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Home My WebLink AboutFriends of Michele Forbes - 2021 2nd Friday Pre-Election Pennsylvania tmate BureauPen s of Cvaampaign FinanceDepar &Civicent EngagemenofStt 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.pov/campaipntmance • ra-stcampalRnf+nancetbpa.aov 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. ahrtidgCOMIT2 Committee, Ga dida e,C6)Lo•b ist Re•ortin: 4fgag 0 Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 8 Cycle 5 bah Tuesday 2"d Friday 30 Day 6th Tuesday 2"6 Friday Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election ❑ Cycle 6 ❑ Cycle 7 0 Cycle 8 0 Cycle 9 30 Day Post-Election Annual Report 2" 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. ti 6/400V66/4) 10/19/2021 Signature of Trdidate, or Lobbyist Date (DD/MM/YYYY) Ann Fields Camp Hill, PA 17011 Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 \;72 yt 117 BureauPenns of CampaignlvaniaDepar Finance&ment Civic EngagemenofStatet 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.Rov/campaignfinance • ra-stcampaignfinance(a 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. 74,/,( 'vh, 1 0/1 9/2021 Signature of Treasurer, Candidate,or Lobbyist Date (DD/MM/YYYY) Michele Forbes Camp Hill, PA 17011 Printed Name Location (City/State/Country) t DSEB-502R Updated 1/22/2021 Reset Form I Print Form 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 (Marfc X) Name of Filing Committee,Candidate or Lobbyist Friends of Michele Forbes Street Address 2107 Chestnut street City Camp Hill PA 4)Code 17011 J Type ofRepon(Place x under report type) 1-6th Tuesday 2- 2nd Friday 3-30 Day Post 4-60h Tuesday 6-2rd Friday 6-3D Day Post 7-Annual Special 2"'Friday Special 30 Day - •Pre-Primary -.Pre-Primary .Primary Pre-Election • -Pre-EElleection -Election . .Pre-Election .Post-Election Date Of Election Year Amendment Termination . (MM/DD/YYYY) 2021 Report Report - "Summary of Receipts and -From-Date To Date For Office Use Only - Expenditures 09/14/2021 10/18/2021 A.Amount Brought Forward From Last Report 3. ° - C) B.Total Monetary Contributions and Receipts $ 30.00 (From•Sthedule f) - , C.Total Funds Available S, (Sum of Lines A and B) 30.00 c D.Total Expenditures $ r`- (From Schedule III) ° 7:} N..) cri E.Ending Cash Balance f -�» (Subtract Line D from Line C) 30.00 C7 F.Value of in-Kind Contributions Received $ C, (from Schedule II) 196.70 C a) G.Unpaid Debts and Obligations S (From Schedule IV) 647.70 _, r" IAffidavit 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 my knowledge and b•filet true,correcrand complete. Sworn to and subscribed before me this ' ,D� day of 20 l/�...•�" Signature o P:.le miffing report Ann Fields Signature Printed Name 1 My Commission expires 717 579-7134 MO. DAY YR. Area Code Daytime Telephone Number Part II-It this is a report of a Candidate's Authorized Committee,candidate shall sign here. • 'I swear(or affirm)tharta the'best of my knowledge and'belietthis political committee has not violated any provisions of•the Act ofVune 3,1937(P:L-1333,-N0.320)as - amended. t Sworn to and subscribed before me this ��1//t� day of 20 /E� t' (it. 16---L-h—bq • Signature of Candidate Michele Forbes Signature Printed Name My Commission expires 717 462-3359 MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE Contributions and Receipts Detailed Summary Page Filer Identification Number 1.Unitemized Contributions and Receipts-$50.00 or Less per ContributorI I Total for the reporting period (1) $ 30.00 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) 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) 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 Cover Page,Item B) 30.00 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: 1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR I 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) $ 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] $ P.O. Box 1415 City State Zip Code Date[MM/DD/YYYY] $ Camp Hill PA 17001 Description of Contribution mailings and sticky notes 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/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 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: Name of Creditor Robert Forbes Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ 2107 Chestnut Street [MM/DD/YYYY] 10/16/2021 City State Zip 647.70 Camp Hill PA Code 17011 Description of Debt loan for signs,door hangers,flyers,cards 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 $ [MM/DD/YYYY] City State Zip Code Description of Debt 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 $ [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt