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Home My WebLink AboutBasom, Patrick - 2021 30-Day Post Election 111 t Reset Form 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 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) 1-6th Tuesday 2- 2nd Friday 3-30 Day Post 4-6h Tuesday 5-2id Friday 6-30 Day Post 7-Annual Special 2nd Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election X Date Of Election Year Amendment Termination (MM/DD/YYYY) Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures ... 10/19/2021 11/22/2021 A.Amount Brought Forward From Last Report $ C"..= r-a 0.00 OD B.Total Monetary Contributions and Receipts $ (From Schedule I) 0.00 I� �7 7,m c'rn) C.Total Funds Available $ t""-. (Sum of Lines A and B) 0.00 N D.Total Expenditures $ C j (From Schedule III) 0.00 C) Ti E.Ending Cash Balance $ CD W (Subtract Line D from Line C) 0.00 C F.Value of In-Kind Contributions Received $ —1 IV (From Schedule II) 583.07 .,-‹ G.Unpaid Debts and Obligations $ (From Schedule IV) 0.00 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 a r� day of 17i"'C�_�l'r!,✓�2 2 a (— zcy\:—.5.71>44. ..1 r . �� -� ' ''! I Signature of Person Submitting report ,, �,r •, s. 2 -[jam'\ ,�,��`�_ �1 - PATRICK BASOM Signature 1 Printed Name . � Iepeurtonias#atltb i@en•s i•-nia y tary a 717 317-1492 - Alan McCulloug t,IA4c YF. Area Code Daytime Telephone Number -- Cumberland County ' FIIIFY IF IMID9 1i•1@ l;PAKHi IMI'ATutgigf fl Committee,candidate shall sign here. -: , _ - U swear Pa1 iMi liAsMA9Tralowlerige and belief this political committee has not violated any provisions of the Act of June 3,1937(P.L.1333,NO.320)'as Atomize,Pennsylvania Association of Notaries Sworn to and subscribed before me this a n day of OM& 200 / . ��'�'IeL I,. I IA �jrlfW`r/ve✓f' PATRICK BASOM jo.,,i,,,..5, Candidate Signature Printed Name My Commission expires I a a oa- 717 317-1492 _ _ ' " 7 MO. DAY YR. Area Code Daytime Telephone Number`• _ '., ' Commonwealth of Pennsylvania-Notary Seal - Alan McCullough,Notary Public - Cumberland County My commission expires December 7,2023 • _ ' Commission number 1295073 , Memher,Pennsyld€nla Association at Notaries r,1"_ - , 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 TOTAL for the reporting period (1) $ 0.00 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$250.00(FROM PART G) TOTAL for the reporting period (3) $ 583.07 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) 583.07 SCHEDULE II Part In-Kind Contributions Received VALUE OVER$250 Filer Identification Number: Patrick Basom Full Name of Contributor Date[MM/DD/YYYY] $ Camp Hil GOP Committee 583.07 11/16/2021 House# Street Address Date[MM/DD/YYYY] $ 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 mailing 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/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[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution