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Home My WebLink AboutFriends of Denise Gembusia - 2015 2nd Friday Pre-Primary iII III Reset Form Print Form Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible. It should be typed) Filer Identification Report Filed ByCandidate IJ Committee Lobbyist Number (Mark X) Name of Filing Committee,Candidate or Lobbyist Friends of Denise Gembusia Street Address P.O.Box 53 city Mt.Holly springs State PA Zip Code 17065 Type of Report(Place x under report type) 1.6`h Tuesday 2- 2nd Friday 3.30 Day Post 4-6th Tuesday 5-2" Friday 6-30 Day Post 7-Annual Speciial 2no 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) 05/19/2015 2015Report Report ❑ Summary of Receipts and From Date To Date For Office Use Only Expenditures 01/01/2015 05/04/2015 A.Amount Brought Forward From Last Report $ 0 B.Total Monetary Contributions and Receipts $ q,543 C7 0 (From Schedule I)C.Total Funds Available $ 0C s n 4,543 (Sum of Lines A and B) y D.Total Expenditures $ r— 1 (From Schedule 111) 1,863.2 E.Ending Cash Balance $ ED (Subtract Line D from Line C) 3,079.8 n _ F.Value of In-Kind Contributions Received $ O W (From Schedule 11) 3,844.64 G.Unpaid Debts and Obligations $ 3,349.18 t0 (From Schedule IV) 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 of r 'I SEAL 414-day of zo N STOUT �11 2-n.l,. - rt - o ar bli0Sig ature of Person,5ubmitting report /LET�UiWF,CUMBERL ND COUNTY Jennifer L.Varner ignatur Printed Name My Commission Expires Aprz 2016 My Commission expires 717 258-4224 O. 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 day of 20 __ _ Si nature of Candidate � Denise Gembusia Signature /— Printed Name My Commission expires 1 {y 717 554-3482 M6. DAY YR. Area Code Daytime Telephone Number llffl vi"T NOTggIAL SEAL UT Notary Public SOUTN MIDDLETON TWP.,CUMBERLAND COUNTY My Commission Expires Apr 27,2016 SCHEDULEI Contributions and Receipts Detailed Summary Page Filer Identification Number Friends of Denise Gembusia 1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total for the reporting period (1) $ 1,074 2.Contributions $50.01 to $250.00 From Part A and Part B) Contributions Received from Political Committees(Part A) $ 100 All Other Contributions(Part B) $ 1,649 Total for the reporting period (2) $ 1,749 3.Contributions Over$250.00(From Part C and Part D) Contributions Received from Political Committees(Part C) $ 0 All Other Contributions(Part D) $ 1,720 Total for the reporting period (3) $ 1,720 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) Total for the reporting period (4) $ 0 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 4,543 Cover Page,Item BJ 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. Filer Identification Number Friends of Denise Gembusia Amount Full Name of Contributing Date[MM/DD/YYYY] $ Committee Capozzi and Associates,PAC 100 03/19/2015 House# Street Address Date[MM/DD/YYYY] $ 2933 North Front Street City State Zip Code Date[MM/DD/YYYY] $ Harrisburg PA 17110 Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYYj $ Committee House# Street Address Date[MM/DD/YYYY] $ city State T7 p Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address .Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY) $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYYj $ City State Zip Code Date[MM/DD/YYYY] $ PART B All Other Contributions $50.01 TO$250 Use this Part to itemize all other contributions with an aggregate value from $50.01 TO$250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYri] Robert Robinson 3/19/2015 118 House# Street Address. Date[MM/DD/YYYY] $ 208 Mountain View Road city State Zip Code Date[MM/DD/YYYY] $ Mt.Holly Springs PA 17065 Full Name of Contributor Date(MM/DD/YYYY] $ Joseph Gembusia 03/19/2015 120 House# Street Address Date(MM/DD/YYri] $ 3510 Raintree Lane city State Zip Code Date IMM/DD/YYYY] $ Mechanicsburg PA 17050 Full Name of Contributor Date[MM/DD/YYYY] $ Connie Bires 03/19/2015 128 House# Street Address Date IMM/DD/YYYY] $ 257 Arch Street City State Zip Code Date[MM/DD/YYri] $ Carlisle PA 17013 Full Name of Contributor Date[MM/DD/YYYY] $ Scott Boise 03/19/2015 140 House# Street Address Date[MM/DD/YYYY] $ 406 N.Walnut Street City State Zip Code Date[MM/DD/YYYY] $ Mt.Holly Springs PA 17065 Full Name of Contributor Date[MM/ ] $ Susan Day 03/19/20152015 150 House# Street Address Date[MM/DD/YYYY] $ 845 Baltimore Pike city State Zip Code Date[MM/DD/YYYY] $ Gardners PA 17065 Full Name of Contributor Date IMM/DD/YYYYI $ Eric Klinedinst 03/19/2015 150 E Street Address Date(MM/DD/YYYYI $ 100 Linn Drive State Zip Code Date[MM/DD/WYYI $ rlisle PA 17013 PART B All Other Contributions $50.01 TO$250 Use this Part to itemize all other contributions with an aggregate value from $50.01 TO$250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYYY] $' Richard Ruda 03/19/2015 120 ECa Street Address Date[MM/DD/YYYY] $ 2 Derbyshire Drive State Zip Code Date[MM/DD/YYYY] $ rlisle PA 17015 Full Name of Contributor Date[MM/DD/YYYY] $ Karla G.Browne 03/19/2015 54 House if Street Address Date[MM/DD/YYYY] $ 259 South Pitt Street city State Zip Code 17013 Date[MM/DD/YYYY] $ Carlisle PA Full Name of Contributor Date[MM/DD/YYYY] $ Andrew R.Eisemann 03/19/2015 80 House# Street Address Date[MM/DD/YYYY] $ 73 Channel Drive city State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Full Name of Contributor Date[MM/DD/YYYY] $ Robert