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Home My WebLink AboutFriends of David Fish - 2021 30-Day Post Election 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/campaignfinance • ra-stcampaignfinance(ipa.gov 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. Name of Filing Committee, Candidate, or Lobbyist of a.v F;s/, Reporting Cycle Name 0 Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5 6th Tuesday 2nd Friday 30 Day 66 Tuesday 2"d Friday Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election Cycle 6 0 Cycle 7 ❑ 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. WI/dDdl Signature of Treasurer, Candidate, or Lobbyist Date(DD/MM/YYYY) 6-4 (S/L�O i vrr T ( , (P1wj jbecd ll Printed Name Location (City/State/Country) DSEB-502R Updated 1/22/2021 yvnepartmnate Irir bureauPenns of l Campaign aiaD Finance&Gvicet EngagemenofStt 210 North Office building,Harrisburg i'A 17120 • 717.787.5280{Option 41 ‘ by Ons m.eovfcarnDaignfina n • ri gcgaip rgniinancetArta ray Part II-if this form is submitted with a report by a Candidate's Authorized Committee, the candidate must sign here. l declare under penalty of perjury under the law of the Commonwealth of Pennsylvania that the accompanying Campaign finance Report is true and correct. '7_,)"1411 1') V ///301),d-i Signature of reasurer,Candidate, or Lobbyist Date (DD/MM/YYYY) 'Dek U./9 ,k1 - Fot tt4_,Iew N. iwp PA Lf_sn Printed Name Location(City/State/Country) OSf B-502ft Updated 1/22/2021 12/1/21,5:56 PM cycle 6 pages for greg.1.jpg , • fleSL... rrn j Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be dear and legible.It should be typed) flier identification T Report filedfly -Candidate 7 f "I Committee X hobbyist — Number (Mark X) _L__, I Name of Filing Committee,Candidate or tibbylsa Friends of David ash -Street Address - —"--- ....--— 405 Larry Poll Lane --- OW 1 Camp Hill PA Fifiaode 17011 I Type of Report(Place x under report type) 1-6"'Tuesday 2-2.4 Friday 3-30 Day Post 4-enTuesday 5,74 Friday 6-30 Day Post 7-Annual Spedal 74 friday Specia130 Day .,. Pre-Primary Pre-Prbnary Primary Pre-Election Pre-Election Election Pre-Election Post-Election Li ill r I 1 1 <1 I I 1 I 1 i ...] Date Of Election 'Year Amendment H Termination (MM/DDIYVYY) 11/02/21,7 I 2021 Report Report I I Sumniary of Receipts and ' From Date To Date For Office Use Only ExpericFrturm . 10/19/2021 1 irm i ...,..... .... ICiiiiiiiiirriirro-Wro'rv—viiiitrit-inlaIt Report --.5— - 2361,46 B.Total Monetary Contributions and Receipts --S 250.12 ' (From Schedule 0 i •1 m'') • - rri C.Total Funds Avagable $ - •I C", r- (Sum AlIf tines A and 11) 2611,50 I -iii.-totas Expenditures S. (From Schedule III) 32160 -- -, E.Ending Cash Balance $ 2289.98 (Subtract Line 0 from Une C) ....„.• F.Value of In4Cind Contributions Received- — --$.' t.,". •. (From Schedule II) 0.00 '...', -', G.Unpaid Debts and Obligations $ ---1 0'- (Frotnschedu1e iv) 0.00 Affidavit.Seaton ....,.. Part 1-It this is a Committee report,treasurer sign here.It this is a Candidate ref n‘f ntate sign here. -- 3 S%Ve2r for affirm)that this report,Oluiagitte att ached scteduITA on papir,is to the best of my knowledge and betel true,correct and complete. Sworn to and subscribed before me this ( day of 2 0 . 1 —,.1,77 A I e '7 .g,, Signature of orn sunnnttoRmort ., ----.....- SignAtore -I Printed Name My Commission expires e"). i 7 577—C3 17 MO. DAY YR. Area Onle Daytime.Telephone number Pan n A this is a report of a Candidates Authorized C.ornruMee,candidate chat Sign hem. I swear for affirm)that to the best my knoWage;abeik4 this potitical committee has not violated any provisions ot the Art of nine 3,19317iP.L .1333,00:3-275)as arnendcd. Sworn to and.011inCtibeti before me this t - 1 . day or 20 c of Candrctate Signature 1 . -t.,).44,0 .Si :r- • i--tily _:...