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Home My WebLink AboutKutz for Lower Allen - 2021 2nd Friday Pre-Election - ' a Vi il r, . ajr y u . (--'rLerr rrri RTrn-runt.ri • 03mmonwealth of Pennsylvania-( mpaigi Finance Report (Note:This report must be dear and legible.It should be typed) Rler Identification Report Rled By Qtrxidate Q ntmittee Lobbyist Number (MarkX) X Name of Rling Oxnmittee,Qvncidate or Kutz for Lower Allen Lobbyist areet Address P.O. Box 3093 0ty Camp Hill Rate PA ZP 17011-3093 Type of Fbport(Race x under report type) 1-6tt Tuesday 2- 2nd Friday 3-30 Day Fbst 4-6t"Tuedday 5-2nd Friday 6-30 Day Post 7-Annual medal 2na Friday medal 30 Day Pre-primary Pre-Primary primary Re-Bedion Re-Section Bedion Re-Bedion Post-Bedion X Date Of Bedion Year Amendment Termination (MM/DD'YYYY) 11/02/2021 2021 Fe a►mmary of Fbceipts and From Date To Date For Office Use Only 6tpenditures 01/01/2021 10/18/2021 A.Amount Broi Ott Forward From Last fii;port $ 4,932.86 f a Total Monetary 03ntributionsand Feceipts $ 4,971.68 RS (From aahedule I) —� C Total FundsAvailable $ 9,9o4.5a CD (axn of UnesA and D.Total Expenditures $ 1,799.54 Lt.) aitedule Ill) 3 a E Biding Cash Balance $ I. 8,105.00 c y (attract line Dfrom Line C) F.Value of In-IGnd Contributions Feceived $ Comnionwealtthbf Pennsylvania-Notary Seal (From ahedule II) 393.26 AlexandrsM Vaccaro,Notary Public a Cumberland County IG.Unpaid Debtsand Obligations $ My commission expires July 17,2023 (From&tiedule IV) 14,620.00 Commission number 1351757 Affidavit Section Member,Pennsylvania Association of Notaries • Part 1-If this is a Comnttee report,treasurer sign here.If this is a Candidate report,candidate sign here. I swear(or affirm)that this report,indudingthe attached schedules on paper,is to the best of my knowledge and belief true,correct and complete. Sworn to and subscribed�beffore�me this 2 +btX r day o 0� 20 21 • 1 9gnatureo rson9ibmittingre Lauren Kutz Lail en k U t--7 Sgnature 1 1 Printed Name My Commission expires v 'l �I 1 702.3 717 439-4829 MO. DAY YR Area Cbde Daytime Telephone Number Part II-If this is a report of a Candidate'sAuthoriaed 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 / 21 day of 20 2( V Sgnature of Candidat Thomas H.Kutz /Re wta.s Z Sgnature Printed Name Myt:,ommiss l/onexpires 7 11 2023 717 602-5741 MO. DAY YR Area Cbde Daytime Telephone Number rcommonwealth of Pennsylvania Notary Seal Alexandra M.Vaccaro,Notary Public Cumberland County My commission expires July 17,2023 Commission number 1351757 Member,Pennsylvania Association of Notaries 9:311EDULE I Gbnt ri but i ons and Receipts Detailed armmary Page Filer Identification Number I1.Unitemized Oxttributionsand Fkaipta$50.00 or temper Contributor I Total for the reporting period (1) $ 470.05 2.Gbrttributionsaf$50.01 to$250.00(From I Part A and Part B) 1 Contributions F oeived from Rolitical Committees(Part A) $ 485.00 All Cther Contributions(Part B) $ 1,295.00 Total for the reporting period (2) $ 1,780.00 I •CbntributionsOuer$250.00(From Part Cand Part D) I Contributions Raceived from F litical Committees(Part q $ 600.00 All Other Oantribut ions(Part