HomeMy WebLinkAboutColleen for PA - 2022 2nd Friday Pre-Primary Pennsylvania Department of State
Bureau of Campaign Finance&Lobbying Disclosure
be
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 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 Reports. This form must be signed
by hand where a signature is required.
Name of Filing Committee, Candidate, or Lobbyist
Colleen for PA
Reporting Cycle Name
❑ Cycle 1 IR Cycle 2 0 Cycle 3 ❑ Cycle 4 0 Cycle 5
6th Tuesday 2nd Friday 30 Day 6th Tuesday 2nd Friday
Pre-Primary Pre-Primary Post Primary Pre-Election
Pre-Election
❑ Cycle 6
❑ Cycle 7 ❑ Cycle 8 El 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 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.
05/03/2022
Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY)
Carol E. Thornton Mechanicsburg, PA, USA
Printed Name Location (City/State/Country)
DSEB-502R
Updated 1/5/2022
TryPennsylvania 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 II-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.
C05/03/2022
Signature of Treasurer, Candidate, or Lobbyist Date (MM/DD/YYYY)
Colleen Gray Nguyen !! n
l a , �� T-I L,`)A
Printed Name Location (City/State/Country)
DSEB-502R
Updated 1/5/2022
PAGE 1
Commonwealth of Pennsylvania 1®1I1111111111111®®111I1NI11111
Campaign Finance Report 367421
(NOTE:This report must be clear and legible. It may be typed or printed in blue or black ink.)
Filer Identification 20210153 Report CANDIDATE COMMITTEE 1 LOBBYIST
Number: Filed By:
Name of Filing Committee,Candidate or Lobbyist: COLLEEN FOR PA
Street Address: 1750 YORKSHIRE PLACE
City: ENOLA State: PA J
Zip Code: 17025-2745
TYPE OF 6TH TUESDAY 1. 2ND FRIDAY PRE- 2.X 30 DAY POST- 3. AMENDMENT Yes No y,
REPORT PRE-PRIMARY PRIMARY PRIMARY REPORT?
(place X to 6TH TUESDAY 4. 2ND FRIDAY PRE- 5. 30 DAY POST- 6. TERMINATION Yes No
PRE-ELECTION ELECTION ELECTION REPORT?
the right of
report type) ANNUAL REPORT 7. Year 2022 FILING METHOD PAPER i DISKETTE
( )CHECK ONE
DATE OF ELECTION District Office Party Code County
Name of Office Sought by Candidate: Number Code Code
MO DAY YEAR DEM 21
11 8 2022 (SEE INSTRUCTIONS FOR CODES)
Summary of Receipts and MO DAY YEAR MO DAY YEAR FOR OFFICE USE ONLY
Expenditures from: 3 29 2022 TO 5 2 2022
A.Amount Brought Forward From Last Report $ 8,947.03 C __
B.Total Monetary Contributions And Receipts(From Schedule I) $ 0.72 N
m 33.
C.Total Funds Available(Sum Of Lines A and B) 8,947.75 ;TJ C
I—
D.Total Expenditures(From Schedule III) $ 2,000.00 › �-
CD
E.Ending Cash Balance(Subtract Line D From Line C) $ 6,947.75 L-)
F.Value Of In-Kind Contributions Received(From Schedule II) $ 0.00
G.Unpaid Debts And Obligations(From Schedule IV) $ 0.00 --I
AFFIDAVIT SECTION
PART I-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 filed on paper or by electronic medium,are jswt of my knowledge and belief,true
correct and complete. /(/ '/
Sworn to and subscribed me this l/�r Signature of Person Submitting Report
day of 20 aLCI2—L—E. :740 e.+4.1— —
,,,,ryryryry per'(�Jf Printe�dd Na a r� ��j//� y�Sign re 0,fi �n/i( `G/ UA (T!\(�l` ins•x-�('
My Commission E G /-J Email y// �7� /�
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 ny provisions of the act of June 3,1937(P.L.1333,
No 320)as amended.
