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Home My WebLink AboutFriends of Denise Gembusia - 2015 30-Day Post-Primary III III Yr 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 (Mark X) Name of Filing Committee,Candidate or Lobbyist Friends of Denise Gembusia Street Address PO Box 53 city Mt.Holly Springs State PA Zip Code 17065 Type of Report(Place x under report type) I.6d'Tuesday 2- 2"d Friday 3-30 Day Post 4-Ed,Tuesday 5-2nd Friday 6-30 Day Post 7-Annual Special 2na Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election E F1 IX-1 El Date Of Election Year Amendment Termination (MM/DD/YYYY) 05/19/2015 2015 Report Report ❑ Summary of Receipts and From Date To Date For Office Use Only Expenditures 05/05/2015 06/08/2015 A.Amount Brought Forward From Last Report $ 3,079.8 B.Total Monetary Contributions and Receipts $ 200 (From Schedule 1) C7 0 C.Total Funds Available $ F= ur (Sum of Lines A and B) 3,279.8 Ca C7 D.Total Expenditures $ � (From Schedule III) 2,017 11 E.Ending Cash Balance $ C) 262.8 1, C9 (Subtract Line D from Line -'O F.Value of In-Kind Contributions Received $ C') (From Schedule 11) 1,122.81 Q W G.Unpaid Debts and Obligations $ Z (From Schedule IV) -�$ (4 35 �o 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 // y/ dayof PiV.1ler n2n � t� 1 � RIAE-SEAL Si nature of Perso ubmitting report Y STOUT Jennifer L.Varner atur Notary Pub11C Printed Name UT M TO UMBERL ND COUNTY 717 258-4224 My Commission expires Ir Apr 27,2016 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 Llll ✓7 /' Signat a of Candidate Denise Gemhusia 9Cnati ♦♦ Printed Name �10T AL 717 554-3482 My Commission expires / T 7n, DAY No lry Public Area Code Daytime Telephone Number SOUTH MIDOLETON TWP.,CUMBERLAND COUNTY 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 Friends of Chris Reilly 100 05/05/2015 House If Street Address Date[MM/DD/YYYY] $ PO Box 206 City State Zip Code Date[MM/DD/YYYY] $ York PA 17405 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 If Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/VYYY] $ Committee House If Street Address Date[MM/DD/YYYY] $ City State 77de1 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] $ 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 TOTALfor the reporting period (1) $ D 2. IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) TOTAL for the reporting period (2) $ D 3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTAL for the reporting period (3) 1 $ 1,122.81 F E OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING $and enter amount totals from boxes 1,2,and 3;also enter eport Cover Page,Item F) 1,122.81 ' r SCHEDULE II Part G In-Kind Contributions Received VALUE OVER$250 Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date[MM/DD/YYYY] $ John Thompson 05/15/2015 1,122.81 F Street Address Date[MM/DD/YYYY] $ 7 North Hanover Street State Zip Code Date[MM/DD/YYYY] $ le PA 17013 Employer Name Self-employed Occupation Printer Employer Mailing Address/Principal Description Place of Business 137 North Hanover Street,Carlisle PA 17013 of Mailer 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 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 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] $ Postmaster 05/13/2015 2,017 House# Street Address Description of Expenditure city Carlisle State PA rip Code 17013 Dostage 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 StateTip Code To Whom Paid Date(MM/DD/7 $ House# Street Address Description of Expenditure City StateZip 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# 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# 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 Identgkation Number. Name of Creditor Denise Gembusia Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ 1402 Bradley Drive,Apt 211 [MM/DD/YYYYJ 05/14/2015 CRV - Carlisle State PA I Code 17013 4.25 Description of Debt copies Name of CYeditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/"'M City State Lp Code Description of Debt Name of Creditor Outstanding Balance of Debt House# treet Address DATE DEBT INCURRED $ - [MM/DD/MM city State Lp Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYYJ city State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY[ city - StateZip 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 IReset Form Print Form Commonwealth of Pennsylvania.CampaignFinance Report (Note:This report must be clear and legible.It should be typed) Filer Identification Report Filed ByCandidate ❑ Committee \ Lobbyist Number I (Mark X) n Name of Filing Committee,Candidate or Lobbyist Friends of Denise Gembusia Street Address PO Box 53 City Mount Holly Springs State PA Zip Code 17013 Type of Report(Place x under report type) 1-6th Tuesday 2- 2rd Friday 3.30 Day Post 4-5th Tuesday S-fd Friday 6-30 Day Post 7-Annual Special 210 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 2015 Report ❑ Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 05/05/2015 06/08/2015 A.Amount Brought forward From Last Report $ 269.38 B.Total Monetary Contributions and Receipts $ 200 (From Schedule 1) C.Total Funds Available $ (Sum of Lines A and B) -69.38 D.Total Expenditures $ 2,021.25 (From Schedule III) E.Ending Cash Balance $ (Subtract Line D from Line C) -2,090.63 F.Value of In-Kind Contributions Received $ (From Schedule ll) 1,122.81 G.Unpaid Debts and Obligations $ (From Schedule IV) a.zs 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 subscri ed before me this �,,,�� ay "'. ."