011 Employer Name • Alpha Consulting Engineers Occupation Employer Mailing Address/ Principal Place of Business 565 Brentwater Drive,Camp Hill,PA 17011 PART D All Other Contributions Over$250.00 Use this Part to Itemize all other contributions with an aggregate value over$250.00 in the reporting period. (Exclude contributions from political committees reported in Part C) Filer Identification Number. 1 Full Name of Contributor Date(MM/DD/YYYYJ $ John Yaple 500.00 9/22/2021 House N Street Address :Date[MM/DD/YYYYJ $ 420 Saint John's Church Road -. City State' Zip Code 'r Date(MM/DD/YYYYJ, $ Camp Hill PA 17011 _ ,3• .. .-fc --� Employer Name . ' Westys Inc Occupation Employer Mailing Address/ Principal Place of Business 420 Saint John's Church Road,Camp Hill, PA 17011 Full Name of Contributor Date(MM/DD/YYYY) _ $ Lou and Shelly Capozai 9/22/2021 500.00 House N Street Address Date(MM/DD/YYYYJ . $ ' 1655 Holly Pike City ,State Zip Code '' °Date(MM/DD/YYYYJ $ Carlisle PA 17015 Employer Name • .,3 Occupation �__ Employer Mailing Address/ Principal Place of Business Full Name of Contributor ' Date(MM/DD/YYYYJ $ Douglass Rohrbaugh 9/22/2021 500.00 House N Street Address Date(MM/DD/YYYY) $ 180 Locust Lane City State Zip Code *1 i Date(MM/DD/YYYYJ $ Dilisburg PA 17019 Employer Name •Occupation y Employer Mailing Address/ — Principal Place of Business Full Name of Contributor Date(MM/DD/YYYY] $ -. 10 Bony Dawood 9/22/2021 500.00 House N Street Address Date(MM/DD/YYYYJ $ 2014 Mountain Pine Drive City State 'Zip Code "I Date[MM/DD/YYYYJ $ Mechanicsburg PA 17050 Employer Name Occupation Dawood Engineering Employer Mailing Address/ Principal Place of Business 2014 Mountain Pine Drive,Mechanicsburg,PA 17050 PART D All Other Contributions Over$250.00 Use this Part to itemize all other contributions with an aggregate value over$250.001n the reporting period. (Exclude contributions from political committees reported in Part C) IFiler Identification Number. _ Full Name of Contributor Date(MM/DD/YYYY] $ Michelle Nestor 500.00 9122/2021 , House*' Street Address Date(MM/DD/YYYY] $ 15 Central Blvd City `State `'Zip Code ' ;Date[MM/OD/YYYY] $ Camp Hill PA 17011 Employer Name ' Occupation Employer Mailing Address/ Principal Place of Business Full Name of Contributor Date[MM/DD/YYYYJ $ House" Street Address 1'Date(MMJDD/YYYY] $ '' City State lip Code ' Date(MM/DD/YY11Y] $ 4. .. 1 yti Employer Name ' Occupation•' Employer Mailing Address/ Prindpat Place of Business Full Name of Contributor Date[MM/DD/YYYY] ^ $ HouseM Street Address +Date(MM/DD/YYYY] $ City ' State Zip Code 'Date(MM/DD/YYYY] $ Employer Name .y Occupation Employer Mailing Address/ Principal Place of Business Full Name of Contributor Date[MM/DD/YYYY] $ House g — Street Address Date(MM/DD/YYYY] $ City State Zip Code .^ Date[MM/OD/YYYY] $ _i 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. Afar Identification Number, I Full Name House H Street Address 41 City State'' Zip i', :Date(MM/DD/YYYYJ $ Code Receipt Description Full Name House N Street Address City •State': Zip h, :Date(MM/DD/YYYY) $ Code tia • ,- ,r�. Receipt Description I Full Name House N Street Address' City I State i -Zip ;r; 'Date(MM/DD/YYYY] $ Code Receipt Description Full Name House N treetL Addreisl� y State Zip t Date IMM/DD/YYYY] $ Code Receipt Description Full Name House N— Street Addntst City State Zip •Date(MM/DD/YYYY] $ Code Receipt Description Full Name House N Street Address �y - State Zip , Date[MM/DD/YYYY] $ Code Receipt Description — SCHEDULE 0 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: - I1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the reporting period (1) S $0 2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE Of$50.01 TO$250,00(FROM PART F) TOTAL for the reporting period (2) $ S340.00 I 3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PARTG) 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) $340.00 SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 Filer IdentIFlwtlon Number. 1 Full Name of Contributor ` Date(MM/DD/YYYY] $ Ray BromleyNolvo 09/22/2021 $100.00 House I Street Address :Date(MM/OD/VYYY) '$. 6281 Carlisle Pike City ,State, Zip Code Date(MM/DD/YYYYj $ Mechanicsburg PA 17050 i _'k.. Description of Contribution Use of Facility Full Name of Contributor Date[MM/DD/YYYYJ $ 811 Kokos/Slerra Madre 9/22/2021 $150,00 House N Street Address Date NM/OD/MY) $ 4035 Market Street x —City State 'Zip Code "f .Date(MM/DD/YYYYJ $ Camp Hill PA 17011 Description of Contribution 150 Wings Full Name of Contributor Date JMM/DD/YYYY] • r$ r Al KominskylAi's of Hampden 9/22/2021 590•00 House k Street Address :Date(MM/DD/YYYY] -$ 2240 Millennium Way city State' Zip Code "Date(MM/DD/YYYY] $ Enola PA 17025 Description of Contribution DD Full Name of Contributor Date[MM/ /yyYYJ $ House I Street Address ;Date(MM/OD/YYY1) ' $ City State• , Zip Code Date(MM/DO/YYYY1 $ Description of Contrbution Full Name of Contributor Date(MM/DO/YYYY] $ Houser, Street Address .Date(MM/DD/YYYY) $ t• city State Zip Code . Date(MM/DD/YYYY] $ Description of Contribution SCHEDULE II Part G In-Kind Contributions Received VALUE OVER$250 Filer Identification Number. 1 Full Name of Contributor Date(MM/DD/YYYYj _$ House N Street Address +Date(MM/DD/YYYY) $ City State -VpCode ' ,Date(MM/DD/YYYYJ $ Employer Name -Occupation Employer Mailing Address/Principal Description " Place of Business of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ r House X Street Address 'Date(MM/DO/YYYY] $ City State• Zip Code ! Date(MM/DD/YYYY] '$ • , Employer Name Occupation " Employer Mailing Address/Principal -Description Place of Business of Contribution cc °, Full Name of Contributor Date[MM/DD/YYYY] $ House N Street Address Date(MM/DD/YYYY] $ -t City 1 State Zip Code :Date[MM/DD/YYYY] f Employer Name Occupation '' Employer Mailing Address/Principal Description Place of Business of Contribution 1 Full Name of Contributor Date[MM/DD/YYYyj I House N 'Street Address Date(MM/DD/YYYY] $ City State Zip Code Date(MM/DO/YYY1f] $ Employer Name Occupation Employer Mailing Address/Principal Description " Plate of Business of 1 Contribution SCHEDULE III Statement of Expenditures Filer Identification Number. To Whom Paid Date(MM/DD/YYYfl $ Sherri Chippo 10/3/2021 1,875.28 House N 1005 Street Address Baythorne Drive 'Description of Expenditure city Mechanicsburg State PA Code 17050 Reimbursement for political signs To Whom Paid Date(MM/00/YYYY) $ John Gaspich 103.54 1011912021 House N 2438 Street Address Lambs Gap Road Description of Expenditure city Enola State PA Cop • de 17025 Reimbursement for food for political fundraiser To Whom Paid r Date(MM/DD/YYYY) $ House N Street Address ,Description of Expenditure __ _. city Statel I zip ,, Code To Whom Paid Date(MM/DD/YYYY) $ House N Street Address Description of Expenditure city 'State-' Zip -# Code r To Whom Paid Date(MM/DD/YYYY) $ House N Street Address Description of Expenditure city State Zip ' Code To Whom Paid Date(MM/DD/YYYY) $ House N Street Address Description of Expenditure • city State Zip Code To Whom Paid Date(MM/DD/YYYY) $ House N Street Address' Description of Expenditure •1 city State Zip ' Code To Whom Paid Date(MM/DD/YYYYJ $ House N Street Address] Description of Expenditure City I 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. Flier Identification Number._ 7 Name of Creditor 1 Outstanding Balance of Debt House N Street Address •- DATE DEBT INCURRED $ IMM/DD/YYYYJ City State' Zip , Code : ,j t Description of Debt ' Name of Creditor Outstanding Balance of Debt House N Street Address DATE DEBT INCURRED $ �, IMM/DD/YYYY] f City State : Zip , Y _ Jr Code ,_ ,i4!r Description of Debt • Name of Creditor Outstanding Balance of Debt House N Street Address . DATE DEBT INCURRED $ [MM/DD/YYYY] City Stile J Zip r 2. -4 Code ' 10.4 Description of Debt Name of Creditor Outstanding Balance of Debt House N Street Address i DATE DEBT INCURRED $ r. [MM/DD/YYYY] City State _ Zip • _i.. _,4. Code ,, s, Description of Debt Name of Creditor Outstanding Balance of Debt House N Street Address DATE DEBT INCURRED '$ (MM/DD/YYYYJ • 4 City •State• ' Zip '0 Code •i '. Description of Debt Name of Creditor Outstanding Balance of Debt House N Street Address ' DATE DEBT INCURRED $ IMM/DD/YYYY] City .. p — State• Zip ' Code q Description of Debt