HomeMy WebLinkAboutBloom for the 199th - 2015 30-Day Post Election-SPECIAL PAGE 1
Commonwealth of Pennsylvania 11111111IVAIMI /11111111
Campaign Finance Report 181097
(NOTE:This report must be clear and legible. It may be typed or printed in blue or black ink.)
Filer Identification 2010108 Report CANDIDATE COMMITTEE 7LOBBYIST
Number: Filed By :
Name of Filing Committee,Candidate or Lobbyist: BLOOM, STEPHEN FORTH E 199TH COM
Street Address: 2100 LONG GAP ROAD
City: CARLISLE State: PA Zip Code: 17013-8651
TYPE OF 6TH TUESDAY 1. 2ND FRIDAY 2. 30 DAY 3. AMENDMENT Yes RNol
REPORT PRE-PRIMARY PRE-PRIMARY POST-PRIMARY REPORT?
6TH TUESDAY 4. 2ND FRIDAY 5. 30 DAY 6. TERMINATION Yes
(place X to PRE-ELECTION PRE-ELECTION POST-ELECTION REPORT?
the right of
report type) ANNUAL REPORT 7. Year 2015 FILING METHOD PAPER DISKETTE
( )CHECK ONE
Name of Office Sought by Candidate: r a a District Number Officde
Office Party Code County
MO DAY YEAR REP 21
8 4 2015 (SEE INSTRUCTIONS FOR CODES)
Summary of Receipts and MO DAV YEAR MO 1 DAY YEAR FOR OFFICE USE ONLY
Expenditures from: 7 21 2015 To 1 8 141 2015 C� ria
A.Amount Brought Forward From Last Report $ 27,634.53 ''`t
f,7
B.Total Monetary Contributions And Receipts(From Schedule I) 0.00
V
r= i
C.Total Funds Available(Sum Of Lines A and B) 27,634.53
D.Total Expenditures(From Schedule III) $ 0.00 f'D
E.Ending Cash Balance(Subtract Line D From Line C) 27,634.53
Z-
F.Value Of In-Kind Contributions Received(From Schedule II) 0.00 C.IT
G.Unpaid Debts And Obligations(From Schedule IV) $ 0.00
AFFIDAVIT
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,ar7 A
o e t y knowledge and belief,true
correct and complete.
rrti
Sworn hand s✓+bscribed before me this Signatu of rson Submitting Report
���� day of ell9
/t,� Printed Name
. "`er L. tU (, I�Z-)N113�R0 J` LC),,(H:i7 .
'commissiplt.YiVl fM OF PENNSYLVANIA —ill -S'IC• Email
1,tlRw�u NOTARMb SEAL DAY YR Area Code Daytime Telephone Number
Part II
If this is a reWlItOMPL.6ndldate' uth rized Committee,Candidate shall sign here.
CARLISLE SORO:,CUMBERLAND CN `�
laws (or aaffjj�iIT� 1AlIDNt 00102 Y7edge d belief this political committee has not violated any provi on t e e 31
,937(P.L.1333,
No 32 as aili6n����
Sworn to and subscribed before me this
1'(1 day of may... 20 Signature of Candid to
Printed Name
My Com ission Expires N A L SEAL !:mail
BETHANY SALZARULO __71 —7 —'7 c"t _ ( Ll- 3
NotatyPgbl
CARLISLE BORO;.000BERLAND CRM' YR Area Code Daytime Telephone Number
9/3/2015 4:25:59 AM
PAGE 2
SCHEDULE I
CONTRIBUTIONS AND RECEIPTS
Detailed Summary Page
Name of Filing Committee or Candidate Reporting Period
BLOOM, STEPHEN FORTH E 199TH COM From: 7/21/2015 To: 8/14/2015
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) $ 0.00
TOTAL for the Reporting Period (2) $ 0.00
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 $ 0.00
totals from Boxes 1,2,3 and 4; also enter this amount on Pagel,Report Cover Page,Item B.)
9/3/2015 4:25:59 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
9/3/2015 4:25:59 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
From: To:
DATE AMOUNT
Full Name of Contributor
MO DAY YEAR
Mailing Address
$ U.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
9/3/2015 4:25:59 AM
PAGE 5
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
9/3/2015 4:25:59 AM
PAGE 6
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
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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
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
9/3/2015 4:25:59 AM
PAGE g
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
BLOOM, STEPHEN FORTH E 199TH COM From: 7/21/2015 To: 8/14/2015
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.)
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PAGE 9
SCHEDULE II
PART F
IN-KIND CONTRIBUTIONS RECEIVED
VALUE OF $50.01 TO $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)
Description of Contribution:
Enter Grand Total of Part F on Schedule II,In-Kind Contributions Detailed Summary Page, PAGE TOTAL
Section 2.
$ 0.00
9/3/2015 4:25:59 AM
PAGE 10
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
NO DAY YEAR
Mailing Address
d 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
9/3/2015 4:25:59 AM
PAGE 11
SCHEDULE III
STATEMENT OF EXPENDITURES
Name of Filing Committee or Candidate Reporting Period
From To:
DATE AMOUNT
To Whom Paid
Mo DAV TEARr
Mailing Address
4 0,00
City State Zip Code(Plus 4)
Description of Expenditure
PAGE TOTAL
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D.
0.00
9/3/2015 4:25:59 AM