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HomeMy WebLinkAboutCumberland County Leadership PAC - 2021 30-Day Post Election 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 X LobbyistNumber: ' 20210185 (MarkX), - Name of Filing Cbrrimittee;Candidate oi- • Lobbyist•' <- - . , Cumberland County Leadership PAC .Street Address •' • - • • P.O.Box 182 City'Y State • Zip Code Camp Hill • PA 17001 Type of Report(Place x under report type) .1..6th Tuesday' '2- 2"d.Friday 3-30,Day..Post 4-'6'hTuesday 5.2"dFriday 6-30 Day Post: 7-Annual SpecialZ eFriday `Special30.Day , Pre-Primary 'Pre-Primary,_;:Primary ._•1. Pre-Election: Pre-Election Election :. . . . Pre-Election.; .. . Post-Election• ` ' 17 , Date Of Election•; Year Amendment Termination (MM/DD/YYYY)„ , 11/02/2021 2021 J 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 $ 13859.01 B.Total Monetary Contributions•and'Receipts $ 8450 (From Scheduled) : . C.Total Funds Available $ (Sum of Lines A'and B) . . .. .• 22309.01 D:Total:Expenditures• $ (From Schedule III)•. 16620.38 E.Ending Cash Balance: . .,; $ • 5688,63 (Subtract Line b from Line C) ,o F.Value of in-Kind Contributions Received..-: : $ _, , (From scheduld Il) .. ••• 0 G.Unpaid Debts-and Obligations $ ,--,, (From ScheduleIV).. , 0 t'3 :., ' Affidavit Section 01 Part 1-If this is a Committee report,treasurer sign here.If this is a Candidate report,candidate sign here. - , CO 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 — oZ.3 day of 20 oZf • I s�% � rson Su .+t r Signature of Person Submitting rf port Si�^8�1tfitBnwealth of P nsyivania-Notary Seal / Printed Name SHEILA REED FLICKINGER,Notary Public • My Commission xpires Dau bin County `7i 7 7/2- -. 94/-77 Myt gmirission§spres mei,2023 Area Code Daytime Telephone Number Commission Number 10 348 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(P.L.1333,NO.320)as amended. • Sworn to and subscribed before me this day of 20 • Signature of Candidate Signature Printed Name My Commission expires , MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Idgrttification Number: 1.Unitemized Contributions and Receipts450.00 or Less per Contributor Total for the reporting period (1) $ 0 2.Contributions of.$50.01 to:$250;00 From PartA and Part"B)'' 1 Contributions Received from Political Committees(Part A) $ o All Other Contributions(Part B) $ 0 Total for the reporting period (2) $ 0 J3.Contributions Over$250.00(From.Part C and Part D) j Contributions Received from Political Committees(Part C) $ 2e00 All Other Contributions(Part D) $ 5850 Total for the reporting period (3) $ 8450 4.OtheiReceipts-Refunds Interest Earned,Returned Checks,ETC.(From Part E) 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 8450 Cover Page,Item B) 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,. - 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 Natiie of Contributing Date[MNI/DD/YYYY] $ Committee - - House# Street-Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY];:. .$.- Full Name of Contributing: k Date[MM/DD/YYYY] '.$' 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] . $: Full.Name of Contribu ting::' Date[MM/DD/YYYY] ,$ Committee':' :. House:#.; Street Address Date[MM/DD/YYYY] $ " city. State Zip Code :Date[MM/DD/YYYYJ .3- 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$250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filii.,.ti a itifi'cation;NLm6er:'•�. FFu11 Name_jci ritrib_lt:tif 1 Fili ei[M3CA%DD`/Y4YYY]s L$i' • :iiS•}:, :rcl y: Li_??,'`.-T; yam.,h t;Hoiis �'ew. ~SfreetrAdd a§-s >.Date, MM.DD YYYY city-i'. ;State;' "Zip,Code•%,,:< Dater[MM DDhhYYY, }Fu11 Nanie of Confribiltor�; f' ;4: ,;.,. !jTl. ?Dafe.[IUIM%DD%YYY1b] ,;,$r_, House#t Stteet Addi:.ess City .'; :State Zi'Coe i[IVIM/DD , �i,{; _r..Pt _d: - ;Date /YYY_Y;] :r$. Full Nameiof Contrib itor te+MM�D.D Y,YY;Y ' y ;House.#'' r`r` ,t* < •'t.,, ,`�<• Street;A d41:ess ;Datej[MIVll.PCV:YYYYt '�Ci*,;" MSate -ZiplCode,'�= ^DateMM/DD/YYYY]r $ ; - Y"'' ;�, :aE` J st :s ,:. _ ppFull?NaitiWil C5nthb 6r .. �,;r :. - .c Dace::IVi1Vl'.DL1"YYYYr . 'i3;t.•'.: ::"..:�>.:��� •i4'sv��:i Shy tiquse#•', ;St a t_Add ess ;pate',1M.M/DD/YYNf,],., ;"$t± 3 c I.;•eI s. : 1 i s }1s,.` _ tI.:; 'Cit r,is ;State', Zip Code ': ,Date;[IVIM/D.D'YYft 1:-.- ., bill Na• me�,ofigiiiTtribuior 7 , 'f7: ;sue:,:t,!...- Y.,Z:. `.IHouree#' Steet{Adares ')atet M CttAr Y$JFi ;$r4ifii;•:°' State;, 'Zip'Code�''; :Date'NIM!DD';YYYY z.•�: Fu11[N_"a'me of<Ciinttib'utor? ?;Dafe MM/DD' r• 1 Housef i 'Street7Address `Date[MM%qQ/,YYYY�r ;.$ •'r:^�• 1. :.:3'filly'• t .,_ ]~ fie.' .�,r !•_4M- i-q r.,-r.•i t..4....-.•1 js•�•i 1CitYc� ' :,State.,' �Zi'iCodee'.i `�Datei MV1 D }4-.. 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$250.00 in the reporting period. .itr:IdentijOtian;IVymr:be ^ I +;Ftil Name of•-.�r;'=-_•:',.; -'A `IYSti MfVJ DD YYYY '$~ Conf i6,uting?Cp,rAr iittee; Commonwealth Horizons PAC 11/02/2021 . 1600 liouse'# Street:Address ";Datet[1VEM/01)/YYYY,]t C:$!,, ,;; ;'__ �144 ':' a":5 Corl 5t :.��; '1City q 'tSt'atee zip'Code: ;Date; MNI'DD/Y,.YYY '`$ State College y:}l-;Tfl PA • ,:,,"`::::. 1,6801 ;t? ..:- N ik :Date[MIDI/DD(YYYYj-)jJ$ „Con ribut ng Committeet Future Leaders PAC i, +J 1000 „ - 11/05/2021 '�•i House;# Street?Address ':Datei[4VIM%DDIXIV.] �$x_ :•;•'-•;, .;y: 213 ,-4 i:: .,.,z Market Sq t t Ci.Y: J•:;� ti.f ,• - ;Date:MMY DD YYYY :.'$c,. Cit ';St'af. . e7ZiprCo'd,-.- ,:+_: L /..;./ �' -••,r ^u,.`- PA t ;::.:'s••' 17101 .,.: Harrisburg ,.�.: v:.'.;, its_..__•s:.• 1.]hi`r• :Y`.rc.=•t'i r..;r. ..... +,Fu11iNWme'i`of= .;�i':=s},:';t'k iirate•:[IVIM/DD/( a.7$*J Coi%nbut:• ng Goilt'miittee"1 gin.'.:?n��ram.- :r.;,.',.7tV.r L DD YYYY <:Woue#s ;` Sheet-Address Date[MM%� /a. (]'.i'$`' j%.jt 3 ;' �;State:� }�:Zptcode; : Date EM VitogiYY;Y.:Y,];;i$.:• Full1Nameiof;, :: Y•?'. -, rDate;.[MMVI/DD/YY>Y,]1 rr$7. :"Contokiiitmg+Committee' '-; ;:House:#, • Street Address :Date1[MNIJUDJYYYY]i'1,ST. i,Zi Code '. "Date[IVIM/DD/,YY,YY]; '$';' ;Citji:: ;:State;! p_.f ;t »...:. C .. `Fuil'[;tame f f-""j';;�._- r'tDatea[MM/DD/YXYY] :;.'.${ Conti fiutirig Committee,- 'House;#::' Street•Ad]ress tOate-.[MVI%OD%•YYYY t •$_' !City.;'4 °;State,-• !Zip •:Code:" Date:IMM/DD/YYYYJ?� $ Rio: Ji.: d�'t j:;:(, • t'i 7: iFufl;Nainiof,- i`.:-;a:iT *Date IMM DDJYYYY] S` uy C n[�ib✓uting'Commttee:,:: ;Hou"se# Stregi:Addre'ss .Date••MM%DD/YYYY1' [_..: mi, i ; iv..<"H ,:State !Z�ispPCade iEtfitej{1Aitii'DD,Y;/W]F t`$ PART D All Other Contributions Over$250.00 Use this Part to itemize all other contributions with an aggregate value over$250.00 in the reporting period. (Exclude contributions from political committees reported in Part C) Kilelr Iden tification°AVumbAi.:: Pit F:611 Name of*Goritriliufoiq Date[MMjDD%Vra• '":p$•`• 800r 'L ; ' r 4 Karen K Dklinski ' Aac,'w. J; 10/20/2021 .,`...f... House:'t.' Stteet;Add" '.13 f;MMVI 4DZ�YY'Q(7 Ct : 'i" 406 P, '.. 't ii err r•; <i<•�!.-.i."?.. N Front St '"City :iStat& s'Zip code c:` ;;Date[MM%DD/Y.Y. YJ'';:i. ;$'L 1 ,..: Wormleysburg ,?,' ..; ; PA :r .'-',.:a c 7.1, 17043 ;iEmployer:Name-' 7.;;''llfFi:i:, - ` , „:OccGPatiori` .�.:.F=Y i-.4,, -'1:! .,•.i 4.'1 Perfectly Pennsylvania :�'=a:,,..-•�,-t' President Employe;Mailin"%direeiir:72�>`;!'4'`- f:x•cr ;,,. y,*-'"<•'7'-11'w 3=-:=,510 Airport Dr Concourse C,Middletown,PA 17057 TrincipaPPlace,of 6usip s;• _-; <<FulliNim_a'c Contr+liuto�-: :Darii[MM%DD/YY0410'.�� 'zr• .:?: 'a Upper Allen Partners Limited Partnership 4-.;:i 4.; ;'4:: .t-G 10/2I/2021 Ls_•ti f;Hiiiiii It9. StEeetlAiidreg. Date[MM/DD4r0(Y] ','.. is,,' ' P.O Box 7a19sy: ,i,,.i y?`:•';:• .. -- t . w" ' s''.i.::-.,,P, ._i _ !.Ci ii;:fir, ;Stte, `"ZipiCadei {� ;Dte? VVJUDWX z: :$F .• ' a) - • ` o:" Mechanicsburg : PA • � i" _ ,17055 %'s a •<e.,,_.........y.Yri.. . lean to .gNIriVe*' _ti. » .-t•-• ? ;Oceu aiton;. •gyp-;y <<.-:. ;f+n .:,�; R,,,;.:; Erii to a Niai1ing iAddr'ess• '' - aaf Place�'of�BustSesst,-..r .• r `FuiI Name;oftContritiuta"r;` ,;Date-MM_ 'DD $ �`bi>•,T,.•,i..:IUl..;{mod;:...,er r•,::, .. -..:E .:Z.:,. !.!i�:'ATI7 ; y'u: ' `"<ir':. ''':i:• �_,T;•--r,;Warren W Stumpf ; u•' 400 i;:+ ~' '•-'v . ;i:: 10/21/2021 House;#; StreetAidd`ress" r,Date IVIM DD';YYYY. ''!' _,:' t ;' 87 -r.: �;^a:Greenwood Cir rti''•• 3,CIty •`' :state:. >;Zi"_Cade=" i D"te'. ,tom i .�, P, a ;[N1NI%DD/_YYYY•] 4:-'j$:A 4.,•:,-;,, ?,•Wormleysburg ii • .•�; PA (::;::.,.i r• .iFf 17043 ,a.e q7: ' ,i :y F iiiig0 e�Naroef ; ,c? ;':�;'i'` .�' ':Occupation; ,r a ti L,': _»: _,. -Capital Region Insurance Agency '• %,. President kmptoyer Mailing 5ddreiiFk*;ri;:;i.rrr tPnncipallPface'ofisusines '^'t' -i•-' 510 N Front St,Lemoyne,PA 17043 s: FF.ujLNatr'teofCont'ributora L L•,' ;RaYe;,jiVIM%EDD%Yi!IYXJ;; '?Stet Ftr:i. ,-1 ip. ?= • : Stephen M Hawbecker ; .• 400 i't;+y_ r• t.{ft 10/21/2021 Ff oUse+tt` Sere_et=Address :;Date:MMVP DD%YyYY,�I' ,ji i.:•ii SD8 •.??" F�;rx.•?•.�'T [.. _i,.-` ]''�"'�t:$... "` ` ':'r N Front St , •Ctty;:`. :; ,.. }.,ti 1 $..` :State i 2'ip;"Cod'e •�,.: � Date;[Nlil!!%pD%Y1G!fY] -. ��$a, v.<;:: Wormleysburg t K.:,' PA `'`'u`,`.. :;p; 17043 '�,• L'Eii,ployeriName+- f` J�• ::F:T ; �Oecupa4ioli-. e. " •'%- :,' 't Self employed > t;;:S r' k;Real estate c' : e:•: ,:N;::M� .:.Y: t. ::r7 ii t;:'..oT:i's =Eitiplgyer Mailiiid.Ni3dregi'V'ir C5 4iFrincipai..lace of Business 4 64 508 N Front St,Wormleysburg,PA 17043 PART E Other Receipts REFUNDS,INTREST INCOME,RETURNED CHECKS,ETC. Use this Part to report refunds received,interest earned,returned checks and prior expenditures that were returned to the filer. uFlieilifeiiiifcationiNumbei .H`ouse#Z: z Street'dilFg'"ss'� !;,City' _ �..c:-�; : ;15fatet' �~Zip,".; ''.•Date:[MM.DD%YYW]:,; 5;; FReceipt'iDesarir tion',• ,+ i {Na• us:e ►+ S- treetA.._ddessa � Nc�tiy, :�, - .1...�.r,r:;,? r ` }S ate� 'Zip:<' . iDatW Ni1M/DD./ Y ?'t9; >:$" rr "',. :# i f ece;p;,D'escriii410i�.:: ' ~ 41o4isei#;; StreetiAd•dress CGity. ` `i =:: T :L- 'States :'Zip:':'� `•,Date[MM%DD YYY-Y,•b -$_, 3 i ] :' ° °" wCodeN 'i r•Fife ipttD:es'.coptiaiic', j.:0111 Name• =;- "r+• :ter::- l ,-,:1 t1.;r-;: .1-Jr, r Flouse ifil Stret4A;ddress 1Citytti`• `r` _i - , :Zips.. :DateIM%DD%YYYYl.. :$'. •c' "' y: .'- , `'State 'a '`"+"' :,> :z ^'` - 4 '. :'i... '.,Code;,,;,,, ✓ ... --•., a.4:.. Y':., '.'}t:3."' ?..',,:i�4 i ailyk;:dc' :7.1K::1 ';Receipt Desc iption,. = iril.. -`max:::.:! ; i- iFiilliNamerr'_"7-j.:— :.:r: louse#▪ i' street Address ;'.Cityi ,'•ri _H. is ,7.5tate :Zip; }%Dafe'[MM%UO/Y1fYYc]� -Az l i -..:: '.--.g. ^' •p { l.. :i•;rt':i' ':it ).,�cS!:r 1- �'�.Y•;71,,T.;•'"=;1;. 