."-f') �CL.q Yic Si nature of Pe son Submitting report SOUTN M Dela N iWP., I$-- ,t' f I r 1 i f, . L. ar B Printed Name CUMB RNO CWyJNTY My c �II@Sssiok�ptres rYf:-201fc� J ri"' 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,NC.320)as amended. Sworn to and subscribed before me this day of J. 20 pGr �d if GI'LIS�� n �nm Y/��1 CL Signature + Muted Name !'- My Commission expires — 0?7— m70i4 55 — Mo. DAY YR. Area Code Daytime Telephone Number tl SCHEDULEI Contributions and Receipts Detailed Summary Page Her Identification Number 1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total forthe reporting period (1) $ 100 2.Contributions at to (From Part A and Part B) Contributions Received from Political Committees(Part A) $ All Other Contributions(Part B) $ 100 Total for the reporting period (2) $ 100 3.Contributions Over$250.00(From Part C and Part D) 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) 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 200 Cover Page,Item B) r 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: Full Name of Contributor Date[MM/DD/YYYY] $ Friends of Chris Reilly 05/05/2015 100 LHou,e# Street Address Date[MM/DD/YYYYj $ PO Boz 206State Zip Code Date[MM/DD/YYYY] $ PA 17405 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] $ House# Street Address Date[MM/DD/YYYYj $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YM) $ House# Street Address Date[MM/DD/YYYY] $ CityState Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ LHouse# Street Address Date[MM/DD/YYYY] $ State Zip Code Date[MM/DD/YYYY] $ • 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: 1. UNITEMIZED IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.00 OR LESS PER CONTRIBUTOR TOTAL for the reporting period (1) $ F IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF$50.01 TO$250.00(FROM PART F) for the reporting period (2) $ 3. IN-KIND CONTRIBUTION RECEIVED-VALUE OVER$250.00(FROM PART G) TOTAL for the reporting period (3) $ 1,122.81 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) 1,122.81 r SCHEDULE 11 Part G In-Kind Contributions Received VALUE OVER$250 Filer Identification Number: Full Name of Contributor Date[MM/DD/YYYY] $ John Thompson 05/15/2015 1,122.81 House# Street Address Date[MM/OD/YYYY] $ 137 North Hanover Street City State Zip Code Date[MM/DD/YYYY] $ Carlisle PA 17013 Employer Name Self Employed Occupation Printer Employer Mailing Address/Principal Description Place of Business 137 North Hanover Street,Carlisle,PA 17013 of mailers Contribution Full Name of Contributor Date(MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Tip Code Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/Principal Description Place of Business 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] $ Employer Name Occupation Employer Mailing Address/Principal Description Place of Business 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] $ Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution SCHEDULE III Statement of Expenditures Filer Identification Number: E id Date[MM/DD/YYYY] Postmaster 05/13/2015 2,017 Street Address Description of Expenditure State PA zip pde 17013 postage To Whom Paid Date[MM/DD/YYYYj $ Cumberland County Election Bureau 4 25 05/14/15 r reet Address Description of Expenditure 01 Ritner Highway,Suite 201e State PA Zi de 17013 copies To Whom Paid Date[MM/DD/YYYY] 1 $ House# Street Address Description of Expenditure CityState 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# Street Address Description of Expenditure Gty 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/YM] $ House# Street Address Description of Expenditure City State Tip Code To Whom Paid Date[MM/DD/YYYYj $ House# Street Address Description of Expenditure Qty 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: Name of Creditor Denise Gembusia Outstanding Balance of Debt n1402 Street AddressBradley Drive,Apt 211 [MM/DD/YYYY] 05/14/2015 City Carlisle State PA ZpdE 17013 4'25 Description of Debt copies 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 n 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 Name of Creditor Outstanding Balance of Debt n Street Address DATE DEBT INCURRED $ [MM/DD/YYY1I City State Zip Code Description of Debt