HomeMy WebLinkAboutAlan 4 PA - 2022 2nd Friday Pre-Primary 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.gov/campaignfinance • ra-stcampaignfinance@pa.gov
Unsworn Statement in Lieu of Sworn Statement for
Campaign Finance Reports
Note: Per the temporary waiver granted by the Governor on April 6, 2020, 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. (See Temporary
Waiver of Notarization Requirement for Campaign Finance Reports and Statements). 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 and
only so long as the waiver referenced above is in effect. This form must be signed by hand or by
typing your name where a signature is required. If you type your name, you understand that's
your electronic signature and will constitute the legal equivalent of your signature on this form.
Name of Filing Committee, Candidate, or Lobbyist
020 d Dad. — ! I cu'm Pam.
Reporting Cycle Name
El Cycle 1 25- Cycle 2 ❑ Cycle 3 ❑ Cycle 9
6th Tuesday Pre-Primary 2"d Friday Pre-Primary 30 Day Post Primary 30-Day Post Special
Election
Part l- 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.
By signing or typing my name below, I hereby declare under the penalty of perjury,
pursuant to 18 Pa.C.S. § 4904, that the information contained in the accompanying
Campaign Finance Report is to the best of my knowledge and belief true, correct and
complete.
'17 /7/14,!2 n. 4 ',Z?
Signature of Treasurer, Candidate, or Lobbyist Date
Printed Name
DSEB-502R
4/15/2020
violPennsylvania Department of State
Bureau of Campaign Finance&Civic Engagement
210 North Office Building,Harrisburg,PA 17120 • 717.787.5280(Option 4)
www.dos.pa.gov/campaignfinance • ra-stcampaignfinance@pa.gov
Part 11-If this form is submitted with a report by a Candidate's Authorized Committee, the
candidate must sign here.
By signing or typing my name below, I hereby declare under the penalty of perjury,
pursuant to 18 Pa.C.S. § 4904, that the information contained in the accompanying
Campaign Finance Report is to the best of my knowledge and belief true, correct and
complete.
Signature of Candidate Date
-(44 /1k,/e
Printed Name
DSEB-502R
4/15/2020
PAGE 1
Commonwealth of Pennsylvania I il,110111111111111113101111111111
Campaign Finance Report 368531
(NOTE:This report must be clear and legible. It may be typed or printed in blue or black ink.)
Filer Identification 20220285 I Report CANDIDATE COMMITTEE LOBBYIST
Number: Filed By:
Name of Filing Committee,Candidate or Lobbyist: ALAN 4 PA
Street Address: 528 N BEDFORD ST
City: CARLISLE State: PA Zip Code: 17013
TYPE OF 6TH TUESDAY 1. 2ND FRIDAY PRE- 2.X 30 DAY POST- 3. AMENDMENT Yes No ,gip
REPORT PRE-PRIMARY PRIMARY PRIMARY REPORT? V
6TH TUESDAY 4. 2ND FRIDAY PRE- 5. 30 DAY POST- 6. TERMINATION Yes No
(place X to PRE-ELECTION ELECTION ELECTION REPORT?
the right of
report type) ANNUAL REPORT 7. Year 2022 FILING METHOD PAPER . DISKETTE
( ).CHECK ONEDistrict Offi.
Cou
Name of Office Sought by Candidate: DATE OF ELECTION Number Code Party code Code
MO DAY. YEAR 199 STH DEM 21
REPRESENTATIVE IN THE GENERAL ASSEMBLY
OS
f' : 2022 (SEE INSTRUCTIONS FOR CODES)
Summary of Receipts and MO DAY YEAR MO DAY YEAR FOR OFFICE USE ONLY
Expenditures from: 1 1 2022 TO
5 2 2022 C7 r•�
c
A.Amount Brought Forward From Last Report $ 0.00 ry
B.Total Monetary Contributions And Receipts(From Schedule I) $ 400.00
r— i
C.Total Funds Available(Sum Of Lines A and B) $ 400.00 CT‘
.a_
CD
D.Total Expenditures(From Schedule III) $ 82,99 `.")
C)
E.Ending Cash Balance(Subtract Line D From Line C) $ 317.01 C W
a2'.
F.Value Of In-Kind Contributions Received(From Schedule II) $ 23.00 "-1 _
G.Unpaid Debts And Obligations(From Schedule IV) $ 0.00
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 to the best of my knowledge and belief,true
correct and complete. `D /��`'A�'s_ D
Sworn to and subscribed before me this Signature of Person Submitting Report
day of 20
is A 4 p. sys-A,.
r Printed Nam
r
Signature )(NIL) !'G jai,,: Ya op. 40,41
My Commission Expires ti $,7.
(3 70) Email ((wg8,3
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 lune 3,1937(P.L.1333,
No 320)as amended.
Sworn to and subscribed before me this
�Z Signatu of Candidate a
day of 20
Gbh arG
Printed Name �
Signature c-. (!-C/'�`lOG�e �� g u i't t o,4
My Commission Expires EmailV
73 SD/- /9/r
MO DAY YR Area Code Daytime Telephone Number
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PAGE 2
SCHEDULE I
CONTRIBUTIONS AND RECEIPTS
Detailed Summary Page
Name of Filing Committee or Candidate Reporting Period
ALAN 4 PA From: j/1/2022 To: 5/2/2022
1.Unitemized Contributions Received-$50.00 or Less Per Contributor
TOTAL for the Reporting Period (1) $ 0.00
'2.Contributions Received $50.01 To$250.00(From Part A and Part B)
Contributions Received From Political Committees(Part A) $ 0.00
All Other Contributions (Part B) $ 400.00
TOTAL for the Reporting Period (2) $ 400.00
3.Contributions Received Over$250.00(From Part C and Part D)
Contributions Received From Political Committees(Part C) $ 0.00
All Other Contributions (Part D) $ 0.00
TOTAL for the Reporting Period (3) $ 0.00
4.Other Receipts,Refunds,Interest Earned,Returned Checks, Etc.(From Part E)
TOTAL for the Reporting Period (4) $ 0.00
Total Monetary Contributions and Receipts During this Reporting Period(Add and enter amount 400.00
totals from Boxes 1,2,3 and 4;also enter this amount on Pagel,Report Cover Page,Item B.)
5/6/2022 7:56:17 AM
PAGE 3
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.
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributing Committee
MO "DAY: 'YEAR
Mailing Address
$ 0.00
City State Zip Code(Plus 4)
PAGE TOTAL
Enter Grand Total of Part A on Schedule I,Detailed Summary Page,Section 2. $ 0.00
5/6/2022 7:56:17 AM
PAGE 4
PART B
ALL OTHER CONTRIBUTIONS
$50.01 TO $250.00
Use this Part to itemize all other contributions with an aggregate value from
$50.01 to $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part A)
Name of Filing Committee or Candidate Reporting Period
ALAN 4 PA From: 1/1/2022 To: 5/2/2022
DATE AMOUNT
Full Name of Contributor
John D Bosha MO DAY YEAR
Mailing Address 5 Gale Cir
100.00
City CAMP HILL State Zip Code(Plus 4)
4 4 2022
PA 17011
Full Name of Contributor
Hiromi Kowaguchi MO DAY YEAR
Mailing Address 528 N. Bedford St.
100.00
City State Zip Code(Plus 4) 4 20 2022
Carlisle
PA 17013
Full Name of Contributor
MO DAY YEAR
Barbara Hench
Mailing Address 3003 Fort Robinson Road
$ 50.00
City State Zip Code(Plus 4) 4 20 2022
Loysville
PA 17047
Full Name of Contributor
Roy Crockett MO DAY YEAR"
Mailing Address 722 Anchor Chain Rd., #3
S 100.00
City State Zip Code(Plus 4) 4 21 2022
Ocean City
MD 21842
Full Name of Contributor
Ellen Graham-Buchanan MO. DAY ' YEAR
Mailing Address 21 Wheatfield Dr.
S 25.00
Ci State Zip Code(Plus 4) 4 23 2022
�' Carlisle
PA 17015
t t . ) 1 1
5/6/2022 7:56:17 AM
PAGE 5
Full Name of Contributor
Molly Shane MO DAY YEAR
Mailing Address 51 I St.
25.00
Ci State Zip Code(Plus 4) 4 24 2022
ty Carlisle
PA 17013
PAGE TOTAL
Enter Grand Total of Part A on Schedule I,Detailed Summary Page,Section 2. $ 400.00
C/(./)n 7•CA•17 AM
PAGE 6
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 from Over $250.00 in the reporting period.
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributing Committee
MO DAY YEAR
Mailing Address
0.00
City State Zip Code(Plus 4)
PAGE TOTAL
Enter Grand Total of Part C on Schedule I,Detailed Summary Page,Section 3.
$ 0.00
s/Fn111 7.gA.17 enn
PAGE 7
PART D
ALL OTHER CONTRIBUTIONS
OVER $250.00
Use this Part to itemize all other contributions with an aggregate value of
over $250.00 in the reporting period.
(Exclude contributions from political committees reported in Part C.)
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributor
MO DAY YEAR
Mailing
Address $ 0.00
City State Zip Code(Plus 4)
Employer Name Occupation
Employer Mailing Address/Principal Place of City State Zip Code(Plus 4)
Business
PAGE TOTAL
Enter Grand Total of Part C on Schedule I, Detailed Summary Page,Section 3.
0.00
c/F.r)n77 7•SF.•17 AM
PAGE 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.
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name
MO DAY YEAR ;
•
Mailing Address $ 0.00
City State Zip Code(Plus 4)
Receipt Description
PAGE TOTAL
Enter Grand Total of Part E on Schedule I,Detailed Summary Page,Section 4.
0.00
S/A/7l177 7•SA•17 AM
PAGE 9
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
ALAN 4 PA From: 1/1/2022 To: 5/2/2022
1.UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR
/ 0.00
TOTAL for the Reporting Period (1)
2.IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F)
TOTAL for the Reporting Period (2) $ 23.00
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 $ 23.00
amount totals from Boxes 1,2,and 3;also enter on Page 1,Reports Cover Page,Item F.)
S/F./7/177 7•SA•17 AM
PAGE 10
SCHEDULE II
PART F
IN-KIND CONTRIBUTIONS RECEIVED
VALUE OF $50.01 TO $250.00
Name of Filing Committee or Candidate Reporting Period
ALAN 4 PA From: 1/1/2022 To: 5/2/2022
DATE AMOUNT
Full Name of Contributor
John D. Bosha MO DAY YEAR
Mailing Address 5 Gale Circle $ 23.00
4 4 2022
City CAMP HILL State Zip Code(Plus 4)
PA 17011
Description of Contribution: lunch meeting
Enter Grand Total of Part F on Schedule II,In-Kind Contributions Detailed Summary Page, PAGE TOTAL
Section 2.
23.00
c/Fi/7n77 7•cA•17 am
PAGE 11
SCHEDULE II
PART G
IN-KIND CONTRIBUTIONS RECEIVED
VALUE OVER $250.00
Name of Filing Committee or Candidate Reporting Period
From: To:
DATE AMOUNT
Full Name of Contributor
MO DAY YEAR
Mailing Address
0.00
City State Zip Code(Plus 4)
Employer of Contributor Occupation
Employer Mailing Address/Principal Place of City State Zip Code(Plus Description of Contribution
Business 4)
Enter Grand Total of Part G on Schedule II,In-Kind Contributions Detailed PAGE TOTAL
Summary Page,Section 3. 0.00
S/A/11177 7•SA•17 AM
PAGE 12
SCHEDULE III
STATEMENT OF EXPENDITURES
Name of Filing Committee or Candidate Reporting Period
ALAN 4 PA From 1/1/2022 To: 5/2/2022
DATE AMOUNT
To Whom Paid
PNC Bank MO DAY YEAR
Mailing Address 110 S. 32nd St. 4 21 2022 $ 82.99
City Camp Hill State Zip Code(Plus 4) Description of Expenditure
PA 17011 checks
PAGE TOTAL
Enter Grand Total of Expenditures on Page 1,Report Cover Page,Item D.
$ 82.99
c/finn77 7•cF.•17 AM