D) $ 2,120.00 Total for the reporting period (3) $ 2,720.00 4.Other FbceiptsFafunds;Interest tamed,Returned Chedcs,ETC(From Part 1 Total for the reporting period (4) $ 1.63 Total Monetary Cbntributionsand Fiptsduring this reporting period(Add and $ enter amount totals from Boxes 1,2,3 and 4;also enter this amount on Page 1,iaport 4,971.68 Cbver Page,Item B) PART Contributions Received From Political Committees $50.01 TO$250.00 Use this Part to stemma only contributions received from Political Committees with an aggregate value from$50.01 TO$250.00 in the reporting period. Filer Identification Ncinber Amount Rill Name oftbntributing I Date[MM/DIYreel $ CZmmittee MIKE REGAN FOR SENATE 250 9/27/21 House# Sleet Add_..._ Date[M M/CD'YYYYJ $ P.O.BOX 811 City MECHANICSBURG Sate PA Zips 17055 Date[MM/DD/YYYYJ $ Rill Name of Q rdributing Date[MM/DD✓YYYY] $ Committee FRIENDS FOR SHERYL DELOZIER 10/2/21 75 Hasse# Sreet Addresi Date[MM/DCYYYYYJ $ P.O. BOX 66 Oty NEW CUMBERLAND Sate PA apt Date[MM/DD/YYYY] $ 17070 Rill Name of Contributing Date[MM/DD/YYYYJ $ Committee DUANE MORRIS GOVERNMENT COMMITTEE 10/07/2021 160 Hasse# greet Address Date[MM/DLVYYYYJ $ 30 S. 17TH ST. City Sate ?ip Code Date[M M/Do/YYYY] $ PHILADELPHIA PA 19103 Full Name of Contributing Date[MM/DD/YYYYJ $ Committee House# Sreet Address Date[MM/DO,YYYYJ $ Oty Sate Zip03de Date[MM/DD/YYYY] $ Rill Name of Contributing Date[M M/DD/YYYYJ $ Committee Hasse# Sreet AdcireEs Date[MM/DD/YYYYJ $ City Sate Zip Cbde ; Date[MM/DLYYYYYJ $ Full Name of Contributing Date[MM/DQ/YYYYJ $ Committee Horse# greet Address Date[M M/DD/YYYYJ $ City Sate ZpCode Date[MM/DD✓YYYYJ $ 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 oontributionsfrom political committees reported in Part A) Filer Identification Number: Rill Name of Contributor Date[M M/DD'YYYYJ $ KATE KLUNK 09/30/2021 75 House# Street Address Date[M M/DLY YYYYJ $ OAK ST. City HANOVER Sate PA 2115Gbde 17331 Date[MM/DD'YYYYJ $ Full Name of Contributor Date[M M/DLY YYYYJ $ JESSICA KEMMERER 10/01/2021 75 House# •S AAdd ess -Dati[MIVI/DO/YYYYJ $ GREEN ST.APT. 107 City HARRISBURG I Sate PA I Zip Code 17102 Date[MM/DLYYYYYJ $ Full Name of Contributor Date[MM/DD'YYYYJ $ CHRISTINE RESTREPO 09/29/2021 75 House# IsreetAddress Date[MM/DD/YYYYJ $ MERIDIAN WAY APT.6 City MECHANICSBURG Sate PA �pCbde 17055 -Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYYJ $ JOHN&ELIZABETH STATLER 09/21/2021 90 House# greet Address Date[MM/DD'YYYYJ $ CANDLELIGHT DR. City MECHANICSBURG Sate PA CO'ZipCbde 17055 Date[MM/ YYYYJ $ Full Name of Oxdrlbutor Date[M M/DLY YYYYJ $ MICHAEL PYKOSH 100 09/21/2021 House# Sreet Acidrel Date[MM/DD'YYYYJ $ MARKET ST. City CAMP HILL Sate PA ZipCbde 17011 Date[MM/DD/YYYYJ $ Full Name of Contributor Date[MM/DD/YYYYJ $ BRUCE MCLANAHAN 09/27/2021 100 House# ;9reet Add Date[MM/DD'YYYYJ $ 16 CHERISH DR. City ; Sate ; Zp03de Date[MM/DLYYYYYJ $ CAMP HILL PA 17011 PART B All Other (bntributions $50.01 TO$250 Use this Part to itemize all other aontributionswith an aggregate value from $50.01 TO$250 in the reporting period. (Bcdude aontributionsfrom political committees reported in Part A.) filer