C.Cairns 03/19/2015 89 House# Street Address Date[MM/DD/YYYY] $ 21 East 1st Street City State Zip Code Date[MM/DD/YYYY] $ Boiling Springs PA 17007 Full Name of Contributor Date[MM/DD/YYYY] $ Louis J.Capozzi 100 03/19/2015 House# Street Address Date[MM/DD/YYYY] $ 1655 Holly Pike city State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17015 Full Name of Contributor Date[MM/DD/YYYY] $ Shaun Foote 100 03/19/2015 LHouse#C"3 Street Address Date[MM/DD/YYYY] $ Mackenzee CourtState Zip Code Date[MM/DD/YYYY] $ PA 17015 PART B All Other Contributions $50.01 TO$250 Use this Part to itemize all other contributions with an aggregate value from $50.01 TO$250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYYY] $ Kevin Merris 03/19/2015 100 House# Street Address Date[MM/DD/YYYY] $ 14 Greenway Drive City State Zip Code Date[MM/DD[YYYY] $ Mechanicsburg PA 17055 Full Name of Contributor Date IMM/DD/YYYY] $ Robert Pantaleo 03/19/2015 100 House# Street Address Date[MM/DD/YYYY] $ 109 East York Street City State Zip Code Date[MM/DD/YYYY] $ Biglerville PA 17307 Full Name of Contributor Date[MM/DD/YYYY] $ John Thompson 03/19/2015 100 House# Street Address Date IMM/DD/YYYY] $ 419 East Market Street City State Zip Code Date[MM/DD/YYYY] $ Mechanicsburg PA 17055 Full Name of Contributor Date[MM/DD/YYYY] $ House# I Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date IMM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $' House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ PART D All Other Contributions Over$250.00 Use this Part to itemize all other contributions with an aggregate value over$250.00 in the reporting period. (Exclude contributions from political committees reported in Part C) Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYYY] $ Bryan Gembusia 1,000 02/04/2015 House# Street Address Date[MM/DD/YYYY] $ 7 woodview Drive 420 03/19/2015 City State Zip Code Date[MM/DD/YYYY] $ Mt.Holly Springs PA 17065 Employer Name Oaupation Vo-Yo computer Services Self-employed/Business owner Employer Mailing Address/ Principal Place of Business 7 woodview Drive,Mt.Holly Springs PA 17065 Full Name of Contributor Date[MM/DD/YYYY] $ Jennifer Varner 03/19/2015 300 House# Street Address Date[MM/DD/YYYY] $ 15 Meadowood Place City State Zip Code Date[MM/DD/YYYY] $ Boiling Springs PA 17007 Employer Name Self-employed Occupation Tax Collector Employer Mailing Address/ Principal Place of Business 520 Park Drive,Boiling Springs PA 17007 Full Name of Contributor Date[MM/DD/YYYY] $. House If Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Employer Name Oaupation Employer Mailing Address/ Principal Place of Business Full Name of Contributor Date[MM/DD/YYYY] $ House If Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/ Principal Place of Business SCHEDULE II IN-KIND CONTRIBUTIONS AND VALUABLE THINGS RECIEVED USE THIS SCHEDULE TO REPORT ALL IN-KIND CONTRIBUTIONS OF VALUABLE THINGS DURING THE REPORTING PERIOD DETAILED SUMMARY PAGE Filer Identification Number: Friends of Denise Gembusia 1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the reporting period (1) $ 205 2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) TOTAL for the reporting period (2) $ 1,463.72 3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTALfor the reporting period (3) $ 2,175.92 TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING $ PERIOD(Add and enter amount totals from boxes 1,2,and 3;also enter on Page 1,Report Cover Page,Item F) 3,844.64 SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYYY] $ John Pappas 03/19/2015 250 F Street Address Date[Wilul YYYY] $ 63 Holly Pike State Zip Code Date[MM/DD/VYYY] $ le PA .17015 Description of Contribution Food for Fundraiser Full Name of Contributor Date[MM/DD/YYYY] $ Shaun Foote 03/19/2015 75 House# Street Address Date[MM/DD/YYYY] $. 1 North Hanover Street City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Description of Contribution Cocktail tables for fundraiser Full Name of Contributor Date[MM/DD/YYYY] $ Ross Morris 03/19/2015 75 Fj StreetAddress Date[MM/DD/YYYY] $ 2 West Pomfret Street State Zip Code Date[Mllil YYY] $ lisle PA 17013 Description of Contribution Food for Fundraiser Full Name of Contributor Date[MM/DD/YYYY] $ Chris Petsinis 03/19/2015 75 House# Street Address Date[MM/DD/YYYY] $ 37 North Hanover Street City State Zip Code Date[MM/DD/YYYY) $ Carlisle PA 17013 Description of Contribution Keg of beer Full Name of Contributor Date[MM/DD/YYYY] $ Michele Landis 03/19/2015 66 House# Street Address Date[MM/DD/YYYY] $ 28 South Pitt Street City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Description of Contribution Yoga&essential oils SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYYY] $ Bryan Gembusia 1/2/2014 57.72 Houle if Street Address Date[MM/DD/YYYY] $ 7 Woodview Drive City State Zip Code Date[MM/DD/YYYY] $ Mt.Holly Springs PA 17065 Description of Contribution supplies Full Name of Contributor Date[MM/DD/YYYY] $ Mike Blumenthal 03/19/2015 65 House# Street Addr!E.rth:H�ar Date[MM/DD/YYYY] $ 876 Street city State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Description of Contribution Crystal&leather flask Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip.Code Date[MM/DD/YYYY] $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ Houseft Street Address Date[MM/DD/YYYY] $ E::: city State Zip Code Date[MM/DD/YYYY] $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY]- $ City State Zip Code Date[MM/DD/YYYY] $ Description of Contribution SCHEDULE II Part G In-Kind Contributions Received VALUE OVER$250 Filer Identification Number: Friends of Denise Gembuso Full Name of Contributor Date(MM/DD/YYYY] $ Brice Arndt 03/14/2015 500 H ouse IIStreet Address Date[MM/DD/YYYY] $ 3975 E.Trindle Road State. Zip code. Date(MM/DD/YYYY] $ p Hill PA17011 Employer Name Camp Hill Dentist Occupation Dentist Employer Mailing Address/Principal Description Place of Business 3975 E.Trindle Road,Camp Hill PA 17011 of Zoom teeth whitening gift certificate Contribution Full Name of Contributor Date ININ /YYYY] $ John Thompson 04/07/2015 675.92 F se# Street Address Date[MM/DD/YYYY) $ 137 N.Hanover Street State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Employer Name The Printed Image Occupation Printer Employer Mailing Address/Principal Description Place of Business 137 North Hanover Street,Carlisle PA 17013 of Palm Cards Contribution Full Name of Contributor Date[MM/DD/YYYY] $ Louis J.Capozzi 03/19/2015 1,000 House# Street Address Date[MM/DD/YYYY] $ 1655 Holly Pike City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17015 Employer Name Capozzi&Associates Occupation Attorney Employer Mailing Address/Principal Description Place of Business 1200 Camp Hill Bypass#205,Camp Hill PA 17011 of Wine Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City state Zip Code Date[MM/DD/YYYY] $. Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution SCHEDULE III Statement of Expenditures Filer Identification Number: Friends of Denise Gembusia To Whom Paid Date[MM/DD/YYYY] $ Invantage 03/15/2015 400 House If 5922 Linglestown Road Street Address Description of Expenditure city State Zip Harrisburg PA Code 17112 Social Media To Whom Paid Date[MM/DD/YYYY] $ High Peak Tent Rentals 173.2 03/19/15 House#. Street Address PO Box 1042 Description of Expenditure City Carlisle State.=...PA CORE 17013 Linens for fundraiser To Whom Paid Date[MM/DD/YYYY] $ Invantage 04/15/2015 400 House# 5922 Linglestown Road Street Address Description of Expenditure City Harrisburg State .PA -Zp 17112 Social Media ode To Whom Paid Date[MM/DD/YYYY] $ Cumberland County Federation of Republican Women 02/06/2015 490 House# Street Address PO Box 1495 Description of Expenditure City State Zip Camp Hill PA Code 17011 Table at dinner To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure city State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House If Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code SCHEDULE IV Statement of Unpaid Debts Use this Section to itemize all unpaid debts and obligations which are outstanding at the end of the reporting period. Filer Identification Number: Friends of Denise Gembusia Name of Creditor Denise Gembusia Outstanding Balance of Debt House If Street Address DATE DEBT INCURRED $ 1402 Bradley Drive,Apt.A211 [MM/DD/YYYY] 01/05/2015 city Carlisle State PA I Zip 17013 3,349.18 Code Description of Debt PO Box,supplies,campaign signs,filing fees. Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ (MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House If Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] city State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State. Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt lli�lll�Il Reset Form 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 I (Mark X) Name of Filing Committee,Candidate or Lobbyist Friends of Denise Gembusia Street Address P.O.Box 53 City Mt.Holly Springs State PA Zip Code 17013 Type of Report(Place x under report type) 1-61h Tuesday 2- 2nd Friday 3-30 Day Post 4-6th Tuesday 5-2"d Friday 5-3o Day Post 7-Annual Special 2" Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election Date Of Election Year Amendment �I/ Termination ❑ (MM/DD/YYYY) 05/19/2015 2015 Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures D1/ol/z01s 05/04/2015 A.Amount Brought Forward From Last Report $ 0 B.Total Monetary Contributions and Receipts $ (From Schedule 1) 4,543 C.Total Funds Available $ (Sum of Lines A and B) 4,543 D.Total Expenditures $ 4,812.38 (From Schedule III) E.Ending Cash Balance $ (Subtract Line D from Line C) -269.38 F.Value of In-Kind Contributions Received $ - (From Schedule 11) 3,844.64 G.Unpaid Debts and Obligations $ 51 Jij - 1 _r -_ (From Schedule IV) 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 XV )) /l d of 20 15 �e�Y1/w,�("/'L'Ll 4. V lf�ti✓Lc't Signature Werson Sub It report Jenn, / L ignatwe �r `` Printed Name My Co issionexpires ALS �yJ/ty 717 arjB' — J 1W.THY yR. Area Cade Daytime Telephone Number Notary Public Part 11 IjilmyrA ee,candidate shall sign here. swear r affi I nd belief this political committee has not violated any provisions of the Act of lune 3,1937 F.L.1333,NO.320)as amende . Sworn to and subscribed before me this qday of 2015 Ignature of Candidate Denise Gembusia SignaturrlIe Printed Name My Commission expires / r�/ .