'a_'ri i .?,.y'1;;,'t. ✓4 ,i;.Code,„,„j ': is !Rece ipt%`ISWeiiptit n4'" Full Naive,.7:.-T ism; -r:r:' =;H• ouse;#.}, Street;Add�'ess, -is:,r{::'.,-d.. .. ice, ..._ ;Eitji i._ ;s .7....;,::-'3;; ='t,'' .'State';' RZip''''`•'' `D"ate;[IIIIM[DD%YYYY;] i.$�' z:.''j:::71 -~'j'::i fCo e!T. TReceipt"Descriptjoif :';. SCHEDULE II IN-KIND CONTRIBUTIONS AND VALUABLE THINGS RECIEVED USE THIS SCHEDULE TO REPORT ALL IN-KIND CONTRIBUTIONS OF VALUABLE THINGS DURING THE REPORTING PERIOD DETAILED SUMMARY PAGE Filer fifeii<tifgAt,oneNti rit er: is7Zi.III:f-••:01111T:f MIZEOSIN�ICUVDTCONT IB!: - x :(. ".:MiV,•,5,..: .sitr _-n.:,=._s-;.:;;.:•• t_ ,. fi U•,5,,..JS'RECEi,...,:.VAIU,E'OE€$SUOOiORL65SP•.ER,CO.NTRiBl7,T0Ei-,.:'s.. 'i,.��:.M..4'.a;•.w . •:,%. F•.'��. .a,tys�3•:i'':.F '"+:�': :yf r+- ..yh.. �•tJ', '1.-c•1.� _`J.• t•`},. -:i s _ •.�y, i;1=-., �.�,._ ;s • TOTAL for the reporting period (1) $ 0 , I :f IN K IND C0nT�ppIB UTION-.RECEIUED-VAtEZ05 50?O1:T 0'$250.00;F�ONAp1T,:Fr� ^ ~;�.'L r : - ,: � � :s.-�u v a e % qa;'. . ,.-, l::: ::>:. _• l!:�.T='iiti- :{.- ..,+C.,.. mr �s.�--T.i1•\ �• _.r.� .4..t � .• C.r . . ! '.:+T' elr .. .,,a , . •:1•..L .....�:,._fir1 .i-. '."ri. F.S• , �-{n st` I:.. •t :AY• �1•Yi .•K" �: i.'...n �oY: �V ^• i.�-.,7... .1.. TOTAL for the reporting period (2) $ 0 J 1:14_,73eT=4N�KIiJD�^O U� V. - - , ,• ..��; .-.;_:..-:r,:•-s�%s..:�'E :�r,•t.r.h•:. ,-`: - :,•s; — C. RTRIB TION.REC$1 ED=VAL`UE:0,1%ER0$20. .-9 jF .9.M`BARG) 7 ;,. `C,. 'r. r" .•t TOTAL for the reporting period (3) $ a 1 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) 0 • SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 :Filer,.;IdentlficatioiNNUrpber: ``'.t: ...'_..�:`....'-=-.-_pis 4Eliti Nanie,.of ga.littibiltpr 1. "D tif i ttt' ......gi : yr:_t 7.,: +:1 •,�`; .,.2F.,?�n ?s Y' .i,<�i.,.:q- '=e'' •:3: IHbuse#= Street Address; ;Date DD%•Y�YYY1;�.;'$r ;City.-A` rState` '_Zip;�Code'3;;' 'pate[MMJDD/.YYYYj's.1:$" ?; r :r Descriptionlegic l*ibution:c' =. Y t.iFull'Name;of`Coiitriliutor: ;.Datea[MM%DD/VYyy]'_ $_ :House'is StreettAddtes; :Date:[MIVI/DD YYYY]V-%?$"; City:- Ste =Zi Code'':. DD;YNYY 1M i P :Description ofContribut .••i,. :iFiilGNaine of Contributor1 "Datiee;[I►INIZDD%YYYY1' $; iu• 3f ;, ,: -r._,•' t: Houseti:#`a Street Address _Date[MM/DD YYYY`',:iST, J. • .':: ::c'� ':City 4 "State &ZiplCode„;a?", Date.ii[MNI/DD/•YYYJwY w *:Deseription.of-Gont afiutioi '' 4 ;,,,v, ;y.Full Name ef.Contntiutorr? 'Date'(IVIM%DD%YYYY].,.S' ,= r tY r ;, ."' .. cHoiii:14;; r 'Date`MIVI/DD YY ( ,; .`' Sfreet;Address. �[... :::a.:1=:: ...,, fi Y'= a 1, I?: <Date'[I1IiM%DD'j� -.,,.)