Identification Number: Name of Contributor I Date[M M/DIY YYYYJ $ RONALD&SUSAN KIRKLAND 09/24/2021 100 House# 3reetAddrese i Date[MM/DIY YYYY] $ 11 DISHLEY DR. City Sate ap Code j Date[MMTDD'YYYYJ $ MECHANICSBURG PA 17055 Rill Name of Contributor Date[MM/DD/YYYY] $ JOHN&DEBRA SNOKE 10/02/2021 100 House# 3 re-et Address Date[M M/DD'YYYYJ $ 222 EWE RD. City Sate apCode ; Date[M M/DIY YYYYJ $ MECHANICSBURG PA 17055 Frill Name of Contributor WDate[M M/DIYYYYYJ $ FRANCIS VACCARO 10/02/2021 100 House# - Steel r Date[M M/DIY YYYYJ $ 397 BENYOU LN. City Sate 21p Code , Date[M M/ YYYYJ $ NEW CUMBERLAND PA i 17070 Full Name of Contributor Date[M M/DIY YYYYJ $ BRIAN KUTZ 160 10/02/2021 House# Rivet Addles1 Date[M M/DIY YYYY] $ 1038 DOGWOOD LN. Coy ENOLA Sate PA apCode 17025 Date[MM/DD/YYYYJ $ Rill Name of Contributor Date[MM/DD►YYYYJ $ CLAIR E.WEIGLE III 160 09/30/2021 House# SreetAddrese Date[MM/DCYYYYYJ $ 1670 NORTHVIEW RD. City ' Rate , apCode Date[MM/DIYYYYY] $ YORK PA 17406 Full Name oftntributor Date[MM/DIY YYYYJ $ W.GREG ROTHMAN 160 10/09/2021 House# 1 Sreet Address j Date[M M/DD✓MY]_- $ 3 LEMOYNE DR. L ! _ City Sate 1p Code Date[M M/DLYYYYYJ $ LEMOYNE PA 1 17043 PART C Contributions Fbceived From Political Committees Over$250.00 Use this Part to itemize only contributions received from Political thmmittees with an aggregate value over$250.00 in the reporting period. filer Identtflcatlon Number: Rill Name of Date[MM/CO/YYYY] $ 03 ntributing Oammittee TAXPAYERS FOR TORREN 300 09/30/2021 House# Creel-Address Date[MM/DD/YYYY] $ 80 STONYBROOK LN. aty Sate ,-Zp-ibde Date[MM/DO?V Y] $ NEW OXFORD PA 17350 Roll Name of I Date[M M/DD'YYYYJ $ GbntributingO mmtttee MCNEES PAC 09/28/2021 300 House# Sreeet Address Date[M M/DD'YYYY] $ 100 PINE ST. P.O.BOX 1166 City Sate ap Dade Date[M M/DD/YYYYJ $ HARRISBURG PA 17101 Full Name of Date[M M/DD/YYYYJ $ Contributing Gbmmittee House# Sreet Address Date[WA/DO/ $ Oty Sate apOade -Date[MM/DIY YYYYJ $ Full Name of Date(M M/DCY YYYYJ $ Gbrdributing Cbminittee House# Sreet Address Date(MM/DDIYYYYJ $ City Sate apCode Date[MM/DD/YYYYJ $ Rut Name of , Date[M M/DD✓YYYYJ $ Contributing Oammittee House# Street Addrel Date[MM/DCYYYYYJ $ City Sate 1 apCbde Date[MM/OD/YYYYJ $ Rs1I Name of Date[MM/DLYYYYYJ $ Contributing Committee House# -- !Sreet Acidrese le LM MI CD'YYYJ $ City Sate ! ZipCbde : Date[MM/DDIYYYYJ $ PART D All Other Contribution Over$250.00 Use this Part to itemize all other contributions with an aggregate value over$250.00 in the reporting period. (Exclude contributionsfrom political committees reported in Part Q Filer Identification Number: RBI Name of Contributor ' Date(MM/DD'YYYYJ $ ROBERT LEIPZINGER 320 09/25/2021 Horse# Sreet AddreEs Date[M M/DLY YYYYJ $ 25 HEATHER RIDGE DR. City Sate apQxie Date[MM/DLYYYYY] $ NEWTOWN PA 18940 Bnployer Name ROBS TOWING Occupation MANAGEMENT Employer MailingAddrese/ 3231 BATH RD. BRISTOL, PA 19007 Pindpai Race of harness Full Name of Qxrtritu for Date[MM/DIY YYYYJ $ GARY EICHELBERGER 09/29/2021 300 House# ',Rivet Address Date[M M/DO/YYYYJ $ 606 S.ARCH ST. Oty Sate apCode Date[MM/DD/YYYYJ $ MECHANICSBURG PA 17055 Employer Name COUNTY OF