� 717 554-3482 MO. DAY YR. Area Code Daytime Telephone Number NOTARIAL SEAL I TIMOTHY STOUT Notary Public SOUTH MIDDLETON TWP.,CUMBERLAND COUNTY My Commission Expires Apr 27,2016 SCHEDULEI Contributions and Receipts Detailed Summary Page Filer Identification Number Friends of Denise Gembusia 1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total for the reporting period (1) $ 1,074 2.Contributions o 50.01 to $250.00 From Part A and Part B) Contributions Received from Political Committees(Part A) $ 100 All Other Contributions(Part B) $ 1,649 Total for the reporting period (2) $ 1,749 3.Contributions Over$250.00(From Part C and Part D) Contributions Received from Political Committees(Part C) $ 0 All Other Contributions(Part D) $ 1,720 Total for the reporting period (3) $ 1,720 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) Total for the reporting period (4) $ 0 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 q 543 Cover Page,Item BJ 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. Filer Identification Number Friends of Denise Gembusia Amount Full Name of Contributing Date[MM/DD/YYYY] $ Committee Capozzi and Associates,PAC 100 03/19/2015 House p Street Address Date[MM/DD/YYYY] $ 2933 North Front Street city State Zip Code Date[MM/DD/YYYY] $ Harrisburg PA 17110 Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House N Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee ]Cou Street Address Date[MM/DD/YYYY] $ State Zip Code Date[MM/DD/YYYY] $ PART B All Other Contributions $50.01 TO$250 Use this Part to itemize all other contributions with an aggregate value from $50.01 TO$250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYYY] $ Robert Robinson 03/19/2015 118 House# Street Address Date[MM/DD/YYYY] $ 208 Mountain View Road city State Zip Code Date[MM/DD/YYYY] $ Mt.Holly Springs PA 17065 Full Name of Contributor Date[MM/DD/YYYY] $ Joseph Gembusia 03/19/2015 120 House# Street Address Date[MM/DD/YYYY] $ 3510 Raintree Lane city State Zip Code - Date[MM/DD/YYYY] $ Mechanicsburg PA 17050 Full Name of Contributor - Date[MM/DD/YYYY] $ Connie Bides 03/19/2015 128 House# Street Address Date[MM/DD/YYYY] $ 257 Arch Street City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Full Name of Contributor Date[MM/DD/YYYY] $ Scott Boise 03/19/2015 140 House# Street Address Date[MM/DD/YYYY] $ 406 N.Walnut Street City State Zip Code Date[MM/DD/MY] $ Mt.Holly Springs PA 17065 Full Name of Contributor Date[MM/DD/YYYY] $ Susan Day 150 03/19/2015 House# Street Address hhhhhr Date[MM/DD/YYYY] $ 845 Baltimore Pike city State Zip Code Date[MINI YYYY] $ Gardners PA 17324 Full Name of Contributor Date[MM/DD/YYYY] $ Eric Klinedinst 03/19/2015 150 House-#] Street Address Date.[MM/DD/YYYY] $ 10D Linn Drive City State Zip Code Date.[MM/DD/YYYY]..... $ Carlisle PA 17013 PART B All Other Contributions $50.01 TO$250 Use this Part to itemize all other contributions with an aggregate value from $50.01 TO$250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYYY] $ Richard Ruda 03/19/2015 120 House# Street Address Date[MM/DD/YYYY] $ 2 Derbyshire Drive City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17015 Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State 'tip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ LH,u,, Street AddressDate[MM/DD/YYYY] $ :7 State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House If Street Address Date[MM/DD/YYYY] $ city State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ PART B PAGEOF 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 i 1(�f S To DATE AMOUNT Full Name of Contributor >%fda, $ I / (5 3 y i 00 ai mg areas /� —I 'l' l 1 4 r $ City lip oaa lua Cit r c.StQ PA Full Nama of Contributor 'tea" L18AFF"" a7mg X.i "Y 3 Chorkrur City tete rPUom rius _ 3Afs, *: xAiihlf u1'fhA:r?; Full Name of Contributor ilikzibc A. 3 / Cr is'Ri Ing AOMMS a I k 4City *A.. Lip COW,1PRIS 41 r? P�. I; PA Il-o - $ FLIT Narrr of COrmributor %F -S j ej /C5 a ng Ackil 'w,(C $D ss ! kc, ty I M.A. rp da us G♦ /'f / — $ Full Nam* of Contributor ' al ang Acareas _.. u ce Co U'4 $ tate ID oae ua :, 3�48� oyer (Ca , Il AA I rUlr $ Full Nama of Contributor 's'^ malling .070" fZ-/ ty ab zip Coda Plus 01e C Iktontc hU P '4v Full Nema of Centrlbutw YC1 Yj 61,o / $ /OJ. ailmy Add, n $ 1c4 k SrtrlE ' 0 city state (ip co a lu: �icfpr f !iq - _ $ Full Name of Contributor Joh —'t �, V&75-9 I ng eaa xai .::rut <:. $ �1 S� ty tate v odeIrlus PAGE TOTAL Enter Grand Total of Part B on Schedule 1, Detailed Summary Page, Section 2. $ 4a3. (k� [3 e5-502 h-egl PART D All Other Contributions Over$250.00 Use this Part to itemize all other contributions with an aggregate value over$250.00 in the reporting period. (Exclude contributions from political committees reported in Part Q Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYYY] $ Bryan Gembusia 1,000 02/04/2015 House If Street Address Date[MM/DD/YYYY] $ 7 Woodview Drive 03/19/2015 420 City State Zip Code Date[MM/DD/YYYY] $ Mt.Holly Springs PA 17065 Employer Name Occupation 'Vo-Yo Computer Services Self-employed/Business owner Employer Mailing Address/ Principal Place of Business 7 Woodview Drive,Mt.Holly Springs PA 17065 Full Name of Contributor Date[MM/DD/YYYY] Jennifer Varner 03/19/2015 300 P Street Address Date[MM/DD/YYYY] $ Meadowood Place State Zip CodeDate[MM/DD/YYYY] $ Springs PA 17007 Employer Name Self-employed Occupation Tax Collector Employer Mailing Address/ Principal Place of Business 520 Park Drive,Boiling Springs PA 17007 Full Name of Contributor Date[MM/DD/YYYY] $ House N Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/ Principal Place of Business Full Name of Contributor Date[MM/DD/YYYYj $ JC,ousell Street Address Date[MM/DD/YYYY] $ State Zip Code Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/ Principal Place of Business SCHEDULE II IN-KIND CONTRIBUTIONS AND VALUABLE THINGS RECIEVED USE THIS SCHEDULE TO REPORT ALL IN-KIND CONTRIBUTIONS OF VALUABLE THINGS DURING THE REPORTING PERIOD DETAILED SUMMARY PAGE Filer Identification Number: Friends of Denise Gembusia 1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the reporting period (1) $ 205 2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) TOTAL for the reporting period (2) $ 1,463.72 3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTAL for the reporting period (3) $ 2,175.92 E VALUE OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING $(Add and enter amount totals from boxes 1,2,and 3;also enter e 1,Report Cover Page,Item F) 3,844.64 SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYYY] $ John Pappas 03/19/2015 250 House R Street Address Date[Mllil YYY] $ 1863 Holly Pike City State Zip Code Date[M111,11 YYY] $ Carlisle PA 17015 Description of Contribution Food for fundraiser Full Name of Contributor Date[MM/DD/YYYY] $ Shaun Foote 03/19/2015 75 House p Street Address Date[11,1111,11i $ 1 North Hanover Street City State Zip Code Date[MM/DD/YYYY] $ Carlisle ^'.. PA 17013 Description of Contribution Cocktail tables for fundraiser Full Name of Contributor Date[MM/DD/YYYY] $ Ross Morris 03/19/2015 75 FIC�11111ale Street Address Date[MM/DD/yyyy] $ West Pomfret Street State Zip Code Date[M11,11 YYY] $ PA 17013 Description of Contribution Food for Fundraiser Full Name of Contributor Date[MM/DD/YYYY] $ Chris Petsinis 03/19/2015 75 F Street AddressDate[MM/DD/YYYY] $ 37 North Hanover Street State Zip Code Date[MM/DD/YYYY] $ rlisle PA 17013 Description of Contribution Keg of beer Full Name of Contributor Date[MM/DD/YYYY] $ Michele Landis 03/19/2015 66 P28 Street Address Date[MM/DD/YYYY] $. South Pitt Street StateZip Code Date[MM/DD/YYYY] $ sle PA 17013 Description of Contribution Yoga&essential oils SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYYY] $ Dennis Burkett,DDS 03/19/2015 100 HouTlr3 Street Address Date.[MM/DD/YYYY] $ BrookwoodAvenue,Suite 1 03/19/2015 150 City State Zip Code Date[MM/DD/YYYY] $i e PA 17013 Description of Contribution Wine Full Name of Contributor Date[MM/DD/YYYY] $ Josh Grundon 03/19/2015 120 Fcallh, Street Address Date[MM/DD/YYYY] $ Mayapple Drive State Zip Code Date[MM/DD/YYYY] $ PA 17015 Description of Contribution 3 private golf lessons Full Name of Contributor Date[MM/DD/YYYY] $ Mary Roell 03/19/2015 130 House# Street Address Date[MM/DD/YYYY] $ 44 North Bedford Street city State Zip Code Date[MM/DD/YM] $ Carlisle PA 17013 Description of Contribution Crock,$25 gift card and wood preservation products Full Name of Contributor Date[MM/DD/YYYY] $ Louis J.Capozzi 03/19/2015 150 House# Street Address Date[MM/DD/YYYY] $ 1655 Holly Pike City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17015 Description of Contribution Mexican Mantel Clock Full Name of Contributor ..Date[MM/DD/YYYY] $ Tracy Hecker 03/19/2015 150 House# Street Address Date[MM/DD/YYYY] $ 3 Sebastian Way City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17015 Description of Contribution Professional Photos SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYYY] $ Bryan Gembusia 12/06/2015 57.72 House# Street Address Date[MM/DD/YYYY] $ 7 Woodview Drive City State Zip Code Date[MM/DD/YYYY] $ Mt.Holly Springs PA 17065 Description of Contribution Intention letter supplies Full Name of Contributor Date[MM/DD/YYYY] $ Mike Blumenthal 03/19/2015 �65 House# Street Address Date[MM/DD/YYYY] $ 876 North Hanover Street City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Description of Contribution Crystal&leather flask Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YM] $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code .Date[MM/DD/YYYY] $ Description of Contribution SCHEDULE II PAGE t !� OF PART G IN-KIND CONTRIBUTIONS RECEIVED VALUE OVER $250.00 Name of Filing Cornmittee or Candidate Reporting Prid C Friends 4 Denise embusi From I I 15 Toy 15 DATE AMOUNT Fullame ice.Of Contributornat MA $ DAY Y Lr 3 A 15 Mailing Address MO. D Y SEAR $ 3 i oad ity State Zip Cade (Plus 4 MO. DAY YEAR Cam 1-1►1 PP t - $ Employer of Comributor OccupatioDenl�st Employer Maili g Address/Principal Place of Business Description of Co triblrti n, T ' le . am Nell PA lip ll teeth w 11{3P1►i int Cert. Full Ne f Contrlb r N DAY Ad $ g 5 . Z Meiling Address Y B $ 3 N• 1-k, e t CityCara Zip Code (Plus 4) N y $lisl l o - Q Em plo er of CprC1utor � e. '11aatlRpjrinteY Employer citing AddressiPrincipel Plae of Business Descripttion of Contribution l . • NkeA r s e PA 1 01 ►m r Full 17,.f Contributor :2:;' Ll YEAR $ 1 ,2000 , 00 I 000 r0 0 Meiling Address ' Mo DAV (/(J 5 I ike $ City State Zip Code (Plus 41 DAY YEAR Z1Y $1G o f - $ C EmployAr of Contr ibutari '14 k;0�rim-eJ5 Occupation ktiXyle Employer Mailing Address/Principal Place of Business Description of Contribution 1200 Nyyviiq '455'tm i11 PN twine Full Name of Contributor MO. DAY YEAR $ Mailing Address DAY YEAR $ City Stats Zip Code (Plus 4) No DAY YEAR $ Employer of Contributor Occupation Employer Mailing Address/Principal Place of Business Description of Contribution Full Name of Contributor MO. DAY YEAR $ Mailing Address MO DAY YEAA $ City Starts Zip Code (Plus 4) DAY YEAR $ Employer of Contributor Docupetion Employer Mailing AddressiPrincipel Place of Business Description of Contribution PAGE TOTAL �n Enter Grand Total of Part G on Schedule II, In-Kind Contributions Detailed is2,, � t (2�Summary Page, Section 3. e DSEB-502 (7-99) PAGE 1ih OF I{� SCHEDULE III ---77T°YY--- STATEMENT OF EXPENDITURES Name of Filing Committee or Candidate Reporting Period From J-/ To _ To Wham Paid a;9•'• ;c:_...,.