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Home My WebLink AboutFriends of Dr. Ryan Argot - 2021 30-Day Post Election yePennsylvania Department of State Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) wwtiv,dos mmov/rp mpa{gptmance • rA stcar_npa HI!,nar ct.2 pa.pov Unsworn Declaration in Lieu of Sworn Statement for Campaign Finance Statements 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 Statements. This form must be signed by hand where a signature is required. i�-PLGI S OC !dr • 6 yeiil ❑ Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5 6th Tuesday 2"d Friday 30 Day 6th Tuesday 2"d Friday Pre-Primary Pre-Primary Post Primary Pre-Election Pre-Election Cycle 6 0 Cycle 7 0 Cycle 8 0 Cycle 9 30 ay Post-Election Annual Report 2nd Friday Pre-Special Election 30 Day Post-Special Election Part i — If this form is submitted with a statement in lieu of full report by a political committee, the treasurer must sign here. If this form is submitted with a statement in lieu of a full report by a candidate, the candidate must sign here. If this form is submitted with a statement in lieu of full 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 Statement is true and correct. •••.) 1 )-6 / Signature of Treasurer, Candidate( or Lobbyist Date (DD/MM/YYYY) 5i)ciwi1 (Ail ; I( 4c I1e (kotok6 . (,2 ft5 r � Printed Name Location (City/State/Country) DSEB-5035 Updated 1/22/2020 g ,t. 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.go/campaignfinance • ra-stcampaignfinance(capa.gov Part 11 - If this is submitted with a statement in lieu of full report by a Candidate's . Authorized Committee, candidate sign here. I declare under penalty of perjury under the law of the Commonwealth of Pennsylvania that the accompanying Campaign Finance Statement is true and correct. ----;------.7")::3) _____ - -- ----, ,. 11/2 ---' /2 c 2 I Signature oftandidate Date (DD/MM/YYYY) Printed Name Location (City/State/Country) DSEB•5035 Updated 1/22/2020 II II 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 Committee Lobbyist Number 834101537 (Mark X) Name of Filing Committee,Candidate or Lobbyist Friends of Dr.Ryan Argot Street Address 1034 Chelmsford Drive City Mechanicsburg State PA Zip Code 17050 Type of Report(Place x under report type) 1-6"Tuesday 2- 2"4 Friday 3-30 Day Post 4-6th Tuesday 5-2nd Friday 6-30 Day Post 17-Annual Special 2""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) 11/2/2021 2021 Report Report Summary of Receipts and From Date To Date For Office Use Only • Expenditures 10/18/2021 11/22/2021 A.Amount Brought Forward From Last Report $ 2937.37 B.Total Monetary Contributions and Receipts $ (From Schedule I) 0 C.Total Funds Available - $ (Sum of Lines A and B) 2937.37 „ ry D.Total Expenditures $ 1500 (From Schedule III) M E.Ending Cash Balance $ P •� c: (Subtract Line D from Line C) 1437.37 `:: F.Value of In-Kind Contributions Received $ NO�� (From Schedule II) 0 G.Unpaid Debts and Obligations $ . (From Schedule IV) 1075.29 ~F Affidavit Section f '�� Part 1-If this is a Committee report,treasurer sign here.If this is a Candidate report,candidate sign here. SO I swear(or affirm)that this report,including the attached schedules on paper,is to the best of my knowledge"nd belief true,correct and corripleter's) Sworn to and subscribed before me this �-- day of 20 `l'"� -�J"- ,Signatur person Submit in repo r 5�sat ,(( tAI5 Signature 1 Printed Name My Commission expires -7 1 ) 27L.' I — ?�75 MO. DAY YR. Area Code Daytime Telephone Number 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 ' 1 ( 4--,--: G .,--- Sign ecif Candidate Signature r Printed Name My Commission expires 7/7 i'/1 7 S,~4 MO. DAY YR. Area Code Daytime Telephone Number r SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number 834101537 1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total for the reporting period (1) $ 0 2.Contributions of$50.01 to $250.00(From Part A and Part 8) Contributions Received from Political Committees(Part A) $ 0 All Other Contributions(Part B) $ 0 Total for the reporting period (2) $ 0 3.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) 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 0 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 834101537 Amount Full Name of Contributing Date[MM/DD/YYYY] $ Committee NA 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/YYYYj $ 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/YYYYJ $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY) $ City State Zip Code Date[MM/DD/YYYYJ $ 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: 834101537 Full Name of Contributor Date[MM/DD/YYYY] $ NA 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] $ 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: 834101537 • Full Name of Date(MM/DD/YYYY] $ Contributing Committee 0 House# Street Address Date[MM/DDJYYYY] $ 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/YYYYJ $ 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: 834101537 Full Name of Contributor Date[MM/DD/YYYY] $ NA House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYYJ $ 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: 834101537 Full Name NA 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/YYYYI $ Code Receipt Description Full Name House# Street Address City State Zip Date IMM/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: 834101537 I1.• UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the reporting period (1) $ NA L2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) TOTAL for the reporting period (2) $ NA 3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTAL for the reporting period (3) $ NA 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) NA 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: 834101537 I1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR I TOTAL for the reporting period (1) $ NA 2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) TOTAL for the reporting period (2) $ NA I3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTAL for the reporting period (3) $ NA 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) NA SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 Filer Identification Number: 834101537 Full Name of Contributor Date[MM/DD/YYYY] $ NA House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date(MM/DD/YYYYJ $ 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/YYYYj $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYYJ $ 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/YYYYJ $ House# !Street Address Date[MM/DD/YYYY] $ City State Zip Code Date(MM/DD/YYYYj $ Description of Contribution SCHEDULE II Part G In-Kind Contributions Received VALUE OVER$250 Flier Identification Number: 834101537 Full Name of Contributor Date[MM/DD/YYYY] $ NA 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 Flier Identification Number: 834101537 To Whom Paid Date JMM/DD/YYYYJ $ Ryan Argot 1500 11/9/2021 House# Street Address Description of Expenditure 1034 Chelmsford Drive City State Zip Mechanicsburg PA Code 17050 Reimbursement To Whom Paid Date[MM/DD/YYYYj $ Ryan Argot 0 House# Street Address Description of Expenditure 1034 Chelmsford Drive City State Zip Mechanicsburg PA Code 17050 Reimbursement 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 To Whom Paid Date[MM/DD/YYYYJ $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYYj $ 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 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: 834101537 Name of Creditor Ryan Argot Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ 1034 Chelmsford Drive [MM/DD/YYYY] various City Mechanicsburg State PA Code 17050 Zip 1075.29 Description of Debt ongoing campaign expenses 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 It Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House It 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