`:''r$ Cit Sf Ye'- `Zi''Cod"e:=-^ YXYY' jr :....fir„-r!.C'.: 'rlD'eleeirptioiiiof.Conerit u",tion::-::`;;.":';w i 'i; a.:ia•) _ .;,.i. :i; .. Vt•i"1]Namekof.:C•,onti�butor Date[MNI%DD/iYYYYJ $• ONousi.##:i Sri ec Address Date[MM/DD%_c,+i `i$l c.a �Cit"'��;� :;State�' :Zi ,Code.;�i'"1;. �tDate'�MM•,�D.D ,YY1lY, :� i;DesaQiptioniof:Contiifiiitiorir-='i',:=; • :.?! SCHEDULE!' Part G In-Kind Contributions Received • VALUE OVER$250 FiIarild`e ititicatfi n!Niimbers' 1:Eull3Name at;Cii tri6 liWZ. ,Dati[MM%DDIY.YYY]r:%"' r-$7i Neer'':::. ::\'''''-i=.—:'?_=� ';'}v 'House:'i1 S • ` treet?Add�ess Date•MNI,DD •r ° ' ;$': `Lity' ,Stater i2iikcode!z-- •,Date;[Nlltii/DD%Y,YYY]i ;- '$ ram.. •`- '�:j_'L:1;'f_;' L';::4:.%.3y;�`0, _ r1 'Erripl.oyer•Narne'c > .C,'`+ ; ."'t=;'"' ;`' -;,Occupation:..' _ . t ri iloyer?Mailing+Addiesss%:Princittal '.iM; iuDescriptiori'ti-'i tPlace,of Busmessyg .,,•;,,'.i,,,j:`, ;•..- .-t .(of.. .r.. f•'._. :'• ;`:..-_._ •� ' `.,--7 • .v ''Contlib uti°n-:.. 1 t-"...'_.i f j'. FuIGN_ame•,:'of:Co"sitEi6:u'£or-= �, .,.�,,,� -•,•�.rt,. _ .5 � 'Date[MNI/..OU%1•YYY�),-:�•rs f: t "� ;iHouse0t, Sireet,Aildress Date.[MIVI%DD%YYYY :] ' ti$' i'Cityw. :State tZ•e•CotIef;71i Date MINI DA.YY•,Y�: f� $ . ;Employer?r4arrj: _ •.'.••;a .• :;T --7:,. 7+Occupation, °s fEmployeifMaiIiii tAatltessTP,iiii ipal;::r 'DescriptFoii i. " :Y7- -,ice A,i•'.•:, ea"s1i^4C"•:1 •ai PlaceioffBus"iness;"q =r .;a, ;'^:,i:';.r:k.:!4 ,of.;::a _ i:.a -;:: . ;;. '�.'1� tii:�'_•'.. p':;.-:.,2: i sir.• ..:;:5' ..._t.:: -.s.7.12.,i�Y•—. _a%'.•....,;JTiiati•� �Contnbutioni'S p;EulfiNami7cil iiikeiliiiitor: "Date;MM'OP/YY:YY1 "` }ioii'se#f' Street= ':Date.MVI/D.D/ :; s:se. ;. -tif- ''State. ''Zi ''Codel,•I'P- ;'Date MM DD YYYY]� ''2 • ^E m ploye Niaie '�T 2 :'!r:' - • =4J ''.Deco atio i` c;y1' :.:t -+=j . .:.( t' . i •.re;;:;:;I:0:i1.r 1 "•' 'Empl(7.VOlyAllingAddress/l1P0inciiiNP:•.:# -Descriptionr".;z; FPjaceofiBusness,,,I.. .:t>•C:._ ^',3`:;i�, `:of:;•':%:,:r:4:';.; :1..- . i,i;TiFj C'4-17' .n;� i., :itl', _ "i':..r.' i .°i-Ittii.:,r'�.'.:'••1 ,7, _,. .....- :•3rrr':: ..'•`.'.. .:� :4. Contributiont:. FulIrNamit.:6• oiFfiib'utor' +,;Date NIM'DD Y•'Y " 'N . s{= St�eet�_Addi:ess �Qate:[MtVI/,DD%YY:YYt],�;,;...•$ti4 f City;"•,; >st e" „Zip Code;,,+_,: ;'Dte['VIM%Db%ireq]:: .•:$t :{ t E j ;y { • :f EittployerName-, 4.`• ',t,i..r ,':. :. .:' •''�����:' :_�'��•.�'f�s�; zQccupatiori� k 1Employe-'-fling Adifiiii%XPHFIi ipah - =QeSGI iptiori: += d_PlaceLof•Business'.,,�; ', =_ *1z >_+. z • 'of r ,•:-,-' '.- r _..��; .,. .. `...7,7>e,..on..:.:;;.:. is r ontrikiutiont. SCHEDULE III Statement of Expenditures :F.Iier ldentifieati`o••njNumtiei `. 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