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Home My WebLink AboutFriends of Mercedes Evans - 2021 Annual Report III .--Reset Form' r_. 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 (Mark X). X Name of Filing Committee,Candidate-or Lobbyist . Friends of Mercedes Evans ',Street Address • . P.O.Box 3213 City•. •- . Camp Hill State; PA Zip Code 17011 Type of Report(Place x under report type) `1-.6th Tuesday 2-•2"s Friday 3-30 Day Post 4-6thTuesday• 5=2nd Friday 6-30 Day Post' 7-Annual $peciat2na Friday Special 30 Day Pre-Primary Pre-Primary .Primary, Pre-Election Pre-Election Election Pre-Election Post-Election Date Of.Election Year Amendment �/ Termination (MM/DD/YYYY) 11/02/202f 2021 Report X Report Summary of Receipts and From Date To Date For Office Use Only Expenditures ••. ' 11/23/2021 12/31/2021 .. -AAmount Brought Forward Frorn Last Report 8 3010.63 B.-Total.Monetary Contributionssd And :. 8 o 100.24 r(From Schedule l) '.. •. C.Total Funds Available _ , 8 � 7-4..ry (Sum of Lines A and B) . 3110.87Xli '0 D.Total Expenditures 8 y„ (From Sched,ulelil) 100.50 E.Ending Cash Balance • 8 t3 3010.37 (Subtract line D from Line C) O mc F.Value of In-Kind Contributions Received • 8 ry (From Schedule II) • 0 cNr'1 G.Unpaid Debi'and Obligations 8 (From Schedule IV) , - _ 0 _ 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 _ day of 20 Lu.-u-[c �.� Signature of Person Submitting report Patricia Smith Signature Printed Name • My Commission expires 717 919-8585 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 //��,�V L/Y��//i1 day of 20 /V L Signature of Candidate ' Mercedes Evans Signature Printed Name My Commission expires 717 303-3932 MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE I Contributions and Receipts Detailed Summary Page Flier identification Number 1 Unitemized Contributions and Aeceipts450.00 or Less perOontributor Total for the reporting period (1) 8 0 2.Contnbutions of 150.01 to 1 50.00:(From Part A and Part B) ' Contributions Received from iolitical Committees(Part A) 8 0 All Other Contributions(Part B) 8 too Total for the reporting period (2) 8 io0 Contributions.Over 8250.00(From Part C and Part D) , . J8. Contributions Received from Political Committees(Part C) 8 0 All Other Contributions(Part D) 8 0 Total For the reporting period (3) 8 '0 4 Other Receipts-Refunds Interest Earned,Returned Checks,ETC.(From Part E) Total for the reporting period (4) 8 .24 Total Monetary Contributions and Receipts during this reporting period(Add and 8 ' enter amount totals from Boxes 1,2,3 and 4;also enter this amount on Page 1,Report 100.24 Cover Page,Item 8) 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. Rill flame •< . Members 1st Federal Credit Union House# Street Address P.O.Box 40 City State Zip Date[MM/DD/YYYY] . $ Mechanicsburg PA Code 17055 .12 11/30/2021 Receipt Description Dividend Full Name Members 1st Federal Credit Union • House# Street Address P.O.Box 40 City State. Zip Date[MMIDD/YYYY] S Mechanicsburg PA Code 17055 .12 12/31/2021 Receipt Description Full Name• • House# Street Address City .. State Zip Date[MM/Dp/YYYY] S Code Receipt.Description Full dame.:. _ . House# Street Address City 'State.,. Zip • • Date[MMIDD/YYYY] $ Code Receipt.Description ' Full Nanle, House# Street Address City State Zip Date[MMIDD/YYYY] $ Code Receipt Description • r Full lfame .Route 'Street Address' City State. Zip . Date[MM/DD/YY11Y] S Code Receipt Description lir Pennsylvania Department of State Bureau of Campaign Finance&Lobbying Disclosure 500 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@pa.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 unworn 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 Friends of Merc • edes Evans Reporting Cycle Name ❑ Cycle 1 0 Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5 6th Tuesday 2"d Friday 30 Day 6th Tuesday 2nd Friday Pre-Primary Pre-Primary Post Primary Pre-Election Pre Election ❑ Cycle 6 8 Cycle 7 0 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. d ,---IY 01/24/2022 Signature of Treasurer, Candidate, or Lobbyist Date(MM/DD/YYYY) Patricia Smith Harrisburg, PA, USA Printed Name Location (City/State/Country) 0SEB-502R Updated 1/5/2022- Pennsylvania Department of State Bureau of Campaign Finance&Civic Engagement 500 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@pa.gov Part I!-If this form is submitted with a report by a Candidate's Authorized Committee, the candidate 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. ONV10--- /. /' 01 /24/2022 Signature of Treasurer, Candidate, or Lobbyist Date(MM/DD/YYYY) Mercedes Evans Camp Hill, PA, USA Printed Name Location (City/State/Country) DSEB-502R Updated 1/5/2022 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 (Mark X) X Name of Filing Committee,Candidate or Friends of Mercedes Evans Lobbyist Street Address P.O.Box 3213 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 6th Tuesday 5-2nd Friday 6-30 Day Post 7-Annual Special 2"0 Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election X Date Of Election 11/02/2021 Year Amendment Termination (MM/DD/YYYY) 2021 Report Report Summary of Receipts and From Date To Date For Office Use OnlyC) Expenditures v N 11/22/2021 12/31/2021 A.Amount Brought Forward From Last Report $ 2,971.30 r".- f.) B.Total Monetary Contributions and Receipts $ 101.56 v'► (From Schedule I) Cr .00 C.Total Funds Available 8 3072.86 C) ' 3 (Sum of Unes A and B) 0 ColD.Total Expenditures $ 100.50 C37 (From Schedule III) E.Ending Cash Balance $ 2972.36 (Subtract Line D from Line C) F.Value of In-Kind Contributions Received $ 0 (From Schedule II) G.Unpaid Debts and Obligations. Y o (From Schedule IV) Affidavit Section Part 1-If this is a Committee report,treasurer sign here.it 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 ! ` :binday of 20 / �u—caSiggnature of Person Sitting report Patricia Smith Signature Printed Name My Commission expires 717 919-8585 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(Pt 1333.N0.320)as amended. Sworn to and subscribed before me this pA rj,// fi /A/�1 day of 20 • i/e4/ d' " �vAi 'r Signature of Candidate Mercedes Evans Signature Printed Name 717 303-3932 My Commission expires MO. DAY YR. Area Code Daytime Telephone Number SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number I1.Uniterrized Contributions and Receipts4 50.00 or Less per Contributor Total for the reporting period (1) t o R 2.Contributions of 550.01 to I 250.00(From .- Part A and Part B) Contributions Received from Political Committees(Part A) t ,0 All Other Contributions(Part B) 8 too Total for the reporting period (2) ' $ 100 &Contributions Over$250.00(From Part Card Part D) Contributions Received from Political Committees(Part C) 8 U All Other Contributions(Part D) 8 o Total for the reporting period (3) 8 o I4.Other Receipts-Refunds,interest Earned,Returned Checks,ETC.(From Part E) Total for the reporting period (4) 8 1.56 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 101.56 Cover Page,Item 8) 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 Federal Credit Union House# 5000 Street Address Louise Drive City Mechanicsburg state PA ZIA. 17055 Date[MM/DD/YYYY] . $ 1.56 Code 12/31/2021 Receipt Description YTD Checking Account Interest Full Name - House# Street Address City State . Zip . Date[MM/DD/YYYY] A Code Receipt Description Full Name. House# Street Address City State Zip Date[MM/DD/YVYY]. S_ 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• f. Receipt Description Full Name House# Street Address' City , State Zip Date[IIAM/DD/YYYY] $ . Code Receipt Description SCHEDULE III Statement of Expenditures Fiferid_entificationNumber. ItaOti. may.y.:,,,-:T, . ;,. .t ; .�t_..:..i e'in. 1'l�..n.- .tn.5ii'�r-`If- IIiffiflitjitiPaitp Val Arkoosh for US Senate zDate{[MMIDD/,;YYY;Yi*s„8 r:100 7,i,t $` 4 = 12/07/2021 ; t� . 4r.?...art: ,.-�S°d�, ;3:y ,.:a= House#r Strt:et Addre PO BOx 627 Description otEXpendmir� � �,-1,, , `, ,,, ��t a-s. ;9 447.4. i0e�* .'..t.'�.Y° x 13.,-�5fi� „tr i'Ei,c s:.. �� cam.. city Norristown a PA `ificin 19404 Campaign Donation t. 'A::, :'A, ::Cod's ti TotWhomtPaid ,ic vanvit,LW xDateF[MM/DDIYYYYj ;Xp1.50 HOi8e#y 8500 StrOet Addem Governors Hill Drive gDescriptianyof Expenditure <�1 � t xt fat. �A Fr sb4�r; ; d_+',F . „ . act, p. I :1fr �P?u's• .,,city-LJ.Symmes Township ,rState1-OH Zip `.'i '.:45249 Merchant fees ' r�° �C Coded' r TO,Wbon1 Paid',1t Date ;5: House#s Street Addre De riptioii of�Expendittire f r .r .z` ��^' City 'State a°Zlpt4 C' �4,' Code To;W trom aid V,�= Date[M M/DDfYYYYJ n is t ''Dsscr� tion f enditure ,k tr oa f' 4 House# Street Addr'esd p P W.WAL4.,, ,„� ,, • Z Y▪ s,a;�,, r��_.n.t <,t�, rii?�„'��r 4�:,iX'rr..x� ;?!r`�.�`a^-,.��r,e,:°k?�3`.9'rr z'• City tzStat@ .,ZipQy , To,WhOmPaid4 tDate{MMIDD/YYYYR. =gx, N House = Street Address 191CtiptiptifOtEXpenddttre ir' i i v..1 �£{rYs•°ii.X _ e�,��i- ^"' r_•" t,0....'n'.t'k.,',„,,,,s...si.ti,„,,,,.., "5,.' : '�w!_,X?,._ . A,. :-,+,4 :City.;,. State"' Zips*', 1 'To:W om Paid' tDateIMM/DD'/:YYYYi, i 1 A• .t "n rDeecrl tlon of e7iditure ^� HOtise#2 Street,Addtesa p E>� %t >r .fr , RC▪itj►▪rr: istate- ip tr*re, 0. r at ',`1 ' Co 11iiWhom;Paid -Date IMM/DD/.YYYY] #Z . ti' .,-Ati ' it rr .3 House# Stt'eet Address • �Dettriptiontof E7tpendit re 's. e t 4, '.City:' %statte2 `:Zip i Yr sz F"'Y t .-. s'!:O +�Xr P.aid3?,�.: Date i.MM/DD/YYYYix O.fir; t'+ �fe I y A i- H• ouse# ro Ot seription ofexpenditure r AVA,� 4 , r.. i W Street.Addresi, r s s >t !�';e. S* ,,. '•iE" y_ .,,rr ' `g e�rts't'':tfy,zi'.r•`.,.'"t 2 35�' f#.+r r i.i` p .. ▪ t F Y.S! a.t;:a _ram. 41:4ti..a$attWa..fr'i z iar df-7 c L. 'CityS1 Statee. `Zi v � � r e. Pr wr i Code ` fix' 'V.',-*t� L fay PART B All Other Contributions t50.01TO$250 Use this Part to itemize all other contributions with an aggregate value from 150.01 TO t 250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: Full Name of Contributor Su Gilius --Date[MM/DDJYYYY) ._ san 12/11/2021 100 House# 18 Street Address s.27th street Date[MM/DDJYYYYJ ; City State Zip Code Date f MM/DD/YYYY] Camp Hill PA 17011 Full Name of Contributor Date[MM/DD/YYYY) $ House# Street Address Date(MM/DD/YYYY) City State Zip Code Date f MM/DD/YYYY] f Full Name of Contributor .Date(MM/DD/YYYY)-. .S House# Street Address Date[MM/DD/YYYY] i - City. State. .Zip Code. Date[MM/DD/YYYY].. 1 . Full Name of Contributor Date[MM/DDIYYYY) _ House# • Street Addre,s1 Date[MM/DD/YYYY) City State Zip Code Date[MM/DD/YYYY]• $ Full Name of Contributor ,Date[MM/DD/YYYY] i n _ House# Street Address Date[MM/DD/YYYY] . _ City State -Zip Code• Date[MM/DD/YYYY] S . • Full Name of Contributor Date[MMJDD/YYYY] $ House# Street Add Date[MM/DD/YYYY] City State Zip Code Date[MM/DD/YYYY].. .3