•.•.^•.•.; ._........ rI1ODn a v rri Ct , iISY eased Mailing Address Description d Expetaliture iry stere Zip Coda (Plus 4) To Whom Paid r:* " " •'^° mOVlt Mailing Address Descriptlan of Ezpantlitwa I w h �l S l — itY State � Zip Cods IPlua C4 r ( - � ,3{(' To Whom Paid Q "%(yp'k '�.�'µ, moDm 1C . CoJrllc �C�'i �Ure 9 IS ( 00• L)'j Mailing Address Description of Expenditure CDU f� i neY ��i Sv f- / �i li rev ty State Zip Code (Plus 4) To Whom Peiay�,��,�, Amount Q 1 �. f r t1MA ! C -n. Mailing AddrseeDescription of Expenditure h 5u, Goo n t tY State ZipCodeiPlus 41 l C.str li,j(e "Ser- rnCLI Te Wham Paid 6i FP, CP $ (� Mailing Address Dee iP- of Eapentu ure City state Zip Code (Plus 1110 u � PA 11C&5- To Whom Paid """.�i: ;avxw t / /r' Is Melling A *Ms Description of E Pam iture itY StJate ZIP Code (Plus 4) To Whom Paid ;. ;e _. ArroLlint Cz Mailing Address Description of ExperMiWre ad I; Ip i k 4q state tY state ZiP epee (Plus 41 Te Wham Paid etIS:3K t Cl C �. Lty Addreas Description of Expenditurer �':Stets Zip Code(Plus 41 Ca r 11 PA i ioirl- awi- PAGE TOTAL Enter Grand Total of Expendittres on Page 1, Report Cover Page, Item D. $ rj of }, 3C DSEB-507 (7.99) ' • Ian OF ,fC ' SCHEDULE 111 PACE STATEMENT OF EXPENDITURES Name of Filing Committee or Candidate Reporting Period ' ti 11 From _ To 5 / To Whom Paid �* mount 1 �q Mailing Address Description of Expenditure Pik. Vase ty Siem Zip Doo. (Plod 4) (`� C hqL f S h y �A `o To Whom PaiQY,. .1 �,LAW c Amount eggs 3. 3 Melling^Ogress Deawiprion of Expenditurs 3l( 5 � .. ra. F Z.-y StanZip Good (Plus 4) 141, 11 im To Whom Paid tw �. "JSIC 9:EAif'..' Amount Meiling Address Description of Expenditure D 5 -� S L) Ii ht crib City state I Zip Code Vim 4) VIea�4 p '5-3/5r To Whom Pa1d �' .; }• YETRF� cunt I I Pr�m Meiling Addrass o , Description of Expenditure P Pj/r�/1� SimZip Code 2 d (Plus 4) To Wham Paid mount Mailing Address Description of Expenditure ity State ZiP Code (Plus 4) t n s hVe VG f�/t]To Whom Paid mOun . CP kl CCC. c e Mailing Addnsa //2L / Description of Expenatiure x tall a (I LY VJ 57eZip code (Plus hen ' �„r M p To Whom Psi d vc, L `` t ease Y�Or Meiling Atlhma yJ Description o, Expenditure Y /\J rty I Sntan Zip lode Ilus 4) Ho ��'i �dY Y ( IJ To Whomgagagagage Paid gg�( weeell Amount vn,l,E la A Cov c�a.�c; n Re ult1i c r Mailing Address / Dascription of/ Expenditure Gi�/ O l [F f l twit itY State Zip Cotle (Phis 4) e chun;cc,bur PAGE TOTAL Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D. $ OSEB-502 (]-99) OF� • SCHEDULE IV PAGE STATEMENT OF UNPAID DEBTS Use this Secton to itemize all unpaid debts and obligations which are outstanding at the end of the reporting period. Name of Filing Committee or Candidate Reporting Period t� From 1// /; To � 3 > Nem. of Creditor umun Ing lance of Uebt 4 3 ' Mailing ttJ�Ad ^f. DATE .,3fA:Y i1+ER'R;e: WUMIN 1-1 p t./% 1Ap4 DEBT I NCURRED I x^ g Ity StateZipCode IPlue 41 Ca111 / I to li - r _ . • Description a Debt D51 u6Fie' 6uAC $u ltc,S r' rleiter; " ( f'-ncf f<15er Cn < vi 5I"Z7 Name of Creditor trtstanding Balance of Debt Melling AddraesIDA B INCURRED h City State zip Cede (Plus 41 Description of Debt Name of Creditor Uutstartaing balance of Uebt Mailing Address DATE ;p Fi.;, DEBT INCURRED [[ - - city State Zip Code (Plus 41 Description of Debt Name of Creditor Uutstanding Balance of De Mailing Address DATE DEBT 'S INCURRED City State Zip Code (Plus 41 Description at Debt Name of Creditor Outstanding Balance of Debt Mal l ing AddressDATE p�,y1'jye '. DEBT " .. INCURRED my' City Steve Zip Code (PIoS 4) „y,� .3 a Description of Debt Name of Creditor Outstanding Balance of Debt Mailing Address DATE ( ••u,> "-�"' „ i` thy” """' r. DEBT INCURRED M City State Zip Coda (Plus 41 — n Description of Debt PAGE TOTAL Enter Grand Total of Unpaid Debts on Page 1, Report Cover Page, Item G. $ -3j DSM-502 (l-ge) Commonwealth of Pennsylvania PAGE 1 OF CAMPAIGN FINANCE REPORT (COVER PAGE) (NCITE: This report must be clear and legible, It may be typed or printed in blue or black ink.) Filer Identification10. Report 3.. low Number: Filed 1 X Name of Filing committee, candidate or Lobbyist: Street Address: Icitr. 1 State: Zip Code: 14,ajj �(q�Lrty I P-A 4o/3 2. 3. TYPE OF .REPORT ....... ........... .......... 4. ............ (place X to the right of ..............• 7. YEAR report type) Name of Office Sought by Candidate. s a District Office Party County Number Code Code Code G-Lr6qo,,d co 4,_izkcOrH Rp I Q/ Ell I c7f 1 .10 15' 1 (SEE INSTRUCTIONS FOR CODES) Summary of Recelpts, and Expenditures from: d0/5 To 0)0/5 A. Amount Brought Forward From Last Report $ B. Total Monetary Contributions and Receipts (From Schedule 1) $ y 5y r 1 C. Total Funds Available (Sum of Lines A and 8) L4, 5 (4 3 - 56 7 D. Total Expenditures (From Schedule 111) $ :3 E Ending Cash Balance (Subtract Line D from Line C) $ ( ,)Cq, 38 F. Value of In-Kind Contributions Received (From Schedule 11) 1 1 "q'I-L CA Ln G. U Cash and t L fnpaidDelb In- Obligations (From Schedule IV) AFFIDAVIT SECTION I swear (or affirm) that this report, including the attached schedules, on paper or computer diskette, are to the best of my knowledge and belief true, correct and complete. SWOmi tq land subscribed before me this day of 20 J_0� 04 A'41- of P 9 Report 4 Sign A\C_ et� er A Ci2=6 - �'r.�_o w I-C de fjfq:4P-- L IGT09 is NUTb Ignintire Printed Name BETSAIL 4 Z 7 UL0 UMUMsston exilftypiihilic V c7t) M1. CARLISLE BoRo;,CUMBINAND CNTY DA YR. Area Code Daytime Telephone Number ........... 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 I, -day of 20-Lci- 0 tit ,;,,,,UTe of Candidate 1 i'se 'H b us)'O_ 0 Prieci Name M commission e( IAL SEAL 5!t- 34SP- BETHANV SWARWY— DAI YR. Area Daytime Telephone Number CARLISLE BORO:,6UMBERLAND CNTY My Commission Expifes .Oc1 7,2017 OSES-502 (7-99) SCHEDULE PAGE 2 OF CONTRIBUTIONS AND RECEIPTS Detailed Summary Page Name of Filing Committee or Candidate Reporting Period From -1—bToZL-21 pwit . .......... TOTAL for the Reporting Period OTC1 ......... .......... Contributions Received from Political Committees (Part A) $ 100100 All Other Contributions (Part B) $ 1 ,6 2% X TOTAL for the Reporting Period (2) $ L FWFW.77..7wwm7ww77777 Contributions Received from Political Committees (Part C) $ 0 All Other Contributions (Part D) $ TOTAL for the Reporting Period (3) $ I jjo. L)() TOTAL for the Reporting Period (4) 1 $ TOTAL MONETARY CONTRIBUTIONS AND RECEIPTS DURING THIS=REPORTING PERIOD (Add and enter amount totals from $ L Boxes 1. 2, 3 and 4; also enter this amount on Page 1 , Report 3 Lv " It , Cover Page, Item B.) DSEB-502 (7-99) PPAGE OF ART 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 Pe 0d I �From 15 To DATE AMOUNT Full Name of Contributing Committee Full Name Cal-Piroq-q:i Ci" d k Snc rt ke 5 d9 OqC too, �)o ailing Address City Zip Code (Plus 4) -S6 ki r C 7?e I (Zoo �x Full Name of Contributing Committee Mailing Address City State Zip Code Wi.. 4) Full Name of Contributing Committee Mailing Address ........ City State Zip Code (Plus 4) mi�mmat�� Full Name of Contributing Committee Mailing Address City slat. Zip Code (Plus 4) .... ... Full Name of Contributing Committee Mailing Address City State Zip Code lPlus 4) Full Name of Contributing Committee Mailing Address City state Zip Code (Pius 41 Full Name of Contributing Committee Mailing Address City State Zip Code Witis 4) 77=7MM Ell Full Name of Contributing Committee $ Mailing Address City State Zip Code (Plus 4) PAGE TOTAL Enter Grand Total of Part A on Schedule 1, Detailed Summary Page, Section 2. $ 30 DSEB-502 (7-99) PART B PAGE L4 OF t-1 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 Fiting Committee or Candidate Reporting Period From To DATE AMOUNT Full Name of contributor —V 15 $ (D Mailing Address City Zip uoane (Plus 4) State lit I n Q (I�OiGg $ [Full Name of contributor 9MAR /-, 4 $ Meiling ..., . q , �(5pial n L $ Cay State Zip Code Plus 4) f C Full Name of Contributor MONSOON! M 'WaTre's ailing 3 City btate —7--pcods iPlus 4) Car Full Name of Contributor Melanesian! Mailing Address cscot-( I se Cityblaze p, Code (Plus 4� R 0 V Fall Name of Co 0`rrQ n MailingAddress a City fhb)-e I' Zip Code (Plus 4) G-)CL r d"a V-T bpi'A" Full Name of Contributor To -Er�,, �- K line J; Ci /-6i Mailing Address JoCi La nn Pr', 1C City— braze Zip Code (Plus 41 Cc-Y I sla- Pit lJJ/3 $ Full Name of Contributor V) 'Mailing Address be V- r c 76�ty State ip Code (Plus 4) (7r,,r ('isle Full Name of =.1r.bl.r Mailing Address ......... City State Zip Code (Plus 4)- $ PAGE TOTAL Enter Grand Total of Part B on Schedule 1, Detailed Summary Page. Section 2. $ qo2(q- C-C) DSEB-502 (7-99) PART B PAGE OF ( _ 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 l6ILS To DATE AMOUNT Full Name of Contributor ( S�(. Od Mailing Adress �f U4h P ; fie 4 $ City blaze lip uoae lus CCt e l i S Le Pel $ Full Name of Contributor r4� 3 !� $ . C® MailingAddress 3 Cha n no �r i v e $ 'rlty tate Zip Code iFlus 4 Full Name of Contributor aYEtk r ':RAY:' h:EAt3 Mailing Address MD -:.'S7YAY "FE4si.' $ a 1 ( ¢ S4 r ny Stateip o e us 7aU. : ':,:may '„ FEARS<: f 1. OA 0 -o - $ NINE Full Name of Contributor � � , $ /00. (jo ailing Address I Co 5-5- City blaze Zip Code Plus 4 _ Capt,S it ! - $ Full Name of Contributor MQ...:..:F:'D $ I oa, OJ ailing Address Q �U/ rty ozone Zip Code (Plus 4 6Q AAI Ic. Full Name of Contributor T.. T ' Mailing Address Iy 6rcc, t. A b+ ', Ve $ HY blaze Zip Code tPlus Y.''_ (h(f hAr;c My PA lac) $ ..................................................... Full Name of Contributor Mailing Address ......._ .. .. rtyp} State ip Code Pus 4 nicl(?r lie 0 — $ Full Name of Contributor John Tho $ lrx). oa Mailing Address :�........::..:.:............ ... ` ( 1ha ko 4 $S� Cty tate iP Code (Plus 4 ....:.........::.>.....�........:.:...,...,._..,..:::: /r lS2 C h0L ki i C-5 l7 v , PA I �U - $ PAGE TOTAL Enter Grand Total of Part B on Schedule 1, Detailed Summary Page, Section 2. $ a3, DSEB-502 (7-99) PART D PAGE Cc. orj_3-_ 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 tcf-, 41-j�/ From To � 4 t] 1 i DATE AMOUNT Full Name of Contributor $ Mailing hdL,;Ji City State Zip Code (Plus 41 Employer Name i occupation "' lz� cc 3 Employer mailing Acioreesttolil Place'�—f B;�k'.r 4, 5 119" U6 Full Nam. of C Mailing Address /'5 /tLC 0 L City 60State Zip Code (Plus 41 Employer(y;me VIA 1 (IW4� Occupation Business IC[X Employer Mailing� ddr�ess4i;Z pafi�Ia��T.us Jr- d'o P6 ' k 0 , ;('( Full Name of Contributor k, Mailing Address City State Zip Code (Plus 4) Employer Name Occupation Employer Mailing Address/Principal Place of Business Full Name of Contributor Mailing Address City State Zip Code (Plus 4) Employer Name Occupation Employer Mailing Address/Principal Place of Business Full Name of Contributor Mailing Address :in5 City State Zip Code (Plus 41 Employer Name Occupation Employer Mailing Address/Principal Place of Business Enter Grand Total of Part D on Schedule 1, Detailed Summary Page, Section 3. PAGE TOTAL DSEB-502 (7-99) 1 ) I � I SCHEDULE 11 PAGE OF I 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 From I ZLZ To r7 TOTAL for the Reporting Period (1) .......................... lum a M J , NW-1, PIRTMUMMMIZ19 .. �wt l TOTAL for the Reporting Period I $ C7 E TOTAL for the Reporting Period (3)� 5 TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING PERIOD (Add and enter amount totals from Boxes 1 , 2, and 3; also enter on Page 1 , Report Cover Page, item F.) -3) DSEB-502 (7-99) SCHEDULER PAGE OF PART F IN-KIND CONTRIBUTIONS RECEIVED VALUE OF $50.01 TO $250.00 Name of Filing Committee or Candidate Reporting Per- d From T� TO DATE AMOUNT Full Name of Contributor r C' > Mailing Ad res qs, Ell ...... $ Or , VQ Citye (Plus 4)Zip Cod Mo L)A..144 VA, _4 OS $ Description at �Cn.keek Full Name of Contributor L,iL)odrhau5,e Mailing Address 14ct no ��r City State Zip Code (Plus 41 Q / Li lf A 1�13 Description of Contribution: Full Name of Contributorao s4q and Liza{ ,., Cla s am"W.WOR" Y"_ -I- rAQ We1 I-t $ 61 Mailing Ar_.. liw* : 4 $ City state Zip Code (Plus 41 _ Cot r ti s P I $ Description of Contributiom Full Name of Contributor $ Mailing Acictress C) 4)-k 14-Walle'— $ City State Zip Code iPlus 41 Ca k-I i)L-_ I tPA $ Description of Contribution: Full Name of Contributor 0� a q 15 Wn� $ 00 Mailing Address a-,=A L"'esj City state Zip Code (Plus 4) Description of Contributiom Full Name of Contributor va Mailing Address I Ajorfh City State Zip Code (Plus 41 Description of C�WA_'6 Enter Grand Total of Part F on Schedule It, In-Kind Contributions Detailed PAGE TOTAL Summary Page, Section 2. $ DSEB-502 (7-99) SCHEDULE II PAGE q OF 1; PART F IN-KIND CONTRIBUTIONS RECEIVED VALUE OF $50.01 TO $250.00 assesses Name of Filing Committee or Candidate Reporting Per d 0 From t 71 To Tr"i d DATE AMOUNT Full Name of Contributor Mailing IddEr r)'14Aon'JrTD lc�44 , T)s 00, aq ass Old ku (�4,0'eli st"Ite 1 '50, 00 State Zip Code (Plus 41 PA lam,13 Description of Contribution: Uu in Full Name of Contributor MKI,t4 4 41 jo n QL/ Mailing Address i %j I City j 'I State Zip Code (Plus 4) ...... Description of Contribution; v" CoW FullNameof Contribufor 'K. =I �'11 % Apd(Ci'd Mailing Address ",-( City State Zip Code Wilds 41 Als, r +V A Description of Contributiow, C (OC le- 5 g; C4 Co I-A C-o-d 49 (4, Full Name of�:rib tjJ. Ca Mailing Address I G 55 Ho City J` state Zip Code (Plus 4) Y. Ca r li-'Ie IPA I /-4r)15* - Description of Contribution; cr,h Y),a tl,.&- I C to c-4- Full Name of Contrib or j Mailing Address LEI C L4 lle r�4 It- ry /5 $ 5-0 , 'i U-1 0, $ City stratle Zip Code (Plus 41 �. i ('(Isu I PAT t%45 $ Description of Contribution- rOC� f k`104 0_5 Full Name of Contributor ra(AqQJLso r'> 440ose 3 icf rc� Mailing Address 141 :h me 1663 1� 01'ke $ 1 City _0 State Zip Code (Plus 41 op ( (i's 1 15 $ Description of Contribution: d rq r PAGE TOTAL Enter Grand Total of Part F on Schedule 11, In-Kind Contributions Detailed Summary Page, Section 2. $ rjo DSEa-502 (7-99) SCHEDULE II PAGE i o OF lij PART G IN-KIND CONTRIBUTIONS RECEIVED VALUE OVER $250.00 Name of Filing Committee or Candidate Reporting Period -:r From To DATE AMOUNT Full Name of Contributor X0 X: Mailing Addre�a rn i)p n 7!7_7 State Zip Code (Plus 4) ........ Employer of Contributory Occupation Employer Mailing Address/Principal Place of Business Description of Contribution t\d le 1�d Ca m. oD/ PA oc)// +'-C'0) C- "kt iii ry 631 IC rel '� Full Name of Contributor --ke P Eaw'* 4 /5 $ G Mailing Address City Zip Code (Plus 4) State AR!, $ C,- V IA I A14 — Employer of Contributor Occupation T kf_! 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DSEB-502 (7-99) PAGE OF 1_ SCHEDULE IV STATEMENT OF UNPAID DEBTS Use this Section to itemize all unpaid debts and obligations which are outstanding at the end of the reporting period. Name of Filing Committee or Candidate Reporting Period From ! / To �` Name of Creditor Outstanding Balance of Debt c�eMailing tlress DATE Mo. DAY YEAR ! V� EBT Y I l IDNCURRED City State Zip Code (Plus 4) r ll A / I-3 on Descriptiof Debt Sf Owl lwy dor w4-o'S ' Furtdf'tivr Cam t n SiclnS �i /1nF �PS Name of Creditor Outstanding Balance of Debt Mailing Address DATE :MO. DAY YEAR DEBT INCURRED City State Zip Code (Plus 41 Description of Debt Name of Creditor Outstanding Balance O e t Mailing Address DATE rMO. DAY I YEAR i. DEBT INCURRED City State Zip Code (Plus 4) Description of Debt Name of Creditor Outstanding Balance of Dert Mailing Address DATE MO, DAY YEAR DEBT INCURRED City State Zip Code (Plus 4) Description of Debt Name of Creditor Outstanding Balance of Debt Mailing Address DATE MO. DAY YEAR DEBT INCURRED City State Zip Code (Plus 4) Description of Debt Name of Creditor Outstanding Balance of Debt Mailing Address DATE -Mo.7C.d— Description DEBT NCURREDCity State of Debt PAGE TOTAL Enter Grand Total of Unpaid Debts on Page t, Report Cover Page, Item G. $ DSEB-501 (7-99)