CUMBERLAND,PENNSYLVANIA • Oowpadion COMMISSIONER Employer MailingAdclress/ 1 COURTHOUSE SQ.CARLISLE, PA 17013 Principal Race of artiness RBI Name of Contributor . Date(MM/DD+YYYYJ $ • ROBERT BOWMAN 09/24/2021 500 House# rreet Address Date(MM/DD/YYYYJ $ 322 N.ARCH ST. 1 Oty Sate ap Gbde Date(M M/DD'YYYYJ $ LANCASTER PA 17603 I Employer Name CHARTER HOMES&NEIGHBORHOODS Ocaipation PRESIDENT Employer MailirlgAddress/ 1190 DILLERVILLE RD.LANCASTER, PA 17601 Principal Race of Bueiness Fill Name ofContributor Date[MM/DD/YYYYJ $ W.SCOTT BURY 500 House# Street Address DEate[MM/DD/YYYY] $ 33 ARGALI LN. Oty Sate ap(bde Date[MM/DLYYYYYJ $ MECHANICSBURG PA 17055 I Employer Name SELF-EMPLOYED Occupation BUSINESS OWNER Employer MailingAddress/ 33 ARGALI LN. MECHANICSBURG, PA 17055 Prindpal Race of Baines PART D All Other thntributions Over$250.00 Use this Part to itemize all other contributions with an aggregate value over$250.00 in the reporting period (6cdude oontributionsfrom political committees reported in Part Q Hier Identification Number: Full Name of Cbrttributor Date[MM/DD/YYYYJ $ JAMES W. KUTZ 500 09/30/2021 Haase# Stet Address Date[MM/DLYYYYYJ $ 25 ARGALI LN. City Sate ZpOpde ; Date[M M/DIY YYYYJ $ MECHANICSBURG PA 17055 Employer Name SELF-EMPLOYED ; Ocarupation ATTORNEY F1TIployer Mailing Address/ 100 PINE ST. HARRISBURG,PA 17101 Principal Race of Business Full Name of Contributor Date[MM/DIY YYYYJ $ House# Sreet Address Date[M M/DLY YYYYJ $ (My , Sate 'Zip Code Date[MM/DCYYYYYJ $ Employer Name Ooaupation Employer Mailing Address/ Rindpal Race of Business Rill Name of Contributor Date[MM/DIY YYYYJ $ House# 3reetAddress Date[MM/DIY YYYYJ $ City Sate 3pCbde Date[MM/DD/YYYYJ $ Bnployer Name Ooalpation Bnployer M ailing Address/ Principal Race of Business Full Name of Contributor Date[M M/DD'YYYYJ $ House# 3reetAddress Date[MM/DD/YYYYJ $ City - Sate ; ZpCbde I Date[MM/DtYYYYYJ $ Bnployer Name Ooaion Employer Mailing Address/ Principal Place of Business PART E Other Receipts FEFUNDSy INTEREST INCOME RETURNED CHECKS ETC Use this Part to report refunds received,interest earned,returned diedcs and prior expendituresthat were returned to the filer. Flier Identification Number: Full Name MEMBERS 1ST FCU House# 5000 I3reet Addres8 LOUISE DR. City Sate ap - Date[MM/DIY YYYY] $ MECHANICSBURG PA 03de 17055 0.20 09/30/2021 Receipt Description DIVIDEND EARNED Full Name MEMBERS 1ST FCU Huse* 5000 $reef Addreel LOUISE DR. City 1-Sate- ap Date[M M/DD'YYYY] $ MECHANICSBURG PA Axle 17055 0.19 02/28/2021 Fpt Description DIVIDEND EARNED Full Name MEMBERS 1ST FCU • House# 5000 Greet Addrel LOUISE DR. City I sate Zip Date[MM/DD'YYYYJ $ MECHANICSBURG PA GUde 17055 03/31/2021 0.21 Receipt Description DIVIDEND EARNED Full Name MEMBERS 1ST FCU Fbuse# 5000 GreetAddre91 LOUISE DR. City Sate Zip Date[MM/DO/YYYYJ $ MECHANICSBURG I PA code 17055 0.20 04/30/2021 Receipt Description DIVIDEND EARNED Full Name MEMBERS 1ST FCU House* 5000 Sreet Addreeil LOUISE DR. City Sate I bp Date[MM/DEVYYYYJ $ MECHANICSBURG PA Q de 17055 05/31/2021 0.21 Ibc 1pt Description DIVIDEND EARNED Full Name MEMBERS 1ST FCU Hot'tse#—5000 Greet LOUISE DR. City Sate I ap . Date[MM/DCYYYYYJ $ MECHANICSBURG PA I 17055 06/30/2021 0.20 Rxelpt Description DIVIDEND EARNED PART E Other Reaeipts REFUND4 INTEREsrINCOME,RETURNED ICHECK ETC Use this Part to report refunds received,interest earned,returned chedcsand prior expendituresthat were returned to the filer. Flier Identification Nuttier: Rill Name MEMBERS 1ST FCU House# 5000 Street Address LOUISE DR. City State Zip I Date[MM/DLYYYYYJ $ MECHANICSBURG PA Gbde 17055 0.21 07/31/2021 Fipceipt Description Full Name MEMBERS 1ST FCU House# 5000 Rreet Addres1 LOUISE DR. CityMECHANICSBURG Zip DEde[MM/DO/YYYYJ $ State PA , 17055 0.21 08/31/2021 Receipt Desaiption DIVIDEND EARNED Hill Name House# Street q city Rate Rate I zip Date[MM/DD'YYYYJ $ Gbde Faaeipt Desaipt ion Full Name House# Street city Rate Ip Date[MM/OQ'YYYYJ $ Code R3oeipt Desarption Full Name House# Street AddreEl City State ap Code D�Date[MM/DYYYYJ $ . Flaceipt Description Rill Name House# Rreet A City I Rate ap ; Date[MM/DD/YYYY] $ Code Flaceipt Description MHEDULE II I N-T4 ND CONTRI BUTTONS AND VALUABLE THINGS RIME IV® USE THIS SCHEDULE TO REPORT ALL IN-KIND OONTAIBUI1ONSOFVAWABLETHINGSDURING THE FEPORi1NG PSI OD DETAILED SUMMARY PAGE Filer Identification Number: I1. UNITBVII2I D IN-KIND WV-II:BUTTONSFECEV®-VAWEOF$50.000R LEES PffiOONTRIBUTOR TOTALfor the reporting period (1) $ 60.02 I2. INANDOONTRIBUTIONSR®VED-VAWEOF$50.01 TO$250.00(FROM PART F) TOTALfor the reporting period (2) $ 333.24 3. IN-IIND CONTRIBUTION VBD-VAWEOV R$250.00(ROOM PARTG) TOTALfor the reporting period (3) $ 0 TOTAL VAWEOF IN-KIND CONTRIBUTIONS DURINGTFiISRBFORTING $ PfffOD(Add and enter amount totalsfrom boxes 1,2,and 3;also enter on Page 1,Report Cbver Page, Item F) 393.26 SCHEDULE!! PART F In-Kind Contributions Fbceived VAWEOF$50.01 ?C$250 Rler Ider*ltk tion Number: Rill Name of Contributor Date[M M/DIY YYYYJ $ JAMES&DEBORAH KUTZ 10/01/2021 53.24 Haase#' Sr qr Date[MM/DIYYYYYJ $ 25 1 1 ARGALI LN. City Sate ; Zp Code Date[MM/DD/YYYYJ $ MECHANICSBURG PA i 17055 Deem ion of� f C EVENT MATERIALS RBI Name of Contributor Date[M M/DO/YYYYJ $ THOMAS KUTZ 10/02/2021 180 Haase# Sri Add es Date[MM/DO/YYYYJ $ 3207 DUNLAP LN.APT.A Oty Rate i Zp0de Date[MM/DOfYYYYJ $ MECHANICSBURG PA I 17055 I Description of Contribution EVENT MATERIALS Full Name ofQxrtributor Date[MM/DO/YYYYJ $ LAUREN KUTZ 10/01/2021 50 House# Sri Addresel Date[M M/DIY WWI $ 1411 1 BENTON WAY City MECHANICSBURG Sate PA I7ipCode 17055 Date[MM/DIY YYYYJ $ Description of Contribution EVENT MATERIALS Rill Name of Contributor Date[MM/DLYYYYYJ $ Haase# Sri iddres Date[MM/DO/YYYY] $ City I Sate 21pCide Date[NI MIDLI/YYYYj $ Description of Contribution Rill Name of Qxdributor Date[MM/DIY YYYYJ $ House# Sri Acidrel Date[MM/DD/YYYYJ $ 0ty . Sate 1 ZpCade Date[MM/DQ'YYYY]- $ Description of Cxiitrlbution SCHEDULE II Part G In-Kind Contributions Received VAWE OVER$250 Filer Identification Number: Full Name of Contributor Date[M M/DO'YYYYJ $ Hasse# 'greet Address Date[MM/DD'YYYYJ $ Oty I Sate Zip Ctxie bate[M-M/DIYYYYYJ $ Employer Name Ocaupation Employer MailingAddress/Principal Description Race of Business of Contribution Full Name of