__ Ftirited N,Pbe • ,.....r- i my Commtzlem expires 1 ) ') 3 ) MO. DAY YR. Area Code Daytime lelephone Number — I https://mail.googic.corn/maiUuNdinbox/EMiegzGlICmcFddslRCeSPQbHVBppBbc7projector=18tmessagePartld .4 I/I — ._ SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number 11.Unitemized Contributions and Receipts-$50.00 or Less per Contributor I Total for the reporting period (1) $ 0 2.Contributions of$50.01 to $250.00(FromI I Part A and Part B) Contributions Received from Political Committees(Part A) $ 250 All Other Contributions(Part B) $ 0 Total for the reporting period (2) $ 250 I3.Contributions Over$250.00(From Part C and Part D) Contributions Received from Political Committees(Part C) $ 0 All Other Contributions(Part D) $ 0 Total for the reporting period (3) $ 0 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E)I I Total for the reporting period (4) $ 0.12 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) 250.12 PART A Contributions Received From Political Committees $50.01 TO$250.00 Use this Part to itemize only contributions received from Political Committees with an aggregate value from$50.01 TO$250.00 in the reporting period. Filer Identification Number Amount Full Name of Contributing Date[MM/DD/YYYY] $ Committee Depasquale for Pennsylvania 11/11/2021 250 House# Street Address Date[MM/DD/YYYY] $ PO Box 1822 City State Zip Code Date[MM/DD/YYYY] $ York PA 17405 Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ 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/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYYJ $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ 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: Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/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) Filer Identification Number: 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 Place of Business 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 Place of Business 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 Place of Business 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 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. Filer Identification Number: Full Name Members First House# 5000 Street Address Louise Drive,PO Box 40 City State Zip Date[MM/DD/YYYY] $ Mechanicsburg PA Code 17055 0.12 10/31/2021 Receipt Description Interest Full Name House# Street Address City State Zip Date[MM/DD/YYYY] $ Code Receipt Description Full Name House# Street Address city State Zip Date[MM/DD/YYYY] $ Code Receipt Description Full Name House# Street Address City State Zip Date[MM/DD/YYYY] $ Code Receipt Description Full Name House# Street Address City State Zip Date[MM/DD/YYYY] $ Code Receipt Description Full Name House# Street Address City State Zip Date[MM/DD/YYYY] $ Code Receipt Description 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) $ 2. 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) $ 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) 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] $ 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 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 II Part G In-Kind Contributions Received VALUE OVER$250 Filer Identification Number: 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/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 SCHEDULE III Statement of Expenditures Filer Identification Number: To Whom Paid Date[MM/DD/YYYY] $ Mellow Mink Brewing 72.00 11/03/2021 House# Street Address Description of Expenditure 4830 Carlisle Pike City Zip Mechanicsburg State PA Code 17050 Victory Party Refreshments To Whom Paid Date[MM/DD/YYYY] $ ActBlue 1.50 11/03/2021 House# Street Address Description of Expenditure 366 Summer Street City Somerville State MA Zip 02144 ActBlue Service Fee To Whom Paid Date[MM/DD/YYYY] $ Vantiv Ecommerce 3.34 11/09/2021 House# Street Address Description of Expenditure 8500 1 Governors Hill Drive City Symmes Township State OH CoZipde 45249-1384 Vantiv Merchant Fee To Whom Paid Date[MM/DD/YYYY] $ David Fish 22.22 11/18/2021 House# Street Address Description of Expenditure 405 Lamp Post Lane City State Zip Camp Hill PA Code 17011 Victory Party Refreshments To Whom Paid. Date[MM/DD/YYYY] $ David Fish 198.54 11/18/2021 House# Street Address Description of Expenditure 405 Lamp Post Lane City Zip Camp Hill State PA Code 17011 Campaign Travel Reimbursements To Whom Paid Date[MM/DD/YYYY] $ Betty Fish 24.00 11/18/2021 House# Street Address Description of Expenditure 405 Lamp Post Lane City Zip Camp Hill State PA Code 17011 Victory Party Refreshments 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 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 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 Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt