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Home My WebLink AboutWestern Cumberland County Republican Club - 2022 6th Tuesday Pre-Primary ir Pennsylvania Department of State Bureau of Campaign Finance&Civic Engagement 210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4) ip �y I ti U www.dos.pa.gov/campaignfinance • ra-stcampaignfinance(aJpa.gov i L2 Hpi tS -( PM II do '` OV Unsworn Statement in Lieu of Sworn SCt�at l ril �t 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), 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. (Name off;Qin:COr amitte a Candidate, or-Lobbyist tAks e-e n Cu,n4 b e r l 0,44d Co a, .LA I,Uca__vi R° ui° [ee or fag_C c_..Name . _ _ - ,. Xi Cycle 1 . ❑ Cycle 2 0 Cycle 3 0 Cycle 4 0 Cycle 5 6th Tuesday 2nd Friday 30 Day 6th Tuesday 2nd Friday Pre-Election Pre-Primary Pre-Primary Post Primary Pre-Election ❑ Cycle 6 ❑ Cycle 7 0 Cycle 8 0 Cycle 9 30 Day 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 foregoing is true and correct. ,' e(/-, '117 004/2009 a Signature of Treasurer, Candidate, or Lobbyist Date (DD/MM/YYYY) chic /� (off, d 1% , n ; /54- I� Printed Name Location (City/State/Country) DSEB-5035 Updated 6/24/2020 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 20190187 (Mark X) Name of Filing Committee,Candidate or Lobbyist Western Cumberland County Republican Club Street Address 1383 Mountain Road City Newburg State PA Zip Code 17240 1 Type of Report(Place x under report type) 1-6`h Tuesday 2- 2"d Friday 3 30 Day Post 4-6th Tuesday 5-2nd Friday 6-30 Day Post 7-Annual Special 2"a 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) 05/17 2022 Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 01/01/2022 03/28/2022 A.Amount Brought Forward From Last Report $ 2383.61 C7 C 0 tti i B.Total Monetary Contributions and Receipts $ xs (From Schedule I) 695.00 rn -0 C.Total Funds Available $ I (Sum of Lines A and B) 3078.61 , .I`" D.Total Expenditures $ a .Q 313.39 (From Schedule III) U = E.Ending Cash Balance $ C 3765.22 (Subtract Line D from Line C) = F.Value of In-Kind Contributions Received $ -..—/< %D (From Schedule II) 0 G.Unpaid Debts and Obligations $ (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,corr ct and complete. Sworn to and subscribed before me this .�//! day of 20 J Sir ',11 /./e, gn re of Per on Suerittin ort Signature [ Printed Name My Commission expires 77( ` 7c 9 ✓( e .. 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 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 Identification Number 20190187 11.Unitemized Contributions and Receipts-$50.00 or Less per Contributor I Total for the reporting period (1) $ 695.00 2.Contributions of$50.01 to $250.00(From I Part A and Part B) Contributions Received from Political Committees(Part A) $ All Other Contributions(Part B) $ Total for the reporting period (2) $ 3.Contributions Over$250.00(From Part C and Part D) I Contributions Received from Political Committees(Part C) $ All Other Contributions(Part D) $ Total for the reporting period (3) $ 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) I • Total for the reporting period (4) $ 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) 695.00 SCHEDULE III Statement of Expenditures Filer Identification Number: 20190187 To Whom Paid Date[MM/DD/YYYY] $ Theresa Myers 104.50 01/31/2022 House# Street Address Description of Expenditure 1383 Mountain Road City State Zip Newburg PA Code 17240 Sam's Club Reimbursement for Winter Potluck Event To Whom Paid Date[MM/DD/YYYY] $ Aldi 37.54 01/26/2022 House# Street Address Description of Expenditure 40 Shippensburg Shopping Center City State Zip Shippensburg PA Code 17257 Supplies for Winter Potluck Event To Whom Paid Date[MM/DD/YYYY] $ Dollar Tree 27.60 01/26/2022 House# Street Address Description of Expenditure 343 Baltimore Road City State Zip Shippensburg PA Code 17257 Decorations for Winter Potluck Event To Whom Paid Date[MM/DD/YYYY] $ Walmart 57.88 01/27/2022 House# Street Address Description of Expenditure 100 S.Conestoga Dr City State ' Zip Shippensburg PA Code 17257 Food for Winter Potluck Event To Whom Paid Date[MM/DD/YYYY] $ Walmart 17.37 03/03/2022 House# Street Address Description of Expenditure 100 Conestoga Drive I City State Zip Shippensburg PA Code 17257 Snacks for We the People Speakers Series To Whom Paid Date[MM/DD/YYYY] $ ALDI 56.86 03/09/2022 House# Street Address Description of Expenditure 40 Shippensburg Shopping Center City State Zip Shippensburg PA Code 17257 Snacks for We the People Speakers Series To Whom Paid Date[MM/DD/YYYY] $ paypal.com 11.64 02/07/2022 House# Street Address Description of Expenditure City State Zip Code Fees To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code