Contributor ! Date[M M/DD'YYYYJ $ Haase# Sreet Add _ Date[M M/ D►D YYYYJ $ Oty Sate ;ap Dade 1 Date[M M/DIYYYYYJ $ Employer Name Ooaupation Employer MailingAddress/Principal ' Desafption Race of Business of Gbrttribution Full Name of Contributor Date[M M/DD'YYYYJ $ Hasse# Sreet Addrees Date[MM/DIY YYYYJ $ City Sate apCbde r Date[MM/DDfYYYYJ $ Employer Name Occupation Employer Mailing Address/Principal Description Raze of Business of Cbntribution Full Name ofCb tributor I Date[MM/DD'YYYYJ $ House# greet A i Date[MM/DCYYYYYJ $ Oty Sate apCbde Date[MM/DtYYYYY] $ Employer Name Oompation Employer Mailing Address/Prindpal Description Race of Budness of Ctxttribution & 1aKJ E III Statement of Bcpenditures Hier identification Minter: To Whom Paid Date[MM/DIY YYYYJ $ REAM PRINTING 368.43 10/01/2021 Hou9e# 515 S ress Add FARMBROOK LN. Description of Expenditure 1 City YORK gee PA 17405 PRINTING , Code To Whom Paid , HOSPITALITY MANAGEMENT CORP. Date[MM/DCYYYYYJ $ 1 217 60 10/01/2021 I House# greet Address Description of Bcpenditure — P.O. BOX 448 i i City ABBOTSTOWN gate PA a 17301 EVENT COSTS 1 Code To Whom Paid 1 Date[MM/DD✓YYYYJ I $ ALPHA GRAPHICS 21.20 10/01/2021 House# 4609 greet Address GETTYSBURG RD. Description of Bcpendhlre City MECHANICSBURG I Sate PA agile 17055 LAMINATING I To Whom Paid ' 1 Date[M M/DO'YYYY] $ PAYPAL , 2.24 09/15/2021 House# 2211 Sreet N. 1ST ST.l 1 �� of B¢1Brlditure City Zip SAN JOSE Sate CA 95131 PROCESSING FEES Code To Whom Paid Date[MM/DD+YYYYJ $ MEMBERS 1ST FCU 2.00 10/01/2021 House# 5000 greet Addreeal LOUISE DR. Descriptionot Expenditure City MECHANICSBURG gate PA a 17055 CHECKS To Whom Paid SIGNS BY TOMORROW j Date[MM/DD'YYYYJ $ 116.07 10/01/2021 House# greet A Description of t3q:eridture 333 I S. FRONT ST. City Zp WORMLEYSBURG sate PA 17043 EVENT MATERIALS Cbde To Whom Paid US POSTAL SERVICE ' Date[MM/DD'YYYYJ $ 72.00 06/16/2021 House# 10 greet Add W. MAIN ST. Desaiptionaf ecperx tune City CAMP HILL I gee PA a 17011 P.O. BOX FEES To Whom Paid 1 Date[MM/DD/YYYYJ $ House#_ greet q I 1 Description of Bge idtture City Sate zp -, . 03de 9CH®ULEIV Statement of Unpaid Debts Use this&ction to itemize all unpaid debts and obligationswhidh are outstanding at the end of the reporting period Hier Identification Number: • Name of Oecitor THOMAS H. KUTZ Outstanding fiance of Debt House# Street Address DiATE DBEIT INCU $ 3207 DUNLAP LN.APT.A [MM/DCYYYYYJ City MECHANICSBURG SatePA 21pte 17055 14,620 Description of Debt LOAN TO CAMPAIGN Name of Creditor Outstanding Fi3lance of Debt House# greet Address DATED133TINCURRED $ [MM/ YYYYJ Oty gate i zp Code Description of Debt Name of Creditor Outstandng Balance of Debt House# greet Address DATE DB3T INCURRED $ [M M/DD/YYYY] City gate • Zip ' Code Description of Debt Name of O ecitar Outstanding Balance of Debt House# Street Address DATE DIET INO JR:ED $ [M M/DO'YYYYI City -aide ap Code Description of Debt -- Name of Guitar Outdandng Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DCYYYYYJ Oty i State Op Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Add -- DiATED133TINCUF113) $ [MM/DD/YYYYJ Oty gate -21p , Code Description of Debt