Sworn to and subscri• • •, •re me this
Signature of Candida
l
day• 20 Ct -c- -N N tJy
Printed Nellie
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ignatu CP.12•{n C?►v1Cjv\f ,, goc/f"ield .co,
My Commission Expi EmailV l v
11-7 4'37 - -i--7 cz
MO . .y YR Area Code Daytime Telephone Number
PAGE 2
SCHEDULE I
CONTRIBUTIONS AND RECEIPTS
Detailed Summary Page
Name of Filing Committee or Candidate Reporting Period
COLLEEN FOR PA From: 3/29/2022 To: 5/2/2022
1:�Jriitem(zed Contri6utionsfRecelved ;�50:"00_orrless?Per Contributor:'
TOTAL for the Reporting Period (1) $ 0.00
2.COntrlbUtions Received=`$50 OPTo•$250:00'(From aW0.0.Part B) by ; h fi' s ;
Contributions Received From Political Committees(Part A) $ 0.00
All Other Contributions (Part B) $ 0.00
TOTAL for the Reporting Period (2) $ 0.00
•
3 Con'tr'ibutions�Receivedl Over'$250"00)(From7Part C anBiPartfiD)A ,
Contributions Received From Political Committees(Part C) $ 0.00
AU Other Contributions (Part D) $ 0.00
TOTAL for the Reporting Period (3) $ 0.00
4.Other Receipts,Refunds,.Interest."Earned i eturned'Checks,�iEtCSFromOPart`E)R r ,,TT;;:
TOTAL for the Reporting Period (4) $ 0.72
Total Monetary Contributions and Receipts During this Reporting Period(Add and enter amount $ 0.72
totals from Boxes 1,2,3 and 4;also enter this amount on Pagel,Report Cover Page,Item B.)
5/3/2022 8:04:28 AM
PAGE 7
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.
Name of Filing Committee or Candidate Reporting Period
COLLEEN FOR PA From: 3/29/2022 To: 5/2/2022
DATE AMOUNT
Full Name
Members 1st Federal Credit Union MO DAY YEAR
Mailing Address 5000 Marketplace Way $ 0.34
City State Zip Code(Plus 4) 4 30 2022
Enola
PA 17025
Receipt Description Dividend
Full Name
Members 1st Federal Credit Union MO DAY YEAR
Mailing Address 5000 Marketplace Way $ 0.38
State Zip Code(Plus 4)
City Enola 3 31 2022
PA 17025
Receipt Description Dividend
PAGE TOTAL
Enter Grand Total of Part E on Schedule I,Detailed Summary Page,Section 4.
0.72
5/3/2022 8:04:28 AM
PAGE 8
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
Name of Filing Committee or Candidate Reporting Period
COLLEEN FOR PA From: 3/22/2022 To: 5/2/2022,
1.UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR
TOTAL for the Reporting Period (1) $ 0.00
2.IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F)
TOTAL for the Reporting Period (2) $ 0.00
3.IN-KIND CONTRIBUTION RECIEVED-VALUE OVER$250.00(FROM PART G)
TOTAL for the Reporting Period (3) $ 0.00
TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING PERIOD(Add and enter $ 0.00
amount totals from Boxes 1,2,and 3;also enter on Page 1,Reports Cover Page,Item F.)
5/3/2022 8:04:28 AM
PAGE 11
SCHEDULE III
STATEMENT OF EXPENDITURES
Name of Filing Committee or Candidate Reporting Period
COLLEEN FOR PA From 3/29/2022 To: 5/2/2022
DATE AMOUNT
To Whom Paid
MO DAY YEAR
Friends of Izzy
Mailing Address P.O. Box 178 4 26 2022
S 1,000.00
City Lancaster State Zip Code(Plus 4) Description of Expenditure
PA 17608 Donation
To Whom Paid
MO DAY YEAR
Friends of Sara Agerton
Mailing Address 52 West Simpson Street 4 4 2022
S 1,000.00
State Zip Code(Plus 4) Description of Expenditure
City Mechanicsburg
PA 17055 Donation
PAGE TOTAL
Enter Grand Total of Expenditures on Page 1,Report Cover Page,Item D.
2,000.00
5/3/2022 8:04:28 AM